CBD For Pain and Inflammation

 

Twisting an ankle on a broken step, or throwing your back out shoveling snow. At one time or another everyone experiences the significant pain that comes from a seemingly small injury.

Stress, trauma, genetics, and poor diet can exacerbate inflammation. For many people, inflammation becomes chronic and can contribute to serious health problems including high blood pressure, heart disease, diabetes, arthritis, and plays a key role in cancer and autoimmune diseases (Anf 2016). Inflammation can also cause or exacerbate depression, which in turn generates new stress, and increases inflammation ( Kiecolt-Glaser 2015)(Halaris 2016).

Conventional means of dealing with pain and inflammation can be effective in the short term, and sometimes life-saving, but can create new problems for many people. In some cases, they contribute to problems that underlie chronic inflammation.

Cannabidiol (CBD), a compound from the hemp plant, shows promise in reducing pain and inflammation in both the short term and the long term with no major side-effects.

What is Inflammation?

Inflammation is part of the body’s natural response to an injury or infection – of the possibility of one.

When injured or sick our immune system sends a host of chemicals into the damaged tissue to fight off invaders, destroy damaged tissue, and generate tissue to repair the injury. Blood rushes into the area, and cellular activity speeds up, thus creating heat – this is why a sprained ankle will be red, swollen, and hot to the touch. Some of these compounds irritate nerve endings and cause pain. That pain is an alarm that helps us identify and pinpoint injury. The problem with experiencing inflammation for a long period of time is that the protective cells end up attacking and damaging healthy tissue (Anf 2016)(InformedHealth.org 2018).

Inflammatory processes run out of control when stress is involved. We don’t yet entirely understand the mechanisms at play, but when our bodies perceive danger, they respond by ramping up inflammatory processes. Inflammatory molecules further trigger our stress response, adding fuel to the fire.

Pain in itself is a stressor that increases inflammation, therefore making the pain worse. Pain and stress both cause sleep deprivation, leading to increased inflammation. Patients who experience trauma are more likely to get trapped in this vicious cycle, which adds to the anxiety and depression connected with their original trauma (Slavich & Irwin 2014).

Conventional medicine responds to inflammation and pain by trying to shut down the body’s immediate response. This makes sense in the moment, but it leaves the underlying problems unaddressed, and can contribute to chronic inflammation.

The Trouble With Steroids and NSAID’s

There are two main kinds of pharmaceuticals used to treat inflammation: corticosteroids and non-steroidal anti-inflammatory drugs (NSAID’s) like aspirin, ibuprofen, and acetaminophen.

Doctors tend to use corticosteroids in very serious conditions. Corticosteroids mimic the stress hormone cortisol, calming down the acute inflammatory response. This can be life-saving when inflammation is damaging an organ or obstructing a vital process like breathing. Unfortunately, some of the medium and long-term effects of corticosteroids mimic symptoms of chronic inflammation and chronic stress.

The side effects of the most frequently prescribed corticosteroid, prednisone, include weight gain, mood swings, aggression, depression, agitation, and swelling (Mayo Clinic 2019). Weight gain itself can increase chronic inflammation (Halaris 2016)(Kiecolt-Glaser 2015, Miller 2018).

Long term corticosteroid use can disrupt the hypothalamus-pituitary-adrenal (HPA) axis, the part of the endocrine system that regulates our stress response (Rensen 2017)(Shapiro 1976). Disruption of the HPA axis leads to increased inflammation (Halaris 2016)(Kiecolt-Glaser 2015)(Miller 2018).*

*It is important to note here that it is never wise to change or discontinue a medicine without medical advice, and it is especially dangerous to suddenly stop taking a corticosteroid. If you are taking a corticosteroid and are worried about its long term effects, talk with your doctor about your concerns.

Doctors tend to treat acute inflammation with the more familiar group of medications: NSAID’s. Aspirin, ibuprofen, acetaminophen, and similar drugs reduce inflammation by partially blocking an enzyme called COX (cyclooxygenase).

