THC vs. CBD for pain

              For thousands of years, cannabis has been used as a medical treatment for a variety of ailments, pain relief being one of the most common reasons. In the medical community, the use of cannabis for pain relief is studied by scientists, not only to understand the mechanisms of the components of cannabis, but also to provide the most safe and effective treatment for various types of pain including analgesic and neuropathic. While in recent studies, both tetrahydrocannabinol (THC) and cannabidiol (CBD) have shown pain relieving properties individually, the entourage effect has seemed to show that a combination of the components of cannabis, including THC and CBD, may be the answer to various types of pain relief.1

              When scientists discovered the endocannabinoid system, they also began to understand how CB1 and CB2 receptors regulate various internal processes, including immune function, appetite and digestion, inflammation, cognition, and behavior.1 Endocannabinoids are produced in the body, however phytocannabinoids, such as THC and CBD, are found in cannabis and hemp in varying concentrations.  THC is a partial agonist for CB1 receptors found mainly in the central nervous system that produces the psychoactive properties of cannabis.  It is also a partial agonist for CB2 receptors found elsewhere in the body, including the immune system.1   CBD can act as an antagonist for endocannabinoid receptors, but is also  an endocannabinoid modulator.1  Both THC and CBD concentrations in the body are dependent of method of administrations, with inhaling producing a shorter response time and half-life, while oral ingestion leads to first pass metabolism and production of metabolites that are longer lived.2

              In scientific studies, both THC and CBD have been seen to have pain relief properties, specifically analgesic and neuropathic.  The mechanisms by which CBD works in the body is largely unknown.  It can be a modulator of opioid receptors, which in turn can make it an analgesic.3 As well, CBD interacts with PPAR-gamma, a protein associated with anti-inflammatory properties.  The CBD and PPAR-gamma interactions may increase anti-inflammatory responses.3 On the other hand, THC is an agonist for CB1 and CB2 receptors.  CB1 activation in the endocannabinoid system is associated with a reduction in pain and inflammation.2 THC is also seen to have 20x the anti-inflammatory properties of aspirin and approximately two times that of hydrocortisone.3  THC works in various ways to produce pain relief, including its interaction with serotonergic, glutamatergic, and the endorphin and enkephalin systems.3 All of these interactions make THC an extremely effective pain relief option.

              The choice between CBD or THC for pain relief depends on two main issues – availability and effectiveness.  While CBD is widely spread available, the acquisition of THC is much more difficult, depending on individual state rules.  Perhaps the most important, though, is whether CBD or THC is more effective.  Because of a lack of research, effectiveness, especially in CBD, is based on anecdotal evidence. It is apparent, however, that the entourage effect allows a combination of THC and CBD to be the most effective for pain relief.  The entourage effect is the synergy of all the components of cannabis.  THC, CBD, terpenes, and flavonoids, along with the hundreds of other compounds found in cannabis, work together by different mechanisms to seemingly produce the greatest pain relief in a variety of circumstances, including neuropathic pain and hyperalgesia. Therefore, the answer to whether CBD or THC is better for these types of pain is not specifically clear.  Both research and anecdotal evidence has consistently shown that the combination of compounds in cannabis is perhaps the best pain relief option.1,2

              The major cannabinoids in cannabis, THC and CBD, both display pain relieving properties individually.  While the mechanism for CBD is not completely understood, it does seem to reduce chronic pain.  As well, THC works on various system to produce pain relief.  The question of which compound produces the best pain relief does not have a simple answer. In fact, the combinations of all the compounds in cannabis, including THC and CBD produce the best synergistic effect of pain relief.  The entourage effect, which includes other compounds like terpenes and flavonoids, shows that the whole plant may be the most effective in combatting both neuropathic pain, hyperalgesia, and inflammation.

  1. Mallick-Searle T, St. Marie B. Cannabinoids in Pain Treatment: An Overview. Pain Management Nursing. 2019;20(2):107-112.
  2. Russo EB. Cannabinoids in the management of difficult to treat pain. Ther Clin Risk Manag. 2008;4(1):245–259.
  3. WHO Expert Committee on Drug Dependence. World Health Organization. Cannabidiol (CBD). https://www.who.int/medicines/access/controlled-substances/5.2_CBD.pdf. Accessed November 16, 2019.

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