Exploring CBD pain creams: What you should know

Our skin is our armor

Our skin is the largest organ in our body, and is composed of many layers of cells, each with their own purpose and life cycle. The skin’s main purpose is to make sure to keep things out of our delicate insides. It does so by creating alternating layers of fat loving and water loving cells. Fatty compounds, like cannabinoids, can pass through the fatty barriers, but get stuck at the watery ones, and vice versa.

Because of this clever layering system, cannabis topicals act strictly at the local levels. Things like oils, lotions, creams, and balms can’t penetrate fully into the bloodstream because they’re blocked by skin’s watery layers from penetrating any deeper. By adding certain compounds to cannabinoid topicals you can create transdermal products—ones that penetrate into the bloodstream. There has been much more research about the transdermal impacts of cannabinoids than the topical applications, largely to figure out if transdermal methods could replace the drawbacks of inhaling or eating cannabis. In short:

• Topicals act locally
• Transdermal products work systemically

Types of pain

Pain is a complex issue, and one that’s not perfectly understood. It is experienced as a sensation, emotionally, and via behavioral factors, all of which means that treating pain is highly personalized. When people reach for a topical to treat pain, it could be for any of those reasons, but here we’ll just focus on the first: the sensation of pain.

Even within the sensation of pain, people express a wide variety of experiences. Acute, or nociceptive, pain is like the pain when you cut yourself. It’s immediate and there’s an obvious cause. Chronic, or neuropathic, pain is pain that continues beyond the healing of an acute injury. It often involves a great deal of inflammation. This type of pain is poorly understood, and treatment options are limited. Which is where cannabinoids come in.

Cannabinoids are incredibly anti-inflammatory. It’s one of the reasons they are used by people with such a wide variety of conditions. Many conditions stem from inflammatory issues, or include inflammation as a root cause. There have been tons of studies showing how effective cannabinoids are at reducing many types of inflammation.

How does CBD work on the skin?

People experiencing pain generally turn to topical application products for two reasons: conditions on the skin’s surface (e.g. psoriasis, eczema, acne vulgaris), and conditions below the skin’s surface (e.g. muscle soreness, arthritis). Both types can be very painful, and the standard treatments are often ineffective or have negative long term health impacts. Patients and researchers are eager to find alternatives that are more effective and safer. Like cannabinoids.

Cannabinoids fit into tiny gates on the surface of cells called receptors. Receptors are like the on/off button that makes processes start and stop in the body. There are thousands of different types of receptors and each type works best with different compounds, some of them our body makes, and some we introduce from our environment. Different cannabinoids interact with different receptors to trigger a wide variety of effects in the body. Cannabinoids can also influence the levels of other influential compounds our bodies produce to regulate a huge number of systems. Cannabinoids interact with many targets on skin cells, and Hungarian researchers have explored the complexity of the so called “cutannabinoid” system.

These are some of the factors that could be involved in CBD caused pain management on the skin’s surface:

• TRPV-1: Also known as the vanilloid receptor. Activation of this receptor by capsaicin mediates the sensation of heat when you put it on your skin. CBD, like capsaicin, can desensitize these receptors, resulting in pain relief.
• FAAH: Our bodies produce cannabinoids naturally: endocannabinoids. If you’ve ever felt a runner’s high, you’ve felt the effects of endocannabinoids. The reason that high is so brief is because the compounds that break down endocannabinoids are released simultaneously. FAAH is one of those metabolites, and CBD partially blocks it,. meaning that those feel good compounds stick around longer, potentially leading to pain killing effects.
• CB₁: This receptor is what THC plugs into to make us feel high. It’s also behind THC’s pain killing effects. When CBD blocks FAAH, it makes our bodies’ natural THC (anandamide) stick around longer, potentially helping with pain and itch.
• Adenosine A_2A: This receptor regulates vasodilation and suppresses immune cells. CBD binds to to A_2A receptors expressed on the skin and has been shown to have anti-inflammatory effects. In addition, it decreases acne causing sebum production.

These targets have been shown to modulate pain perception not only on the skin, but internally as well. Which means these same targets are activated by CBD when using a transdermal product.

