Lotion and a cannabis leafPhoto: PRO Stock Professional (Shutterstock)

Products containing CBD are often marketed for pain relief, but there is no solid evidence that they actually make a difference. In fact, the FDA recently warned two companies that specifically make CBD products for pain relief.

What is CBD again?

It is cannabidiol that comes from cannabis. It’s not that part of the plant that gets you up, and the 2018 Farm Bill opened a void that somehow, somehow – maybe – technically allows it to be sold, even if cannabis is otherwise illegal. When the CBD market later boomed, The compound has been added to everything from lotions to slats, with implicit promises of relaxation, pain relief, and general healing from whatever makes you sick.

Illustration for article titled Does CBD Really Work For Pain?

Does CBD Help Pain?

It’s really hard to say. The way it is marketed, one would think that pain relief is a well understood use of CBD. There are versions of the product that you can swallow or inhale, but there are also tons of ointments and lotions that are aimed at making you feel better about rubbing it on a part of the body that hurts. But the truth is, nobody knows if it works.

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A few months ago I wanted to write about CBD products that are being marketed to athletes for “recovery” and muscle pain. I have received samples of CBD gels and roll-ons from various companies and tried them. I interviewed the CEO of a CBD company and a supplement expert who was skeptical of the claims. I’ve read a couple of studies. In the end, all I had to say was a big old shrug. I couldn’t feel the themes working, and I couldn’t find any solid evidence that CBD relieves pain or promotes recovery – outside of a possible placebo effect. On the other hand, I haven’t been able to find solid evidence that this is not the case.

There is research on CBD, but the makeup of the studies only vaguely relates to the scenarios in which people use over-the-counter CBD products. Sometimes the studies give a massive dose of CBD that is outside the average person’s budget for regular use, or they test CBD / THC combination products – and even then, the results aren’t necessarily clear. The studies often also look at patients with cancer or certain medical conditions, rather than people who want to treat everyday pain. This 2020 Review Paper on CBD for Chronic Pain summarizes the state of science:

During this [CBD + THC] Products have shown some promising results in treating chronic pain, the effectiveness of CBD must be questioned as the product contains both THC and CBD. Additionally, the safety profile of current CBD products, especially non-pharmaceuticals, should be questioned due to their false advertising and the variable amounts of CBD in the product. Hence, doctors and patients should carefully select a CBD product to ensure that patients are taking a good quality product. Despite these concerns, CBD remains a promising area for the management of chronic pain, and more studies need to be conducted to evaluate the role of CBD in the management of chronic pain.

Does the FDA have anything helpful to say about this?

A drug made from CBD called Epidiolex is an FDA-approved drug used to treat a certain type of epilepsy. Otherwise, CBD falls into one very bizarre legal gray area.

CBD is not approved as an over-the-counter drug, so consumer products that use it for pain relief are believed to be selling unapproved drugs. But because the FDA knows that CBD is a drug, companies can’t get away with including it in their “inactive ingredients” or calling it a supplement and making either of these statements: “This statement has not been evaluated by the FDA … “Disclaimer on it.

Illustration for article titled Does CBD Really Work For Pain?

Rather than cracking down on every product that contains CBD, the FDA sends out warning letters to the specific companies it believes are causing the greatest harm. This month’s letters contain one to a company that sells Elixicure CBD pain relief products, and Another to a company that markets a variety of undetected products as if they were pharmaceuticals, including products containing silver in addition to CBD. Both companies also failed the factory inspections.

But what if I like my CBD lotion?

If you’re using a CBD product and you think it works, I’m certainly not going to tell you to stop. But the FDA can eventually come for the manufacturer.

In the meantime, it might help to ponder the inconclusive science: if CBD were a potent drug, it would be much easier for studies to find results. So if it works, the effect is likely to be small. It can be worthwhile to think about what else you are doing to relieve pain. For example, does a hot bath help your sore muscles? Or do you like a non-CBD liniment as much as an expensive one containing CBD? It may be worth experimenting just to expand your possibilities.