how to use cbd oil tincture for pain

Top 7 CBD Oils for Pain Management

CBD oil for pain management has become a popular natural remedy in recent years. What is CBD? Cannabidiol, or CBD, is a compound derived from the Cannabis sativa plant. CBD is different from another well-known cannabinoid in cannabis, THC, in that it may help ease pain and relax the mind without the psychoactive effects.

Read below to learn more about the best CBD oils for pain management, how CBD may help relieve aches and inflammation, and how to use CBD oil for pain.

Does CBD Help With Pain Management?

CBD may work to reduce pain through the endocannabinoid system, or ECS, which involves CBD binding to certain receptors. In particular, the receptor CB1, found in the central nervous system, helps mediate pain regulation and activation of it can result in inflammation and oxidative stress. On the other hand, the CB2 receptor, found mostly in the tissues and cells outside of the nervous system, can help slow down chronic inflammatory processes in the body.

When CBD binds to these receptors it potentially acts as an anti-inflammatory compound, and reducing inflammation can help relieve pain.

7 Best CBD Oils for Pain Management 2021

Each product featured here has been independently selected by the writer. You can learn more about our review methodology here. If you make a purchase using the links included, we may earn commission.

  • Best Overall – Spruce
  • Strongest Full Spectrum – CBDistillery
  • Best USDA Organic – Cornbread Hemp
  • Best for Inflammation – Plant People
  • Best Full Spectrum – NuLeaf Naturals
  • Best CBD Capsule – Prima
  • Best CBD Cream – Spruce

How We Chose Our List of Oils for Pain Relief

When looking for a CBD product, it’s important to choose a high-quality product you can trust. This is because some CBD products, since they are not regulated by the FDA, may not contain the potency the label states and/or they may contain other ingredients that could cause harmful side effects.

We used the same five criteria to compare each CBD oil product and brand to find the best ones to recommend. Here is how we made our list:

Type of CBD: It’s important to consider the type of hemp extract used in the CBD product you choose. We tried to include a range of options, both full spectrum oils that contain trace amounts of THC and broad spectrum CBD that is THC-free, so that you can select the right type of CBD for you.

Strength: In general, the CBD oils for pain relief we recommend contain higher concentrations of CBD in order to help provide a stronger effect. This may allow the product to better help you manage your pain.

Source: Not only is the type of extract important when it comes to CBD, but it’s also important to consider where the hemp plant was sourced. We prefer hemp from Colorado, Kentucky, and North Carolina, states with robust industrial hemp programs. We always try to support American-grown hemp.

Flavor: The best CBD products should be effective and offer a clean, natural taste. We look for products that are vegan, non-GMO, gluten-free, and contain no artificial sweeteners or preservatives.

Transparency: It’s vital to choose a CBD product that has been independently lab-tested by a third-party to ensure that what you see on the label is what you get in your product. It can also help to choose products that have certification by ISO 9001: 2015 or by places that ensure trusted testing practices like the U.S. Hemp Authority. Tests should include a measure of heavy metals, pesticides, solvents, and bacteria and mold, and brands should make those results easily accessible.

All of these factors went into our list of recommendations below.

Our Top CBD Picks for Pain Management

​Best Overall: Spruce Max Potency CBD Oil

Type of CBD: Full Spectrum

Concentration: 80 mg of CBD per dropper

What we like: Comes in a hemp seed oil or coconut MCT oil base; 100% natural; free of pesticides and preservatives; only 0.3% THC; made in U.S.A; vegan; gluten-free.

Why buy: We like this product because it’s free of artificial flavors or sweeteners and contains a dropper to ensure accurate dosing. The high concentration means that this formula is best for people who have been using CBD for a while or require a higher daily dosage.

​Strongest Full Spectrum: CBDistillery 2500mg Full Spectrum Tincture

Type of CBD: Full Spectrum

Concentration: 83 mg of CBD per serving (2500 mg per bottle)

Navigating Cannabis Options for Pain and Related Symptoms

A growing body of clinical research and a history of anecdotal evidence support the use of cannabis for the relief of some types of chronic pain, including neuropathic pain, and spasticity (ie, stiffness or tightness) associated with multiple sclerosis. 1 In a recent comprehensive review of existing data on the health effects of cannabis and cannabinoids, the National Academies of Science concluded that adult patients with chronic pain who were treated with cannabis/cannabinoids were more likely to experience a clinically significant reduction in pain symptoms. 2 They rated these effects as “modest.”