NSAID’s are associated with gastrointestinal side effects including ulcers and damage to the mucosa that protects the digestive tract (Sostres 2013). Damage to the gut lining and to the gut microbiome can lead to increased chronic inflammation throughout the rest of the body and dysregulation of the HPA axis (Michielan & D'Incà 2015, Russo 2018).

Individual NSAID’s have their own side effects. Acetaminophen is notoriously hard on the liver, and is responsible for more cases of liver failure than any other drug (mainly from overdose)(Lee 2017). Ibuprofen can damage the kidneys, especially if someone is dehydrated from a fever (DeMartino 2017). Aspirin can increase bleeding and hemorrhages (García Rodríguez 2016).

CBD works in an entirely different way and has none of these negative side effects.

How CBD Addresses Inflammation

The nervous system, the immune system, and the endocrine system, work together to coordinate our body’s response to danger – including inflammatory processes. Most drugs target one particular aspect of the process – CBD gets to the root of inflammation.

These three systems are all strongly influenced by the relatively newly discovered endocannabinoid system. The endocannabinoid system is a series of receptors that respond both to molecules contained in the cannabis plant – cannabinoids – and compounds with similar effects that are produced by our own bodies – endocannabinoids. All of the major types of cells involved in inflammation contain endocannabinoids and endocannabinoid receptors, suggesting that when the system is healthy, it helps balance inflammation (Pellati 2018). Researchers theorize that an endocannabinoid deficiency plays a role in chronic pain and inflammation in diseases like fibromyalgia and irritable bowel syndrome. Ethan Russo states that:

“If endocannabinoid function were decreased, it follows that a lowered pain threshold would be operative, along with derangements of digestion, mood, and sleep among the almost universal physiological systems sub served by the endocannabinoid system ” (Russo 2016).

Back in 2008, Russo notes that while we have found many molecules that act on the endocannabinoid system, the “first clinically available” compound that acts to balance the whole system, to modulate the modulators, is CBD (Russo 2008). CBD is a molecule created by plants of the cannabis genus that has been shown to reduce inflammation in conditions ranging from osteoarthritis to Parkinson’s disease (Philpott 2017). It is being investigated for its potential in reducing cancer risks by regulating inflammation (Pellati 2018).

 CBD has also been identified as a possible adaptogen (Pellati 2018). Adaptogens are compounds that help regulate the body’s stress response without creating any significant side effects by balancing the HPA axis (Panosssian & Wilkman 2010). Scientists recently discovered that the hypothalamus has endocannabinoid receptors that respond to anandamide, a molecule produced by our own bodies whose name is derived from the Sanskrit word for “bliss” (Hill 2019). Anandamide helps soothe us, which in turn helps soothe inflammation. CBD helps the body use anandamide more efficiently (Prud'homme 2015).

CBD also has pain relieving properties. It both directly reduces pain and changes the way the body perceives pain, to make it less overwhelming (Vučković 2018).

CBD shows great promise in breaking the vicious cycle where inflammation causes pain, pain causes stress and loss of sleep, and stress and loss of sleep cause more inflammation.

Managing pain and inflammation is complex. Dietary and lifestyle changes play an important role in helping people’s bodies come back into health. CBD, a molecule that acts in the body in unique and complex ways, can play an important role in a multi-pronged approach to bringing inflammation back under control. It is one of the few molecular tools we have for addressing inflammation that does not feed into the underlying problems. In the coming years, new research will continue to shed light on the applications of this amazing compound in promoting whole body health.

