CBD for Nerve Pain: Does it Work? (+Dosage)

For several years, shops selling CBD (sometimes called cannabidiol Or medical cannabis) have opened in France (as in other countries around the world).

They are often called Coffee shops or CBD shops. The sale of CBD, one of the components of cannabis, is in fact authorized in France. People affected by neuropathic pain may want to test CBD for relieve their pain.

However, there is still very little reliable and accessible data in French on the effectiveness of CBD on neuropathic pain, the type of CBD to take and the dosage.

This article presents the information currently available on CBD for neuropathic pain.

It may be useful to people with neuropathic pain, to those around them, but also to health professionals who wish to answer their patients’ questions about CBD and medical cannabis.

📢 Disclaimer: Amazon and Sensilia affiliated links.
Last updated: October 2023
Written by Nelly Darbois, physical therapist and scientific writer

What do we mean by neuropathic pain?

If you are reading this article on neuropathic pain, you are probably in a good position to know what this type of pain is!

Either because you experience it on a daily basis, or because someone close to you (relative or patient) is concerned.

But to be sure that we are talking about the same thing, let us understand the meaning given here to “neuropathic pain”. Because this article is abouteffectiveness of cannabidiol only on neuropathic pain, and not on other types of pain.

It’s important to distinguish the effect of CBD according to the type of pain. Because the mechanisms generating pain are different.

CBD can thus be effective on certain mechanisms but not on others. A bit like a master key: it opens several different locks, but not all the locks in the world!

Likewise, CBD may be effective for some pain, but not all. For that, you have to test it, as you would with keys.

Neuropathic pain:

• affects approximately 1% of the population;
• East chronic, that is to say it lasts several months, or even a lifetime;
• is due to a dysfunction or damage of the nervous system central (brain, spinal cord) or peripheral (nerves);
• may be caused by illness, accident, medication, substance use, or be of unknown cause.

The DN4 questionnaire is used by doctors, physiotherapists and occupational therapists to identify neuropathic pain.

Here are some examples of pathologies leading (but not always) to neuropathic pain:

• multiple sclerosis, amyotrophic lateral sclerosis;
• spinal cord injury (tetraplegia, paraplegia);
• stroke;
• polyneuropathy;
• diabetic neuropathy ;
• complex regional pain syndrome (algoneurodystrophy) ;
• traumatic mononeuropathy;
• root avulsions;
• phantom limb pain (following amputation).

Finally, here are some characteristics of neuropathic pain:

• sensations of burns, throbbing, electric shocks ;
• sensations of itching, tingling, tingling ;
• great sensitivity to heat or cold;
• very sensitive skin ;
• muscle contractions.

Other article that may interest you: CBD and joint pain.

1% of the population suffers from neuropathic pain. They manifest themselves by sensations of burning, throbbing, tingling, itching. They occur in the case of different pathologies.

What is CBD or cannabidiol?

The cannabis plant has long been used to combat pain.

But not within official health systems. However, some scientific studies attempting to evaluate the effect of different constituents of cannabis have appeared in recent years.

They identified two active components interesting in cannabis:

• THE cannabidiol (called CBD) ;
• Δ9-Tetrahydrocannabinol (called THC).

THC has a relaxing effect, modifies perceptions and improves libido. However, it has many undesirable effects: short-term memory loss and motor problems, long-term anxiety and paranoia.

CBD appears to have anti-inflammatory and anti-oxidant effects without causing the unwanted effects of THC. This has been demonstrated by in-vivo animal studies.

This is why CBD is increasingly being offered for therapeutic purposes.

It is marketed under many different shapes, and can therefore be administered as desired:

• by inhalation/vaping (by smoking it);
• orally in oil or capsule, tablets or honey;
• by spray in the nose or mouth;
• by application to the skin;
• while drinking infusions.

Her concentration varies a lot depending on its shape and brand. In addition, there are still few studies to evaluate its effectiveness compared to a placebo or other pain treatments.

Many people live for long periods of time with severe pain. They are little relieved by usual pain treatments. These often include dafalgan, morphine, benzodiazepines (Xanax, Lexomil, etc.) or antiepileptics (gabapentin and pregabalin).

