Can We Have More CBD in Pain Studies?

A recently concluded study that was conducted by a team of top urologists has found that cannabidiol (CBD) is not effective in relieving pain or reducing need for opioids after kidney stone treatment (through stent placement). The study however found that CBD was safe and well tolerated. 

Here are details of the study.

The researchers comprised a team of top urologists from different US based medical institutions including The Mayo Clinic and The University of North Carolina. This was a double-blind and placebo-controlled study set to investigate if CBD was at all effective in relieving pain from kidney stone stent placement. The hypothesis was that CBD oil would provide a significant reduction in pain levels. The results of this study were published in the Journal of the American Urological Association.

During this procedure the doctor begins by inserting a scope into the bladder through the urethra. A guidewire is then inserted through the blockage caused by the kidney stone and this is used to place the ureteral stent. The cystoscope and guidewire are then removed while the stent remains in place for a couple of days. Pain and discomfort which usually lasts for a few days  is the most frequently reported symptom after this procedure. 

The active arm of the research received 20mg of CBD oil in the form of Epidiolex once daily for three days after the procedure. The control arm received an inactive oil but that was packed in a syringe that was identical to the CBD. Both arms were also offered “rescue opioids” in the form of oxycodone to be used in case of breakthrough pain. 

What did the research find?

Patients in both arms of the study experienced the same level of pain and discomfort. In a nutshell, the researchers found that CBD was not superior to placebo in offering pain relief after stent placement for kidney stone treatment.

Why Is 20mg of CBD a Concern?

Here's some background on Epidiolex.

In 2018, the FDA approved Epidiolex as the first ever cannabis-derived medication in the form of pure cannabidiol (CBD). This drug has so far been approved for the treatment of some rare and severe forms of childhood seizures. This makes the treatment of pain an off-label use.

The standard dosage of CBD is 2.5mg/kg/day to 5 mg/kg/day. This means that a 70kg man should be consuming about 175 to 350 mg of Epidiolex per day, for seizures. In one phase three Epidiolex trial, participants were offered CBD up to 50 mg/kg/day. This makes 20 mg of CBD for pain management appear to be too  low in whatever context. And given that safety at much higher doses has not been a concern, bumping up the doses would seem appropriate for subsequent studies. 

Science is just beginning to catch up with the true potential and risks that are associated with medical cannabis. In a recent study, a combination of CBD with THC  was more than opioids in managing chronic neuropathic pain. Entourage benefits offered by terpenes and minor cannabinoids is another promising area that needs to be exploited in subsequent research. 

In summary, there’s more to cannabis than pure isolates and a dose of 20 mg is probably too low for just anything other than relaxation.