People use CBD for many reasons – its versatility is one of its most appealing features. But, according to multiple industry surveys, pain relief is one of the most common reasons that people experiment with CBD and stick with it.
And pain is a complex thing. We know, for example, that the expectation of intense pain can actually create it. (Check out this story, for example, of a construction worker who thought he had hammered a nail through his foot). And the same can be said of pain relief. If you expect something to work for you, it probably will – to some degree at least.
So when a new substance like CBD comes along that seems to help people manage pain, there are always questions about what is actually going on. Does the substance actually help at a physiological level? Or did the expectation that it would help create an analgesic effect?
Researchers at Syracuse University decided to tackle this question head-on in the first systematic review and meta-analysis of experimental research examining the effects of CBD for pain.
They designed a study using 15 healthy volunteers that would help parse out the physiological from the psychological effects. The volunteers were divided into groups that determined whether they would be given CBD or a placebo, then subgroups which determined what they were told they were given.
The researchers used equipment that safely induces experimental heat pain, which allows them to measure how the volunteer’s nervous system reacts and responds to it. Then, according to Dr. Martin De Vita, one of the study’s lead researchers “we administer a drug, like pure CBD, or a placebo and then re-assess their pain responses and see how they change based on which substance was administered.”
If you think of pain as the noxious noise coming from a radio - the volume can represent the intensity of the pain, while the station can represent the quality. It's not sunshine and rainbows pleasant, but something slightly less bothersome.
This particular study, though, took things a step further by giving volunteers different information about what substance they received. For example, some participants who took CBD were told that they were given a placebo and vice versa. This helps researchers understand the degree to which expectancy is playing a role in any effects of CBD.
According to Da Vita:
“We hypothesized that we would primarily detect expectancy-induced placebo analgesia (pain relief). What we found though after measuring several different pain outcomes is that it’s actually a little bit of both. That is, we found improvements in pain measures caused by the pharmacological effects of CBD and the psychological effects of just expecting that they had gotten CBD. It was pretty remarkable and surprising.”
These results, while surprising to the researchers, do reflect other findings on using cannabinoids for pain. A 2012 study out of Oxford University, for example, found that brain imaging shows little reduction in the brain regions that code for the sensation of pain. Instead, according to Dr. Michael Lee, “cannabis appears to mainly affect the emotional reaction to pain in a highly variable way.”
This could help us understand some of what is going on in the Syracuse study. Pain, according to Da Vita, is not just an on/off switch, but comprises very complex biological and psychological factors. To account for this, researchers differentiate the sensory side of pain, which is referred to as the “pain intensity” from “unpleasantness,” which refers to the emotional aspect of pain.
What this most recent study found is that CBD can have a profound impact on that affective, or emotional, side of pain. The volume of pain was still there (though that was also somewhat reduced), but what stood out most was that the pain seemed to bother the volunteers less.
According to Stephen Maisto, there’s still a lot of work to do in parsing out what is due to physiological effects and what is psychological:
“The data is exciting but pretty complex in that different pain measures responded differently to the drug effect, to the expectancy, or both the drug and expectancy combined–so we’re still trying to figure out what is behind the differential data with different kinds of pain measures. The next step is studying the mechanisms underlying these findings and figuring out why giving instructions or CBD itself causes certain reactions to a pain stimulus.”
Since another ongoing conversation in the CBD industry circles around what type of CBD is most effective, it’s worth noting that for this study they used pure CBD isolate oil. Says De Vita, “Commercially available CBD products differ in their content and purity, so results might be different for different CBD products, depending on what other compounds they may or may not contain.”