These people want more information on the possible effect of CBD against pain.

But most of the information accessible in French comes from sites selling CBD. They provide little reliable and sourced information on its effectiveness. Hence the interest of this article.

CBD is the main active component contained in the cannabis that can reduce pain with few side effects and without triggering addiction.

How effective is CBD for neuropathic pain?

To answer this question, we could simply ask the opinion of a few people suffering from chronic pain and who have tested CBD. But this poses several problems:

• their testimony may be biased;
• they may forget to mention important details, such as taking another treatment in addition to CBD;
• we do not necessarily know in detail the quantity and type of CBD they took;
• we cannot be sure that another person in the same context would react the same way.

This is why it is ideally necessary study things more squarely, and on as many volunteers as possible. That’s good, clinical studies are made for that!

Effect of CBD in humans

here is a summary table of studies on CBD against neuropathic pain in human beings.

You may not understand all the terms in this table, especially if you are not used to reading scientific publications. Don’t panic, I’ll summarize things in a simpler way later in the article.

Type of CBD	Dosage	Pathology	Efficiency	Side effects	Type of study	Reference
Emu oil and CBD, in cream form	Application to painful areas 4 times a day for 4 weeks. 250mg of CBD per 90 gram tube	Peripheral neuropathy, pain and sensory disorders in the lower limbs	Yes, reduction in certain types of pain of around -1 to -2 points/10 compared to before treatment	None reported	Randomized controlled trial (placebo = emu oil without CBD), crossover	Xu 2020
Oral pump spray with THC and CBD (Sativex/Nabiximols)	2.7mg of THC and 2.5mg of CBD per 100-microL activation. Max 8 activations per 3 hours and 24/24 hours	Peripheral neuropathy associated with diabetes or allodynia	Yes, reduction in pain of 2.7 points/10 on average after 38 weeks	Yes, frequent. 75% give in at the end of treatment. Fatigue, dizziness and insomnia may persist	Trial without control group	Hoggart 2015
Oral pump spray with THC and CBD (Sativex/Nabiximols)	2.7mg of THC and 2.5mg of CBD per 100-microL activation. Max 8 activations per 3 hours and 48/24 hours	Central neuropathic pain + multiple sclerosis	Yes, reduction in pain of around -1 to -2 points/10 compared to before treatment	Yes in 92% of patients. Most often: dizziness and nausea	Trial without control group	Rog 2007
Oral pump spray with THC and CBD (Sativex/Nabiximols)	2.7mg of THC and 2.5mg of CBD per 100-microL activation. Max 12 activations per 24 hours	Central neuropathic pain + multiple sclerosis	Yes, reduction in pain of around less than -1/10, and improvement in sleep quality by around 1 point/10	10% of patients stopped the study due to side effects	Randomized controlled trial (placebo = spray with only excipients and dyes)	Langford 2012
Oral pump spray with THC and CBD (Sativex/Nabiximols)	2.7mg of THC and 2.5mg of CBD per 100-microL activation.	Chronic pain including neuropathic pain	Yes, reduction of greater pain in people suffering from neuropathic pain	20% of patients reported side effects	Trial without control group	Ueberall 2019
Oral pump spray with THC and CBD (Sativex/Nabiximols)	2.7mg of THC and 2.5mg of CBD per 100-microL activation. Max 24 activations per 24 hours	Peripheral neuropathic pain + allodynia	Yes, reduction in pain and improvement in sleep in 30% of patients (38% did not see any improvement)	Common, considered moderate to severe in severity	Randomized controlled trial (placebo = spray with only excipients and dyes)	Serpell 2014

• CBD allows you to reduce chronic pain 1 to 2 points out of 10 among receptive people
• CBD-based product on which we have the most perspective is the Nabiximols/Sativex, marketed as a medicine. It also contains THC. It’s an oral spray.

Effect of CBD in animals

As is often the case, substances intended to treat or relieve humans are first tested in animals. This makes it possible to study its possible harmfulness, but also its way of acting, if there is indeed an effect. CBD has been tested in animals.

