Study: Placebo Effect May Play a Role in Effectiveness of CBD

Using CBD as a pain reliever may not actually reduce your pain intensity, but it might make it feel less unpleasant, according to researchers.

A small study by researchers at Syracuse University suggests that the placebo effect may play a role in cannabidiol’s (CBD) ability to provide relief for chronic pain.

The researchers recruited 15 participants, who were compensated for their involvement, to participate in four experimental sessions. The participants were randomly assigned either CBD or a placebo and received information about the substances they were given. In some cases, participants were told they were given CBD when they actually received a placebo and vice versa. The study was published in the Experimental and Clinical Psychopharmacology journal in April.

In this study, people who received the active CBD with the expectation that they were receiving CBD reported having a higher threshold and tolerance for pain than those who received active CBD but believed they were receiving a placebo. Therefore, the researchers suggest that “verbally emphasizing the positive and realistic effects of CBD on pain, without overemphasizing negative side effects, may optimize” its benefits.

Making Pain Less Unpleasant

The researchers found, after measuring participant’s pain outcomes, that both, the pharmacological effects of CBD and the psychological effects of just expecting they’d receive CBD, helped relieve feelings of pain.

While the pain intensity didn’t dissipate entirely, the process helped people feel a little less bothered by it.

Vernon Williams, MD, pain management specialist and founding director of the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, tells Verywell that this study shows how people’s views on CBD and cannabis may potentially play a role in its effects. “This whole concept of whether people may or may not have a kind of some negative predisposition to cannabis, particularly as relates to the stigma of ‘is this making someone high or intoxicated’ interests me,” he says.

There were some limitations to the study, in addition to the small number of participants. The participants in the study were between 18 to 30 years old, a group that may not be as likely to use CBD to manage chronic pain. “Whereas younger adults may use CBD recreationally or as part of a health/lifestyle regimen, older adults may be motivated to use CBD to treat conditions that commonly co-occur with aging, such as chronic pain,” the researchers wrote.

Eloise Theisen, RN, MSN, AGPCNP-BC, full-time Medical Cannabis program faculty at Pacific College of Health and Science and current President of the American Cannabis Nurses Association, questions whether this study design could successfully mimic similar effects to active CBD in the placebo. “One of the challenges with cannabis research in humans, particularly with THC, is they often know if they’re getting it,” Theisen tells Verywell. “We haven’t really seen studies with active placebos that can still mimic the effect but don’t actually have the drug in it.”

CBD May Be Helpful in Managing Chronic Pain

Using CBD to manage chronic pain may be considered an ideal option for some people due to its limited side effects and low risk of addiction.

“The benefits of CBD versus over the counter pain medications or prescription medications are that CBD has [been] demonstrated to have fewer side effects and is very well tolerated even in large dosages,” Theisen says.

Previous research indicates that CBD may be effective in managing chronic pain from certain conditions. A 2018 study published in the Frontiers of Neurology journal found that CBD improved chronic pain in people who live with the condition multiple sclerosis, and it reduced spasticity, inflammation, fatigue, and depression.

CBD is often used to manage some of the following conditions as well:

• Crohn’s disease
• Temporomandibular disorders or TMD
• Nerve damage in the hands and feet

As older adults continue to turn to CBD as a way to manage chronic pain, Theisen says it’s important that clinicians become more educated about the benefits of this substance and how it could be used. “What we’re starting to see is that older adults are one of the faster-growing groups of cannabis users, and they are looking to their health care professionals to give them guidance and often health care professionals are uneducated or uninformed,” she says.

People who live with chronic pain may also use CBD in addition to other prescribed pain medication or over-the-counter pain medications. “Most of the people who have pain that is moderate or severe…are typically using prescription medications or over the counter oral medications in addition to the CBD,” Williams says. He adds that it is important for patients to disclose their CBD use in case this substance negatively interacts with a medication someone is already prescribed.

Some drug-to-drug interactions which may pose a moderate risk for people who use CBD include:

• Brivaracetam
• Carbamazepine
• Clobazam
• Eslicarbazepine
• Everolimus
• Lithium

The Need for the Regulation of CBD

The 2018 Farm Bill legalized the sales of hemp and hemp products in the United States, but CBD products—including what is in it—can range drastically. “I talk to patients about [how] we don’t have detailed and specific recommendations about dosing because it is not regulated,” Williams says.

In fact, a 2017 study published in the JAMA Psychiatry journal found that nearly 70% of CBD products sold online are mislabeled. Due to the lack of regulation of CBD, Theisen encourages people to see clinicians who are educated about cannabis.

“I’m always going to encourage people to work with a knowledgeable cannabis clinician,” she says. “Some things to consider are side effects and possible drug-to-drug interactions, and then the quality of CBD because it’s not regulated right now.”