CBD Vs THC: Which One Is Better for Pain?
It’s a complicated world out there for people seeking alternative remedies for chronic pain. More often than not, people end up frustrated with the conventional options. There are really only two options in the traditional pharmaceutical landscape: over the counter medications and opioids. A recent report published in the Journal of the American Medical Association presents evidence suggesting that opioids are no more effective for the treatment of chronic pain than, for instance, Ibuprofen. If over-the-counter pain meds don’t work, and if opioids fail, what else is there to use? The quest to finally get the pain under control has led many to explore the possibilities of cannabis. The problem with cannabis? The industry remains mostly unregulated when it comes to dosage guidelines, product strengths, and acceptable ingredients. It's unfortunate that there aren’t any cohesive guidelines for patients or physicians to follow. Consumers are largely left on their own, and it's up to them to explore which is better for their personal pain journey: CBD vs. THC for pain relief.
CBD VS THC: What’s the difference?
For many people, the term “THC” is interchangeable with the word “cannabis.” Cannabis, however, encompasses a wide variety of strains, and each has measurably different effects. Marijuana and hemp (essentially another cannabis strain) each contain their own unique mixtures of cannabinoids that work flawlessly with the human body’s endocannabinoid system.
Historically, THC is better known because it causes the most-noticeable psychoactive effects. Commonly reported effects include euphoria, anxiety, fear, and a noticeable ‘high’. Its powerful psychoactive side effects have had repercussions for the more than 60 other cannabinoids found in cannabis. 
All other cannabinoids trigger a much different sensation. In fact, most trigger no noticeable shift in perception or mood at all - no fear, no anxiety, no euphoria. This includes the other most popular cannabinoid: cannabidiol (CBD). The most common way to describe CBD’s action is a gentle sense of relaxation and calmness.
Cannabidiol may be responsible for the general shift in popular perceptions on the cannabis plant. Because it doesn’t trigger a high, and has very visible effects when used for treating epilepsy, there has been a marked shift across the medical community. Cannabis is no longer regulated to the shadows, as scientific research is exploring it for many new avenues of therapeutic application, including for pain. 
What about CBD vs. THC and the Endocannabinoid System?
THC and CBD interact with the endocannabinoid system in very different ways. In a sense, THC directly stimulates the body's endocannabinoid receptors, particularly the CB1 receptors concentrated in the brain and throughout the central nervous system. The THC molecule links to the CB1 receptor like a key in a lock, allowing it to influence, among other functions, memory, mood and some modulation of pain. Cannabidiol (CBD) interacts quite differently with the endocannabinoid system. Instead of linking directly with either the CB1 or CB2 receptors (the majority of CB2 receptors is found on white blood cells in the spleen and tonsils), it seems to modulate them. This effect inhibits the action of some cannabinoids (such as THC) that may have linked to the cannabinoid receptors, as well as inhibiting the reuptake of others. It interrupts receptor activity in different, more subtle manners. 
CBD vs. THC for Pain: Which Cannabinoid Is Better?
The preliminary research on the use of either CBD or THC for pain modulation is inconclusive, partially due to the difficulties getting federal approval to research marijuana. Despite the limited scientific conclusions, many patients, particularly in the states with legal access to cannabis, still turn to the plant to seek pain relief.
According to a recent report published by the National Academies Press, almost 100 percent of licensed medical marijuana patients in Colorado use it to treat pain. In Oregon, nearly the same percentage of patients rely on cannabis for pain. This data doesn’t break down the strain or cannabinoid content preferred by those polled.
In Europe, a medication prepared from a THC:CBD mixture has passed through phase III placebo-controlled trials. These phase III trials have demonstrated efficacy for the treatment of neuropathic pain, spasticity, and sleep disturbances in patients with multiple sclerosis. Beyond this very specific application, the research into cannabinoid use for the treatment of other types of pain doesn’t clearly differentiate between CBD vs. THC. 
In one of the most extensive literature reviews on the subject of cannabinoids and pain regulation, Role of the Cannabinoid System in Pain Control and Therapeutic Implications for the Management of Acute and Chronic Pain Episodes, the authors concluded the following:
“Clinical trials seem to indicate that either extracts of the cannabis sativa plant containing known amounts of the active compounds (mainly THC and CBD), or diverse synthetic derivatives of THC are promising treatments for painful conditions that do not respond to available treatments, such as neuropathic, inflammatory and oncologic pain. Specifically, cannabis extracts have shown effectiveness to relieve some symptoms of the patients with multiple sclerosis, mainly for pain and spasticity.” 
Until more thorough research is published, exploring CBD vs THC for pain in isolation, and when combined, one can only make assumptions about which cannabinoid is better. The National Academies Press concluded, based on substantial evidence, that cannabis is an effective treatment for chronic pain in adults, yet there is only limited research as to which cannabinoid works best.  
What Other Compounds Should You Look For?
The science so far has explored to a limited extent how individual cannabinoids interact with our bodies, as well as with each other. There is also the cannabinoids’ interaction with terpene compounds, which are responsible for the potent cannabis aroma most users know so well. These are also showing a lot of promise for pain treatment.
RELATED: A Crash Course On Endocannabinoids
While the interactions among terpenes, THC, and CBD are only partially understood, their ability to target pain when taken as whole-plant medicine is extremely promising. Also, it's no longer even just about CBD vs. THC for pain. Based on the current body of research, look for products containing CBD, THC, cannabigerol (CBG), and cannabichromene (CBC) for the most potential in pain management. 
Don’t forget that there are many different applications for cannabinoids, far beyond smoking the straight flower. These days cannabinoid products come in oral sprays, capsules, extracts and even topical salves. There are many preparations out there to explore, and in this way find your own CBD dosage for pain.
CBD vs THC for Pain: Picking the Perfect Combination
There are a few things to keep in mind when picking out the perfect strain for your specific needs:
- CBD oil improves mood, which can be of benefit to those suffering from long-term chronic pain. 
- THC-heavy strains can minimize pain to an extent, but it alters your state of mind. While some prefer to get high to forget about their pain, this isn’t always the preferred option. Some find the high quite off-putting. To minimize the high, source strains with higher CBD content.
- Extremely aromatic strains of cannabis contain high levels of terpenes. Like the combination of THC and CBD, terpenes also have shown to be effective pain relievers.
Until the Food and Drug Administration approves and regulates cannabis products as it does other conventional medicines, it remains up to the patient to determine what specific combination of cannabinoids effectively reduces their pain experience. While the preliminary reviews of the research have demonstrated that cannabinoids do regulate pain, there is a need for more robust, placebo-controlled clinical trials.  
Chronic pain is a very nuanced and complex experience, which calls for a multi pronged approach. Exploring different cannabinoids, and their interaction with your body and each other, is the best way to determine what combinations work for your own journey.
National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. https://doi.org/10.17226/24625.
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