Studies carried out on rats show that:

• CBD has an action on the serotonin receptor. It is a compound found naturally in the body. In particular, it helps reduce stress and pain. This is why it is assumed that CBD can relieve pain;
• CBD causes a reduction in pain and anxiety by activating or deactivating certain neuronal receptors.

(De Gregorio et al. 2019. Review: Pain)

Potential and proven interactions with drugs

CBD can interact with various substances.

If you are taking large doses of CBD over a long period of time, it is recommended that you consult a physician familiar with your medication regimen and the potential interactions of CBD.

Notably :

• Estrogen medications and oral contraceptive pill : Consumption of high amounts of CBD can reduce or even cancel the effectiveness of the birth control pill.
• Blood thinners such as warfarin (an anti-vitamin K): It is advisable to monitor the INR (International Normalized Ratio) at the start of CBD consumption in a person taking warfarin.
• THE cancer immunotherapies : There is a potential risk of reduced effectiveness due to CBD consumption, which may reduce the immune response.

Source: Henson 2022, Grayson 2018

Thanks to researcher Jérémy Henson from the University of New South Wales (Australia) for reminding me of the existence of these interactions.

CBD: what dosage for neuropathic pain?

Know what quantity of CBD taking per day is difficult. When used for therapeutic purposes, the amount of CBD taken per day ranges between:

• 2.85 mg per kg per day;
• and 50 mg per kg per day.

(De Gregorio et al. 2019. Review: Pain)

This means that a woman weighing 60 kg will have to take a quantity of CBD of:

• minimum 171 mg per day ;
• maximum 3000 mg per day.

Please note, this is the amount of CBD that must be taken per day. The product may contain other substances. It is not necessarily easy to know the quantity of CBD delivered with each activation of a spray, spreading of oil or taking of a capsule.

In addition, it is reasonable to think that a dosage of 200 mg of CBD in capsules does not have the same action as 200 mg of smoked CBD.

Try to get as much information as possible about the amount of CBD included in the product and released with each use before purchasing a CBD product..

This information is often difficult to find: hemp oil products often presented as including CBD sold on Amazon do not mention this information. It is therefore probably better to refrain from buying them.

• The amount of CBD taken per day should be 2.85 mg/kg to 50 mg/kg (increase gradually, start at low doses)
• Always find out about the quantity of CBD included in the product before any purchase. Refrain from purchasing the product if you do not have precise information. Most often, the amount of CBD is much lower.

Which CBD product have I identified as relevant for nerve pain?

I created this article in French June 2021. I regularly searched for reliable online stores to which to refer people reading this article, if they cannot identify one on their own and want to try.

The most challenging aspect is identifying products containing a sufficiently substantial amount of CBD. Here is the result of my research.

CBD Oil for Nerve Pain if you reside in America, Oceania, Africa, or Asia

Here is the oil that I found on a website for which I found:

• the most reliable feedback
• the most detailed information on the quantity and nature of the products.

I am not being compensated to speak about them, but by clicking the link, if you make a purchase, I may receive a small commission.

Additionally, it becomes 10% cheaper for you if you use the code CONC10 on purchases for CBD CONCENTRATES products.

CBD Oil for Nerve Pain if you reside in Europe (UK, etc.)

After several years of attempting to find a manufacturer that clearly communicated on this matter, I discovered the CBD brand Sensilia. They provide clear information about the quantity of CBD contained in their products and in each serving, which I find highly commendable. Moreover, the prices are quite reasonable considering the CBD content.

I am not being compensated to speak about them, but by clicking the link, if you make a purchase, I may receive a small commission.

Additionally, it becomes 10% cheaper for you if you use the code NDB10 on purchases over 50 euros.

CBD Oil in a non-online store near you

You will also probably be able to find similar products in physical CBD store to your home. However, I encourage you to ask for precise information on the quantity of CBD, particularly per serving (and not just that contained in the total product).

How do I know if taking CBD is relevant in my case?

Talk to the doctors or physiotherapists who follow you. This will be an opportunity to discuss again the different medical or non-medicated treatments that you can put in place to relieve your pain.

Sometimes, some health professionals are not very open to discussing CBD. Try to discuss it with other professionals who follow you.