 

 

REFERENCES

Anft, M. (2016) Understanding Inflammation. Johns Hopkins Health Review. 3(1).

de Martino, M., et al. (2017). Working Towards an Appropriate Use of Ibuprofen in Children: An Evidence-Based Appraisal. Drugs, 77(12),

Gallily, R., et. al. (2018). The Anti-Inflammatory Properties of Terpenoids from Cannabis. Cannabis and cannabinoid research, 3(1)

García Rodríguez, L. A., et al. (2016). Bleeding Risk with Long-Term Low-Dose Aspirin: A Systematic Review of Observational Studies. PloS one, 11(8),

Halaris A. (2016) Inflammation-Associated Co-morbidity Between Depression and Cardiovascular Disease. In: Dantzer R., Capuron L. (eds) Inflammation-Associated Depression: Evidence, Mechanisms and Implications. Current Topics in Behavioral Neurosciences, vol 31

Hill, M., et al. (2010) Functional Interactions between Stress and the Endocannabinoid System: From Synaptic Signaling to Behavioral Output. Journal of Neuroscience. 30(45)

InformedHealth.org. (2018) . What is an inflammation? 2010 Nov 23 [Updated 2018 Feb 22]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279298/

Kiecolt-Glaser, J. K., et al (2015). Inflammation: depression fans the flames and feasts on the heat. The American journal of psychiatry, 172(1

Ko, G. D., Bober, et al.. (2016). Medical cannabis - the Canadian perspective. Journal of pain research, 9,

Lee W. M. (2017). Acetaminophen (APAP) hepatotoxicity-Isn't it time for APAP to go away?. Journal of hepatology, 67(6)

Mayo Clinic. (2019) Prednisone (Oral Route)

Michielan, A., & D'Incà, R. (2015). Intestinal Permeability in Inflammatory Bowel Disease: Pathogenesis, Clinical Evaluation, and Therapy of Leaky Gut. Mediators of inflammation, 2015, 628157. doi:10.1155/2015/628157

Miller, M. W., et. al (2018). Oxidative Stress, Inflammation, and Neuroprogression in Chronic PTSD. Harvard review of psychiatry, 26(2),

Panossian, A., & Wikman, G. (2010). Effects of Adaptogens on the Central Nervous System and the Molecular Mechanisms Associated with Their Stress-Protective Activity. Pharmaceuticals (Basel, Switzerland), 3(1)

Pellati, F., et al. (2018). Cannabis sativa L. and Nonpsychoactive Cannabinoids: Their Chemistry and Role against Oxidative Stress, Inflammation, and Cancer. BioMed research international, 2018

Philpott, H. T., et. al.. (2017). Attenuation of early phase inflammation by cannabidiol prevents pain and nerve damage in rat osteoarthritis. Pain, 158(12)

Prud'homme, M., et. al.. (2015). Cannabidiol as an Intervention for Addictive Behaviors: A Systematic Review of the Evidence. Substance abuse : research and treatment, 9,

Rensen, N., et al. (2017). Hypothalamic-pituitary-adrenal (HPA) axis suppression after treatment with glucocorticoid therapy for childhood acute lymphoblastic leukaemia. The Cochrane database of systematic reviews, 11(11)

Russo E. B. (2008). Cannabinoids in the management of difficult to treat pain. Therapeutics and clinical risk management, 4(1)

Russo E. B. (2016). Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes. Cannabis and cannabinoid research, 1(1)

Russo, R. et al (2018). “Gut-brain Axis: Role of Lipids in the Regulation of Inflammation, Pain and CNS Diseases”, Current Medicinal Chemistry. 5

Shapiro, GG et al. (1976) Growth, pulmonary, and endocrine function in chronic asthma patients on daily and alternate-day adrenocorticosteroid therapy. The Journal of Allergy and Clinical Imunoligy. 57 (5)

Slavich, G. M., & Irwin, M. R. (2014). From stress to inflammation and major depressive disorder: a social signal transduction theory of depression. Psychological bulletin, 140(3

Sostres, C., et. al. (2013). Nonsteroidal anti-inflammatory drugs and upper and lower gastrointestinal mucosal damage. Arthritis research & therapy, 15 Suppl 3

Vučković, S., et al. (2018) Cannabinoids and Pain: New Insights From Old Molecules. Frontiers in Pharmacology. 9