Studies also suggest some efficacy for cancer-related pain, migraines, and fibromyalgia, and other pain conditions. 3 However, how different species, routes of administration, and doses differ in their effect is less clear, and more research is needed.

Cannabis is Complex: CBD Versus THC

The chemical complexity of cannabis itself has made it difficult for researchers to untangle its effects on pain and, at the same time, difficult for clinicians and patients to find the most effective species and route of administration. Cannabis is the genus name for a disputed number of plant species. The two most widely accepted species are Cannabis sativa and Cannabis indica, though hybrid species are also common.

Cannabis oil and edibles

Chemically speaking, cannabis is complicated. To date, 568 unique molecules have been identified in the cannabis; of these, more than 60 are cannabinoids — these are compounds that act on receptors in the body’s endocannabinoid sy stem. This system plays a key role in endogenous pain control. 4

Two of the cannabinoids found in cannabis, Δ 9 -tetrahydrocannabinol (THC) and cannabidiol (CBD), along with other cannabinoids, terpenes, and flavonoid compounds, are thought to exhibit synergistic effects that promote pain relief. 5 THC is the most psychoactive cannabinoid found in cannabis and is primarily responsible for the “high” associated with marijuana. It can also reduce nausea and increase appetite. CBD does not provide the euphoria associated with THC and is associated with reduced pain and inflammation. 6

The FDA’s View on Cannabis for Pain

Approval by the US Food and Drug Administration has, so far, been limited to synthetic or pharmaceutical-grade components of cannabis. In June 2018, the agency approved Epidiolex (GW Pharmaceuticals) — a high CBD, low THC whole-plant alcohol extract — for the treatment of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome in patients age 2 and older. FDA has also approved Marinol (AbbVie) and Syndros (Insys Therapeutics), which both contain dronabinol, or synthetic THC. Both are indicated for weight loss associated with anorexia and HIV. Marinol is also indicated for severe nausea associated with cancer chemotherapy, as is FDA-approved Cesamet (Meda Pharmaceuticals). Cesamet contains the active ingredient nabilone, which has a chemical structure similar to THC.

Herbs, Oils, and Edibles, Oh My!

The form/route of administration may also play a role in the pain effects of cannabis. Medical cannabis comes in herbal (marijuana), tincture, oil, and edible forms. It can be smoked, vaporized, ingested in edible or other oral forms, taken sublingually (under the tongue), or applied topically (oil). Research on the efficacy of different routes of administration for pain is sparse. However, a 2013 randomized, placebo-controlled, double-dummy, double-blind study compared analgesic effects of smoked marijuana and dronabinol. 7 The results indicated that under controlled conditions, marijuana and dronabinol both decreased pain. However, compared with marijuana, dronabinol produced longer-lasting decreases in pain sensitivity and lower ratings of abuse-related subjective effects, which can be predictive of use and abuse patterns. Other studies suggest that smoking cannabis produces rapid effects, while oral forms take longer to work but may last longer. 8

Strains of cannabis may come with names like Purple Diesel and Blue Sky. While the term “strain” is commonly used by dispensaries, medical cannabis users and even physicians, it’s not a term used for plant nomenclature. 9 A strain name may come from a grower, producer, processor, or dispensary. A 2018 study out of Washington state found that commercial Cannabis strains fell into three broad chemotypes (chemically distinct plants that otherwise appear indistinguishable) that were defined by the THC:CBD ratio. 10

“There is little consistency in plant constituents between products’ strain names,” said David Bearman, MD, a physician in private practice who specializes in pain management and has more than 40 years of experience in managing substance abuse. “These names are mainly marketing tools and tell little about the constituents of the product. The best advice is to read the label and understand it.”

Dr. Bearman is also the co-founder of the American Academy of Cannabinoid Medicine, and a board member of Americans for Safe Access – a national member-based organization of patients, medical professionals, scientists and concerned citizens promoting safe and legal access to cannabis for therapeutic use and research,and of Patients Out of Time – a Virginia-based nonprofit that works to educate all disciplines of healthcare professionals, the legal profession, and the public about medical cannabis. It’s also important to know that dispensary cannabis is not regulated by the FDA so what you get in one state, or at one time, may be different from another.

A Word About Hemp

Hemp products — including oils, extracts, and even “gummies” — aimed at relieving pain and anxiety abound on the internet. But what is hemp and how does it differ from marijuana? The conventional answer is that hemp and marijuana are two different species of the Cannabis genus of plants.