Here are the questions to ask yourself:

• have I already tried all other pain treatments (see this article on diabetic neuropathy rehabilitation) who have shown more evidence of their effectiveness?
• Am I willing to invest money and hope in trying a CBD product? Knowing that it can reduce my pain by 1 to 2 points out of 10 after a few weeks of treatment, and that there is uncertainty about the quantity of CBD really present in the product.

What is the difference between CBD and hemp oil?

If you have searched for information on CBD, or if you have tried to purchase a CBD product, you have undoubtedly already come across articles or products mentioning hemp oil.

Caution: products based onhemp oil does not contain cannabidiol/CBD ! Hemp oil a priori has no effectiveness against pain, whether of neuropathic origin or not. There are no published studies on the effectiveness of hemp oil for pain.

Still have questions or comments? Head over to the comments below the article, I’ll always answer you!

Where does this confusion come from? Hemp is a sou-species of Cannabis plantis sativa. There is CBD in cannabis sativa, but not in hemp which is a subspecies.

L’hemp oil does not contain CBD. It does not act against pain.

Summary: CBD and neuropathic pain

• CBD (=cannabidiol) is a substance in cannabis that does not cause dependence, unlike THC
• he can relieve neuropathic pain approximately -1 to 2 points/10
• It is sold without a prescription
• The dose taken per day should be 2.85 mg/kg to 50 mg/kg
• Many manufacturers and sellers do not indicate the precise amount of CBD per serving.

You will like also :

1. CBD for fibromyalgia
2. CBD, painkiller for osteoarthritis?
3. CBD & CRPS
4. What dosage of CBD for chronic pain ?

📕 Sources 📕

This gives 51 results as of May 2021. The first studies published on the subject date from 2006, which is relatively recent on the scale of medicine.

I then selected the studies that dealt with choice:

• of the’effectiveness of CBD on pain chronicles in general, whatever the pathology, but which distinguishes pain of neuropathic origin within chronic pain;
• of the’effectiveness of CBD on pain of neuropathic origin of peripheral or central origin.

For this article, I have therefore not included studies relating, for example, to the effectiveness of CBD against osteoarthritis, back pain, polyarthritis, pain linked to chemotherapy or fibromyalgia. Other articles will surely come, you can subscribe to the site (button below) to receive them for free when they appear.

The publications selected are as follows.

Theoretical/empirical mechanism of action CBD against pain and its anti-inflammatory effect. Langford RM, Mares J, Novotna A, Vachova M, Novakova I, Notcutt W, Ratcliffe S. A double-blind, randomized, placebo-controlled, parallel-group study of THC/CBD oromucosal spray in combination with the existing treatment regimen, in the relief of central neuropathic pain in patients with multiple sclerosis. J Neurol. 2013 Apr;260(4):984-97. doi:10.1007/s00415-012-6739-4. Epub 2012 Nov 21. PMID: 23180178.

Theoretical and empirical mechanisms of action (experiments on rats) CBD on neuropathic pain. De Gregorio D, McLaughlin RJ, Posa L, Ochoa-Sanchez R, Enns J, Lopez-Canul M, Aboud M, Maione S, Comai S, Gobbi G. Cannabidiol modulates serotonergic transmission and reverses both allodynia and anxiety-like behavior in a model of neuropathic pain. Bread. 2019 Jan;160(1):136-150. doi: 10.1097/j.pain.0000000000001386. PMID: 30157131; PMCID: PMC6319597.

CBD nasally : what characteristics are important for it to diffuse well in the body and be effective? Matarazzo AP, Elisei LMS, Carvalho FC, Bonfílio R, Ruela ALM, Galdino G, Pereira GR. Mucoadhesive nanostructured lipid carriers as a cannabidiol nasal delivery system for the treatment of neuropathic pain. Eur J Pharm Sci. 2021 Apr 1;159:105698.

Effectiveness of CBD on neuropathic pain of central origin in people with multiple sclerosis (MS) Rog DJ, Nurmikko TJ, Young CA. Oromucosal delta9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: an uncontrolled, open-label, 2-year extension trial. Clin Ther. 2007 Sep;29(9):2068-79. doi: 10.1016/j.clinthera.2007.09.013. PMID: 18035205.

