Does CBD Oil Work For Pain And Anxiety

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Hearing a lot about CBD oil for pain management or anxiety? Many CBD products might not be the cure-all they claim to be. Learn more here. Here’s what science says regarding CBD’s anxiolytic—or anxiety relief—properties, along with experts’ dosage guidelines and advice on how to take CBD safely.

CBD Oil — Are the Benefits Claimed Too Good To Be True?

These days, many of us could certainly go for a miracle cure-all, especially those of us who struggle with chronic pain, overwhelming anxiety, cancer-related symptoms and/or hard-to-treat neurological disorders. So, it’s no wonder that CBD oil is popping up in our search results. But can we really count on CBD oil to positively impact our symptoms in the ways we hope? Internal medicine specialist Paul Terpeluk, DO, explains why CBD oil may not be as effective as we’d like.

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What is CBD?

CBD, or cannabidiol, is just one of more than 100 chemical compounds found in the cannabis sativa plant. But it’s THC (tetrahydrocannabinol), not CBD, that’s the main psychoactive compound in cannabis that gives you a euphoric high.

CBD is pulled from hemp, a type of cannabis plant that contains very low levels of THC, so it doesn’t get you high. CBD oil is simply a product that contains CBD extract and an oil, like coconut oil, typically for topical use.

It’s important to know that since the implementation of the 2018 Farm Bill, the production and sale of CBD products in the U.S. has been legalized on the federal level as long as they contain less than .3% of THC. However, it’s still illegal under some state laws.

Plus, Dr. Terpeluk explains the market has been oversaturated with CBD products — from bath bombs to gummies, lotions, creams, tinctures and oil — none of which are Food and Drug Administration (FDA) approved and may not be 100% pure CBD. As of mid-December 2021, the FDA has only approved one cannabis-derived and three cannabis-related products, all of which you can safely get with a prescription from a licensed healthcare provider.

“There’s no oversight of the majority of CBD products from a regulatory authority,” says Dr. Terpeluk. “Most of the CBD that you’re buying, unless they have a rigorous marketing campaign and quality control that says it’s 100% CBD oil, more than likely, it’s contaminated with other cannabinoids, including THC.”

What are some of the benefits of CBD?

Several studies show the benefits of pure CBD may have wide-ranging positive effects, though. To understand those benefits, it’s important to consider our body’s endocannabinoid system, a complex system of enzymes, neurotransmitters and receptors that plays an important role in the development of our central nervous system. This system helps regulate a variety of functions, including pain, motor control, memory, appetite, inflammation and more. By further studying CBD’s effects in these specific areas, we may better understand how CBD impacts a variety of conditions and disorders.

Helps with neurological-related disorders

The FDA has approved Epidiolex as a treatment for several seizure disorders, including two rare disorders known as Duvet syndrome and Lennox-Gastaut syndrome. Several case studies suggest CBD may also be beneficial to patients who are resistant to anti-epileptic drugs. “With epilepsy, there’s a threshold in your brain that gets excitatory, and you go into a seizure,” says Dr. Terpeluk. “CBD increases that threshold.”

Other studies suggest CBD may also be useful in managing symptoms of multiple sclerosis, Parkinson’s disease and Alzheimer’s disease, as it has neuroprotective, anti-inflammatory properties. More studies are needed, however, as many suggest that it’s not just CBD alone, but a combination of CBD and other cannabinoids, that may help reduce many of these symptoms.

It may assist with pain relief

By interacting with neurotransmitters in your central nervous system, CBD could potentially relieve pain related to inflammation, arthritis and nerve damage (peripheral neuropathy). In one four-week trial, people who had nerve damage in the lower half of their body reported a significant reduction of intense, sharp pain after using a topical CBD oil.

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“All of our different anti-pain drugs affect some section of our pain system, whether it’s Tylenol®, Aspirin®, morphine or opioids,” explains Dr. Terpeluk. “No one wants to be addicted to opioids, so if there’s a cannabinoid you can take that’s not addictive but can repress the pain, that would be the Holy Grail with chronic pain.”

Still, he cautions, there’s a lot left to be studied, including whether there are significant adverse long-term effects of CBD when used for pain relief.

“If you’re taking it in an unregulated fashion, you don’t know how much is in there, and you’re not quite sure how it affects you outside of your particular pain,” says Dr. Terpeluk.

It may help with anxiety and mood disorders

Anxiety and mood disorders like depression or post-traumatic stress disorder can have a severe effect on your daily life and may often cause both physical and emotional stress that could lead to other underlying conditions like sleep disorders, high blood pressure, chronic pain and heart disease. It’s too early to understand the full gamut of effects that CBD may have on anxiety and mood disorders, but individual studies seem to suggest varying positive results. In one study of 57 men who received either oral CBD or a placebo 90 minutes before participating in a simulated public speaking test, researchers learned that a 300-mg dose of CBD significantly reduced social anxiety during the test.