Hemp, which is primarily used for industrial purposes (particularly fiber products), is considered to be the Cannabis sativa species; marijuana (used for medicinal and recreational purposes) is considered to be the Cannabis indica species. The two species differ not only in appearance but also in levels of THC and CBD.

C. sativa is associated with higher levels of THC while C. indica is associated with higher levels of CBD. The science is more complicated. A 2015 study 11 of genetic structures of marijuana and hemp suggests that “C. sativa and C. indica may represent distinguishable pools of genetic diversity but that breeding has resulted in considerable admixture between the two.” Researchers also found that hemp has more in common genetically with C. indica than with C. sativa. Differences in THC production held true.

See also, a 2019 blog on PainDr (managed by Jeff Fudin, PharmD, PPM editor-at-large) on hemp use and drug screenings).

State Legalization of Medical Marijuana

Medical cannabis is currently legal in 34 states (as of spring 2019), many of which require patient registry or identification cards for the purchase and use of the substance for specific diagnosed medical conditions. These conditions differ by state and continue to change. At the federal level, marijuana is classified as a Schedule I substance under the “Controlled Substances Act,” and there are no recognized medical uses. In many of the states with legalized cannabis, some type of product testing is required, however, testing varies by state and may be limited contamination tests or may include quantification of CBD and THC levels.

California, for example, requires dispensaries to sell only marijuana that has been tested for pesticides, contaminants, and microbial impurities. Beginning in July 2018, California also began to require testing to determine plant potency (ie, levels of THC and CBD). This information is included on the product label. 12 In addition to t he above, 12 states have enacted legislation allowing for limited use of medical marijuana (ie, low CBD: THC ratios).

These states, as of spring 2019, include: Alabama, Georgia, Indiana, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Virginia, Wisconsin, and Wyoming. It is important to know that consistency and quality of the product received may vary from dispensary to dispensary and from state to state. Stay up to date with the National Conference of Sttae Legislatures which lists current medical marijuana laws at http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx.

The Amount of CBD or THC You Use Matters

Where does this leave chronic pain patients interested in trying medical cannabis? Regardless of the strain or form of cannabis, the key is the amount of THC and CBD in the final product, according to Dr. Bearman.

For those with concerns about the psychogenic effects, he recommends starting with a one-to-one ratio of THC to CBD for chronic pain. “I usually suggest that people start with 7.5 mg [which, using a standard unit converter amounts to 0.003 oz.] of THC and 7.5 mg of CBD, three or four times a day,” he told Practical Pain Management. “I tell them that the most likely effect is that (a) it’s not going to make their pain go away, and (b) they’re not going to get high.”

For pain relief, he recommends a dose of 15mg THC (0.0005 oz) to 15 mg CBD. In his experience, doses of THC less than 15 mg generally don’t provide pain relief. Doses may be increased if necessary, best guided under a doctor’s orders, to achieve pain relief without unacceptable side effects.

The key to using medical cannabis for pain is two-fold. For starters, a personalized approach is needed. Each person is different, and many adjustments may be needed to zero in on the dose that controls pain with minimal side effects. It’s also important to start on a low dose of THC and CBD.

Dr. Bearman said he also prescribes dronabinol, the man-made or synthetic THC, for some patients. “It doesn’t work as well as cannabis, it’s more expensive than cannabis, and it has more side effects than cannabis. Nevertheless, there are some good reasons for prescribing it,” he noted. Specifically, because dronabinol is regulated by the FDA and must meet purity and manufacturing standards, he knows exactly how much THC a patient is getting.

Be sure to talk with your doctor about the right dose and route of administration before taking any prescribed of dispensed medical cannabis product for pain relief or related symptoms. Note that Medicare does not cover the product; check with your insurer for other program coverage.

Read more about CBD Oil and its risks on our sister publication.

In PPM online poll, about half of respondents said they had tried medical marijuana to help alleviate their pain and related symptoms.