Effectiveness of CBD oral spray on neuropathic pain in people with multiple sclerosis. Langford RM, Mares J, Novotna A, Vachova M, Novakova I, Notcutt W, Ratcliffe S. A double-blind, randomized, placebo-controlled, parallel-group study of THC/CBD oromucosal spray in combination with the existing treatment regimen, in the relief of central neuropathic pain in patients with multiple sclerosis. J Neurol. 2013 Apr;260(4):984-97. doi:10.1007/s00415-012-6739-4. Epub 2012 Nov 21. PMID: 23180178.

Effectiveness of CBD oral spray against severe neuropathic pain. Ueberall MA, Essner U, Mueller-Schwefe GH. Effectiveness and tolerability of THC:CBD oromucosal spray as add-on measure in patients with severe chronic pain: analysis of 12-week open-label real-world data provided by the German Pain e-Registry. J Pain Res. 2019 May 20;12:1577-1604. doi: 10.2147/JPR.S192174. PMID: 31190969; PMCID: PMC6535492.

Effectiveness of the CBD spray oral for neuropathic pain of peripheral origin. Hoggart B, Ratcliffe S, Ehler E, Simpson KH, Hovorka J, Lejčko J, Taylor L, Lauder H, Serpell M. A multicentre, open-label, follow-on study to assess the long-term maintenance of effect, tolerance and safety of THC/CBD oromucosal spray in the management of neuropathic pain. J Neurol. 2015 Jan;262(1):27-40. doi:10.1007/s00415-014-7502-9. Epub 2014 Sep 30. PMID: 25270679.

Another study on the effectiveness of CBD spray on neuropathic pain of peripheral origin. Serpell M, Ratcliffe S, Hovorka J, Schofield M, Taylor L, Lauder H, Ehler E. A double-blind, randomized, placebo-controlled, parallel group study of THC/CBD spray in peripheral neuropathic pain treatment. Eur J Pain. 2014 Aug;18(7):999-1012. doi: 10.1002/j.1532-2149.2013.00445.x. Epub 2014 Jan 13. PMID: 24420962.

Effectiveness of theCBD oil on pain related to peripheral neuropathy affecting the lower limbs. Xu DH, Cullen BD, Tang M, Fang Y. The Effectiveness of Topical Cannabidiol Oil in Symptomatic Relief of Peripheral Neuropathy of the Lower Extremities. Curr Pharm Biotechnol. 2020;21(5):390-402. doi:10.2174/1389201020666191202111534. PMID: 31793418.

Summary of studies on CBD against chronic pain and its effects on pregnant women. Argueta DA, Ventura CM, Kiven S, Sagi V, Gupta K. A Balanced Approach for Cannabidiol Use in Chronic Pain. Front Pharmacol. 2020 Apr 30;11:561. doi: 10.3389/fphar.2020.00561. PMID: 32425793; PMCID: PMC7204604.

Summaries of studies on nabiximols (CBD in oral spray) against chronic pain. Uberall MA. A Review of Scientific Evidence for THC:CBD Oromucosal Spray (Nabiximols) in the Management of Chronic Pain. J Pain Res. 2020 Feb 14;13:399-410. doi: 10.2147/JPR.S240011. PMID: 32104061; PMCID: PMC7027889.

Skeptical article on the current level of evidence for the effectiveness of CBD against pain. Svensson CK. CBD for the treatment of pain: What is the evidence? J Am Pharm Assoc (2003). 2020 Nov-Dec;60(6):e80-e83. doi: 10.1016/j.japh.2020.06.009. Epub 2020 Jul 4. PMID: 32636158.

See as well

Articles from the journal Prescrire: “Medical cannabis for chronic pain.” Rev Prescrire 2021; 41 (448): 116-121. Reserved for subscribers.

Jagailloux, Y., Lelong, J., Mura, P., & Brunet, B. (2019). Legal aspects and analysis of cannabidiol-based products. Analytical and Clinical Toxicology, 31(2), S48-S4