And while there are a wide variety of treatments available for anxiety and mood disorders — ranging from talk therapy and counseling to prescribed medications — Dr. Terpeluk suggests the most important thing is to get at the root of the underlying causes of the anxiety you’re experiencing.

“Anxiety is better approached by looking at what’s causing it in your life rather than trying to figure out which drugs can reduce it,” says Dr. Terpeluk.

It might help with cancer-related symptoms

CBD may help with nausea, vomiting and weight loss caused by chemotherapy treatments. The FDA has approved three cannabis-related products to help alleviate these symptoms, as well as help increase the appetite for those who have AIDS. These drugs all contain some level of THC or synthetic THC and are not purely CBD alone.

But some studies seem to suggest that CBD can help decrease the size of tumors and help stop the spread of cancerous cells in skin cancer, breast cancer, prostate cancer and more. As with other areas of study, further human clinical trials are needed to understand the full effect CBD has on various kinds of cancer.

What are the side effects or risks of CBD?

If you’re purchasing CBD oil and other products online or from a local vendor, Dr. Terpeluk says there’s no real way of knowing the purity of the CBD you’re using, as it could be mixed with other cannabinoids, such as the dangerous delta-8, or THC.

“It’s a little bit mysterious. It’s not as harmless as you think,” says Dr. Terpeluk. “If you take CBD oil because you buy it on the market, you have a very high likelihood that you could turn a drug test positive for THC because it could actually contain THC.”

CBD can also affect a variety of medications, including pain medications, antidepressants, antipsychotics and more. It could also cause several side effects that may include:

  • Issues with coordination. .
  • Drowsiness or fatigue. .

The best advice? Before considering CBD oil or other CBD products, make sure you talk to your healthcare provider to decide whether it’s safe for you and to ensure it doesn’t have harmful interactions with any medications you’re currently taking.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

How To Use CBD To Help Alleviate Anxiety

Dr. Bindiya Gandhi is an integrative medicine physician with expertise in functional and holistic medicine based in Atlanta, Georgia.

Commissions we earn from partner links on this page do not affect our opinions or evaluations. Our editorial content is based on thorough research and guidance from the Forbes Health Advisory Board.

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Table of Contents

  • CBD for Anxiety
  • How to Use CBD for Anxiety
  • CBD Dosage for Anxiety
  • Potential Risks and Side Effects

While delta-9-tetrahydrocannabinol (THC) can have a bad rap for being intoxicating and anxiety-inducing, cannabidiol (CBD) can actually be used to relieve anxiety. Research supports this benefit, with several studies reinforcing the positive effects CBD can have on various anxiety conditions. In fact, 51% of U.S. adults who use CBD do so to help alleviate their anxiety, according to a recent Forbes Health survey of 2,000 U.S. adults conducted by OnePoll.

CBD isn’t yet legally cleared as an anxiolytic, or anxiety relief medication. Therefore, it’s up to you—and, ideally, a doctor who specializes in cannabis administration—to determine whether CBD is a safe treatment for your anxiety.

Here’s what the science says regarding CBD’s anxiolytic properties, along with experts’ dosage guidelines and advice on how to take CBD safely.

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CBD for Anxiety

The Food and Drug Administration (FDA) has yet to approve any CBD-based medications for anxiety. However, many studies indicate the substance can be an effective anxiolytic.

CBD for Generalized Anxiety

In 2011, a small trial-tested CBD on participants with generalized social anxiety disorder (SAD) and healthy control patients undergoing a simulated public speaking test (SPST), which is a common anxiety testing method [1] Bergamaschi MM, Queiroz RH, Chagas MH, et al. Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients. Neuropsychopharmacology. 2011;36(6):1219-1226. . Compared to a placebo, CBD significantly reduced anxiety and discomfort in the participants with SAD. In fact, their reduced anxiety levels were comparable to those of the control participants.

Eight years later, a 2019 test compared the efficacy of three CBD doses (150 milligrams, 300 milligrams and 600 milligrams) and a placebo in men taking an SPST [2] Linares IM, Zuardi AW, Pereira LC, et al. Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test. Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999). 2019;41(1):9-14. . Compared to a placebo, 300 milligrams of CBD significantly reduced participants’ anxiety during the speech, but the 150-milligram and 600-milligram doses did not. These results highlight how dosage can be highly variable and that more CBD isn’t necessarily more effective.

Meanwhile, another 2019 study tested CBD in much lower doses than most other clinical studies—some participants consumed 25 milligrams a day while others consumed 50 milligrams or 75 milligrams a day [3] Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in Anxiety and Sleep: A Large Case Series. Perm J. 2019;23:18-041. . Researchers thought higher doses might be too expensive for participants to maintain in their normal lives and that low doses would still prove effective. Indeed, anxiety decreased within the first month for most participants and remained low. Sleep quality also improved, although it fluctuated more than anxiety. Only three patients reported side effects.