  1. National Academies of Sciences, Engineering, and Medicine. 2017. The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research. Washington, DC: The National Academies Press.
  2. Hill KP. Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems: A Clinical Review. JAMA. 2015;313:2474-83.
  3. Fine PG and Rosenfeld MJ. The Endocannabinoid System, Cannabinoids, and Pain. Rambam Maimonides Med J. 2013;4:e0022.
  4. Lewis MM, Yang Y, Wasilewski E, et al. Chemical Profiling of Medical Cannabis Extracts. ACS Omega. 2017; 2: 6091–103
  5. Russo EB. Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br J Pharmacol. 2011; 163: 1344–64.
  6. “Marijuana as Medicine.” National Institute on Drug Abuse, June 2018, https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine Accessed September 11, 2018.
  7. Cooper ZD, Comer SD, and Haney M. Comparison of the Analgesic Effects of Dronabinol and Smoked Marijuana in Daily Marijuana Smokers. Neuropsychopharmacology. 2013;3;1984–92.
  8. MacCallum CA and Russo EB. Practical considerations in medical cannabis administration and dosing. Eur J Intern Med. 2018;49:12-9.
  9. United States Department of Agriculture, Natural Resources Conservation Service, National Plant Materials Manual, Fourth Edition (Washington, DC, 2010). Available at: www.nrcs.usda.gov/Internet/FSE_DOCUMENTS/stelprdb1042145.pdf. Accessed September 1, 2018.
  10. Jikomes N and Zoorob M. The Cannabinoid Content of Legal Cannabis in Washington State Varies Systematically Across Testing Facilities and Popular Consumer Products. Sci Rep. 2018;8:4519.

Sawler J, Stout JM, Gardner KM, et al. The Genetic Structure of Marijuana and Hemp. PLoS One. 2015;10(8):e0133292.

7 Benefits of CBD for Pain Management

Move over, coconut oil: It’s time to share the spotlight with CBD. Now that CBD products are legal in states across the nation, you may have noticed how quickly acceptance of this once-controversial substance has spread. Many stores proudly display signs stating they sell CBD oil or capsules, and social media is filled with testimonials detailing how CBD helps people manage everything from anxiety to chronic pain. Tools for cbd products like a pocket size wooden hemp grinder, are also displayed from a cannabis dispensary. Some medical providers even sell CBD products to patients seeking a nonsurgical approach to pain relief.

But is CBD really worth the hype?

In many situations, yes, especially if you’re looking for a natural pain management solution. We’ve compiled seven benefits of using CBD for pain management below so you can check here and decide if cannabidiol extract is right for you.

1. CBD Comes in Many Forms

Hate swallowing pills or capsules? Many people take CBD orally, but that’s not your only option. You can also try tinctures or oils, vape CBD, gobble down edibles (like gummies from Westword.com), or massage CBD-infused lotion into your skin. Let’s do a brief rundown of each method below:

CBD Pills and Capsules

Pills and capsules are typically filled with a liquid version of CBD combined with a carrier oil, such as coconut oil. Depending on your digestive system, you can take CBD capsules with or without food. However, there may be a delay in symptom relief, as you have to wait until your body breaks down the capsule and distributes its contents.

You can get CBD pills without a prescription, but the FDA has approved a cannabidiol prescription drug called Epidiolex for epilepsy patients.

Oils and Tinctures

People who dislike pills often appreciate the convenience of tinctures that you ingest. Simply place a drop of the tincture under your tongue and wait for pain relief.

Oils are sometimes edible, but they’re generally designed for topical use. When using CBD for pain management, apply the oil where you have aches, burning, tingling, or stiffness.

Lotions and Creams

CBD lotions and creams are made for topical use. You can massage these products directly into your skin for fast-acting pain relief as well as skin-moisturizing benefits.

Gummies and Other Edibles

CBD edibles often come in candy form. You can find gummy bears, fruit chews, caramels, and chocolate with CBD on the ingredient list. Some people make their own edibles by adding food-grade CBD oil to brownies or cookie dough.

CBD for Vaping

Vaporized CBD oil goes straight from your lungs to your bloodstream, providing fast relief from painful symptoms. Be careful, though — vaping anything, even natural CBD oil, may still damage your health.

With so many options available, from pills to vaping, it’s easy to find a way to incorporate CBD into your pain management routine. If you aren’t sure which form of CBD is right for you, experiment with a few different types to figure out which offers the most benefits.

2. Different Types of CBD Extracts Are Available

Shopping for CBD products can feel overwhelming, and many people wonder: Are all these products the same, just with different labels? The answer is no, they’re not — and we’ll explain why.

Check out the label or ingredient list on the CBD product you want to try. You may notice terms such as full-spectrum, broad-spectrum, or isolate. These words describe the type of CBD inside.