What the scientists have to say

Humans have used cannabis to manage pain for centuries, but it’s only recently that we’ve started to understand how it works. Many patients are blown away by the efficacy of cannabis topicals in treating their pain, and scientists are just starting to try and make sense of it. It’s important to note that studying CBD’s impact on pain topically is still in its infancy. Of the few studies published, most are experiments done on mice, not people. There is still an enormous amount to learn before we figure out how and why topical CBD can help manage pain for so many.

In 2019, Italian doctors recruited twenty volunteers with inflammatory skin conditions to study the impact of a topically applied CBD ointment. They wanted to collect evidence of CBD’s efficacy at treating the inflamation, pain, and skin lesions, something sorely lacking in the scientific literature. They found that across all parameters they studied, all of the patients showed significant improvements, and no significant side effects. Unfortunately, the researchers did not record the concentration of CBD in the trial cream. A similar balm by the same manufacturer contains 120mg of CBD per 1.69 fl oz. Additionally, the ointment contained several additional beneficial herbs like calendula, lavender, and chamomile.

CBD was found to have significant anti-inflammatory action on rodent skin in a 2010 study. THC interacts with the two main activation sites of the endocannabinoid system, CB₁ and CB₂. CB₁ activation is strongly tied to cannabis’ anti-inflammatory effects. The researchers were interested in figuring out if cannabinoids that didn’t interact with those sites, like CBD, had comparable anti-inflammatory effects. While somewhat less effective than THC, CBD significantly reduced inflammation. The researcher theorized that it’s anti-inflammatory effects could be due to activity at TRPV-1, COX-2, and A_2A.

Psoriasis is a common inflammatory skin condition that is characterized by lesions. Those lesions are caused by the over producing keratinocytes, the most common form of skin cell. It can be itchy, painful, and stress inducing for those affected. Multiple studies have shown that topically applied CBD can regulate the production of keratinocytes in psoriasis. In another disease characterized by dysregulated keratinocyte production, epidermolysis bullosa, three patients who used topical CBD reported faster wound healing, less blistering, and a decrease in pain.

Itching can drive a person crazy, and is often a symptom of a chronic skin condition. While THC is well known for its anti-itch properties, CBD could also help with itching. A 2015 study on mice focused on FAAH inhibition, something that CBD does, demonstrated reduced itching in mice.

There is currently no research related to topically applied cannabinoids for treating deeper types of pain, like muscle pain.

Helping hands: CBD and beneficial ingredients

Most CBD topicals have additional ingredients that could make them more effective at killing pain. Everything from the other botanical herbs in the cream, to the oils and butters used to make them can contribute to skin health.

• Manuka honey has been shown to help with wound healing, and could double down on CBD’s antibacterial effects for open wounds.
• Calendula (aka marigold) has also been shown to help with wound healing, dermal inflammation, and pain. All things that complement CBD’s ability to do the same.
• Lavender is another well known wound healer, and can help speed the reduction in size of open wounds. It’s scent is also proven to help with anxiety, always a good thing when dealing with any kind of pain.
• Capsaicin is the active compound in spicy peppers. It’s employed widely as a topical cream for pain relief. It works by desensitizing pain sensitive targets on cells.
• Menthol is the active compound found in mint plants. It’s been shown to help reduce muscle soreness when applied topically.
• Arnica is a common herbal compound used for muscle soreness. It’s been shown to reduce bruising and reduce arthritis related pain in higher concentrations.

How much CBD should be in your topical?

The short answer is we don’t know. There hasn’t been a clinically approved pharmaceutical preparation of CBD for any skin level condition. And so far, researchers have not reported the concentration of CBD in topical applications. This makes it hard to figure out just how concentrated your CBD cream should be. A 2017 Phase 2 clinical trial of a transdermal CBD gel used 250mg of CBD per day, but the study has yet to be peer reviewed or move onto Phase 3.

Three patents have been filed related to topical formulations of CBD for pain related to inflammation; pain in deep tissues and inflammation; and skin lesions. It is vital to note that these patents have not undergone testing or peer review, and the amounts indicated have not been proven to be effective treatments for any condition. The patents indicate, respectively, 100mg of CBD per ounce of cream, 1mg CBD per mL, and 1mg CBD per mL.

We know that when taking CBD internally, larger doses are sometimes necessary to produce the desired effect, and the same could hold true for topicals. At this point, the only way to gauge what concentration works is to try different products for yourself.