CBD for Anxiety and Depression

In 2020, researchers tested the effects of CBD oil at varying doses across 397 patients with a variety of ailments [4] Gulbransen G, Xu W, Arroll B. Cannabidiol prescription in clinical practice: an audit on the first 400 patients in New Zealand. BJGP Open. 2020;4(1):bjgpopen20X101010. . Participants with non-cancer pain or mental health-related symptoms experienced significant improvement in anxiety and depression, as well as in their abilities to complete their usual activities. The use of CBD oil suggested significant pain relief in these groups as well.

CBD for PTSD and Phobia Therapy

A small 2019 study of 11 patients found that, when consumed orally and administered alongside routine psychiatric care, CBD decreased patients’ posttraumatic stress disorder (PTSD) symptom severity [5] Elms L, Shannon S, Hughes S, Lewis N. Cannabidiol in the Treatment of Post-Traumatic Stress Disorder: A Case Series. J Altern Complement Med. 2019;25(4):392-397. .

Other studies suggest CBD can reduce PTSD symptoms when consumed with THC [6] Bitencourt RM, Takahashi RN. Cannabidiol as a Therapeutic Alternative for Post-traumatic Stress Disorder: From Bench Research to Confirmation in Human Trials. Front Neurosci. 2018;12:502. . When taken together, the two compounds create what’s known as the “entourage effect,” where THC enhances the effects of CBD as CBD tempers the effects of THC, resulting in a more well-rounded experience [7] Ferber SG, Namdar D, Hen-Shoval D, et al. The “Entourage Effect”. Terpenes Coupled with Cannabinoids for the Treatment of Mood Disorders and Anxiety Disorders. Curr Neuropharmacol. 2020;18(2):87-96. .

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Some studies also suggest CBD can enhance the effects of exposure therapy—which assists patients in dissociating certain cues with a fear response—and cognitive behavioral therapy [8] Das RK, Kamboj SK, Ramadas M, et al. Cannabidiol enhances consolidation of explicit fear extinction in humans. Psychopharmacology (Berl). 2013;226(4):781-792. [9] Blessing EM, Steenkamp MM, Manzanares J, Marmar CR. Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics. 2015;12(4):825-836. .

How to Use CBD for Anxiety

Without clear FDA guidance, optimal CBD use for anxiety varies from person to person. You may find one method works better for you over another. You can consume CBD in the following forms:

  • Oils and tinctures, which come in dropper bottles and are consumed by mouth
  • Gummies, which are chewable, sweet and often fruit-flavored
  • Sprays, which come in bottles with a nozzle to be sprayed in the mouth
  • Capsules, softgels or tablets, which are taken individually by mouth like a pill
  • Vapes, which heat CBD oil without igniting it, resulting in an inhalable vapor
  • Flowers, which are dried hemp plants that are typically ignited and smoked
  • Creams and gels, which introduce CBD topically (through the skin) as a more localized treatment

You may have to try different forms to determine what works best in addressing your anxiety. For instance, when it comes to the absorption of CBD in your bloodstream, vaping and smoking are more effective than edibles like gummies.

CBD Dosage for Anxiety

You also have to find the right CBD dosage for your anxiety. Experts suggest starting small and working your way up depending on how your body reacts.

Many clinical trials jump right to testing high doses. Successful doses evaluated for anxiety relief specifically include:

  • 600 milligrams in patients with SAD in a speech simulation [10] Bergamaschi MM, Queiroz RH, Chagas MH, et al. Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients. Neuropsychopharmacology. 2011;36(6):1219-1226.
  • 300 milligrams in male patients in a speech simulation [11] Linares IM, Zuardi AW, Pereira LC, et al. Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test. Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999). 2019;41(1):9-14.

However, other trials suggest much lower doses are also quite effective in treating anxiety.

  • 25 to 75 milligrams for generalized anxiety and/or sleep problems [12] Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in Anxiety and Sleep: A Large Case Series. Perm J. 2019;23:18-041.
  • 33 to 49 milligrams a day for PTSD, in addition to routine psychiatric treatment [13] Elms L, Shannon S, Hughes S, Lewis N. Cannabidiol in the Treatment of Post-Traumatic Stress Disorder: A Case Series. J Altern Complement Med. 2019;25(4):392-397.

Another study involving hundreds of patients noted success with doses from 40 milligrams to 300 milligrams a day, further supporting the idea that CBD dosage varies significantly, depending on a person’s symptoms and physiology.

Potential Risks and Side Effects

The World Health Organization deems CBD a safe and generally well-tolerated substance. Studies report very few adverse effects, if any.

However, taking CBD while on other medications may pose a risk, as these substances may interact and cause unwanted effects, such as weight gain, drowsiness, upset stomach and change in appetite.

Cheryl Bugailiskis, M.D., a cannabis specialist at Heally, a telehealth platform for alternative medicine, also warns people with preexisting liver injuries and people taking medications that can cause liver injuries should practice caution when using CBD.

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