Let’s quickly break down each term to help you choose CBD for pain management or other purposes:

Hemp Seed Oil

Despite common misconceptions, hemp seed oil is not the same as CBD oil, nor does it contain any phytocannabinoids. Hemp seed oil is derived from hemp seeds during a cold-press process. Hemp can be a part of a heart-healthy diet but look for another product if you actually want CBD.

CBD Isolate

As its name suggests, CBD isolate contains CBD. However, you won’t find any other phytocannabinoids in this simple compound.

Broad Spectrum

Broad-spectrum CBD products are a step up from isolates. They contain all of a plant’s phytocannabinoids, but they don’t have any THC (the drug found in marijuana associated with causing a “high”).

Full Spectrum

Full-spectrum CBD products offer numerous nutritional benefits for your body. If you buy a full-spectrum product, you’re getting something derived from the entire cannabis plant, including the parts with THC, CBC, and CBG. These are phytocannabinoids that help reduce pain signals in the brain.

Nano CBD

Nano CBD is made from shrunken molecules that are water soluble. It’s ideal for people who need an easy-to-digest CBD product that delivers nearly immediate symptom relief.

The form of CBD you choose depends on what you plan to treat. If you want to enhance your overall well-being, choose a full-spectrum or broad-spectrum product. Topical isolates may work well for patients who just want to manage pain in a specific location.

3. CBD Helps Reduce Joint Inflammation

If you’ve read some of our other blog posts, you may remember that inflammation is the culprit behind numerous symptoms and conditions we treat at Northeast Spine and Sports Medicine.

Wondering what that has to do with CBD?

Well, research indicates that CBD helps reduce inflammation in the joints, particularly when osteoarthritis is involved. The 2017 study found that not only does CBD help reduce pain, it also helps prevent nerve damage when administered via injections. Thwarting the development of nerve damage in arthritic patients may help stop the condition from worsening.

4. CBD Has Antifungal and Antibacterial Properties

If you’ve got slow-healing wounds from diabetes or other conditions, CBD may help enhance your recovery. CBD has antifungal and antibacterial properties, which can speed up your recovery time and also fend off infections.

When using CBD for wounds or blisters, you may want to apply it directly to the affected area rather than ingesting it. This helps create a protective barrier around the injured skin and ensure that nutrients are distributed where they’re needed most.

5. CBD Mimics the Effects of Prescription Pain Relief Medications

Like prescription medicines, cannabis works by activating receptors in your brain. When this happens, your receptors are basically saying, “Hey body, your pain is gone!” even if an injury or ailment still exists.

CBD isn’t just a brain-receptor manipulator, though. It has anti-inflammatory properties, so it addresses symptoms directly at their source rather than just masking your pain. Yes, you may experience relief before you’re fully healed, but CBD also helps your body repair itself.

6. CBD Treats Numerous Health Conditions and Concerns

Trouble sleeping? Stressed at work? Battling back pain?

CBD can help with all of these issues. You can also use CBD for relief from arthritis pain, foot pain, scratches and scrapes, headaches, and some digestive problems. CBD may even enhance your existing pain management treatments for sciatica and other hard-to-treat conditions.

Conflicting information is available about the benefits of CBD tinctures and capsules for cancer treatment. Speak to a medical provider before you replace your current treatments with CBD products.

7. CBD Is Easily Attainable

Now that many forms of CBD are legal options for pain management, it’s easy to find the types and formulas you need. You can order CBD online, get it from a health food store, find it at medical offices, or even get it at some pharmacies — without a prescription, of course.

CBD is often affordable when compared with other options for pain management, such as prescription pain pills and surgery, and no appointment is required before you purchase CBD.

Things to Consider Before Taking CBD for Pain Management

As we’ve described above, there are numerous benefits associated with using CBD for pain management, from its anti-inflammatory properties to its widespread availability. However, CBD is not for everyone, and there is a chance that you may experience side effects when using cannabidiol extracts.

Minor side effects include:

  • Fatigue
  • Nausea or upset stomach
  • Irritability
  • Dry mouth
  • Reduced appetite

Let your doctor know if you plan to combine CBD with prescription drugs, as there is a possibility for a negative interaction. CBD may interfere with your bloodstream if you take a blood thinner such as Coumadin, and it can also enhance the strength of some psychiatric medications — which isn’t necessarily a good thing.

At Northeast Spine and Sports Medicine, we understand the popularity of CBD for pain management, but we also realize cannabidiol extracts may not be an ideal choice for you. Give us a call to learn more about our other pain management services, whether you have a misaligned spine, aching knees, or activity-impacting joint pain.