Pain is the most common complaint for which people seek medical care. The most prevalent pain condition is chronic pain (pain lasting at least three months), which affected over 20{6b2fa08d5993bc7e76ffaca7a3a295e96a3274ffb0576a302ceddffe26335ebd} of adults in 2021, of which 6.9{6b2fa08d5993bc7e76ffaca7a3a295e96a3274ffb0576a302ceddffe26335ebd} had “high-impact chronic pain” (chronic pain that significantly affects activities of daily living).
Other pain conditions include acute pain, cancer pain and surgical pain. The financial, social and emotional costs of pain are staggering. For example, it is estimated that around 75{6b2fa08d5993bc7e76ffaca7a3a295e96a3274ffb0576a302ceddffe26335ebd} of people with high-impact chronic pain are . In contrast, people with chronic pain have twice the risk of suicide and four times the prevalence of depression and anxiety. Pain costs in the US are over 600 billion dollars per year.
Massage therapy has been shown in clinical studies to be highly effective in the treatment of pain. In 2016, a three-part comprehensive analysis of clinical research looking at massage therapy as a treatment for different types of pain was published in the journal Pain Medicine.
In Part 1, 67 randomized controlled trials comparing massage therapy to placebo in treating pain in the general population concluded that compared to no treatment, massage “should be strongly recommended as a pain management option.” In Part 2, 16 trials comparing massage therapy to placebo in treating cancer pain also found massage to be of benefit, albeit less so than for general pain. And in Part 3, massage was similarly found to benefit surgical pain patients in a small number of studies.
For years, pharmaceuticals were used as first-line therapies for pain, with manual therapies such as massage being viewed as less relevant; however, the widespread use of opioids resulted in an epidemic of addiction that necessitated the search for new ways to deal with pain. As a result, there has been a shift toward integrative health approaches that include massage therapy as an essential modality for pain treatment for many patients.
Massage therapists, including physicians, nutritionists, acupuncturists and others, are important players on pain-management teams. An integrative approach to pain management can also include using plant-derived pain-reducing and anti-inflammatory compounds such as cannabidiol (CBD).
CBD for Pain Relief
CBD is a cannabinoid found in the plant Cannabis sativa. Hemp, a sub-species of cannabis, contains very high levels of CBD and less than 0.3{6b2fa08d5993bc7e76ffaca7a3a295e96a3274ffb0576a302ceddffe26335ebd} THC, the primary compound in cannabis that makes users feel high. CBD is non-psychoactive and does not cause any perception of impairment. In the U.S., hemp was legalized with the passing of the 2018 Farm Bill, while cannabis remains illegal at the federal level. Cannabinoids, including CBD, have a long history of treating pain, and the recent legalization of hemp-derived CBD products has spurred massive public interest in CBD for pain management. A recent survey found that among CBD users, 60{6b2fa08d5993bc7e76ffaca7a3a295e96a3274ffb0576a302ceddffe26335ebd} of them were using it to treat pain.
A recent review article on CBD and pain identified 76 molecular targets of CBD, including many in the nervous system, that could explain these benefits. These targets include well-known pathways, such as opioid and serotonin receptors, and others less well understood, such as transient receptor potential (TRPV) channels.
Many of the pain-reducing effects of CBD are mediated by the endocannabinoid system (ECS), which is increasingly understood as an important player in the process of pain. The ECS is a system of receptors, enzymes and molecules distributed throughout our entire body. It is often referred to as the body’s “master regulator” for its critical role in maintaining balance or homeostasis.
Research has shown that CBD can be used for pain management in inflammatory conditions such as arthritis and joint pain. CBD has also been shown to reduce myofascial, neuropathic and postoperative pain. It has also been suggested that cannabinoids, including CBD, can reduce headaches. Many of these conditions are common to massage therapy practices, suggesting a potential synergy between massage therapy and CBD.
Forms of CBD
CBD products come in a variety of different forms. Many types of products are consumed orally, including tinctures, capsules, gummies and powders. Most oral formulations are oil-based, but water-soluble products are available that are more easily absorbed by the body. Topical CBD products applied to the skin are also popular in products such as creams, lotions, balms and serums.
The main difference between oral and topical products are that orally consumed products are absorbed from the digestive tract into the bloodstream and distributed throughout the body. In contrast, topical products are absorbed into the skin but do not pass into the bloodstream. Less commonly, CBD products are smoked, vaporized, or used as a suppository.
CBD products also come in different formulations, including isolate, broad-spectrum and full-spectrum. The only active ingredient you are consuming in CBD isolate products is CBD since all other compounds naturally found in the hemp plant have been removed.
In broad-spectrum products, these other compounds are present, including additional cannabinoids (such as CBN and CBG) and some terpenes, which may have complementary effects on the body. This is known as the “entourage effect.”
Broad-spectrum CBD products are THC-free. In contrast, full-spectrum CBD products can contain up to 0.3{6b2fa08d5993bc7e76ffaca7a3a295e96a3274ffb0576a302ceddffe26335ebd} THC, in addition to CBD and other hemp-derived compounds. Isolate, broad-spectrum and full-spectrum CBD products can be consumed orally or applied topically to the skin.
Oral vs. Topical CBD For Pain Relief
When it comes to pain, oral CBD is better at treating pain in deeper tissues and/or that is found at multiple sites, while topical CBD is a good option for superficial pain, such as in joints like the knees and elbows, the hands and feet, and the superficial musculature.
Topical CBD products may contain other compounds supporting manual therapy, such as cooling or warming ingredients that can reduce muscle pain and tension. They also often include essential oils that have anxiety-reducing and calming effects.
Both oral and topical CBD for chronic pain and other pain conditions can be used synergistically with massage therapy, albeit in different ways. Massage therapists can directly use CBD-containing topical lotions or oils as part of their treatment.
Alternatively, they can use massage to address pain in conjunction with the client’s personal use of CBD, which would ideally be informed by a member of the pain-management team trained in the use of medical use of CBD.
Massage and CBD for Pain Relief
There are two important issues to consider when considering whether to use CBD with massage therapy to treat pain.
First, while the hemp plant, by definition, is supposed to contain less than 0.3{6b2fa08d5993bc7e76ffaca7a3a295e96a3274ffb0576a302ceddffe26335ebd} THC, some studies have found higher THC levels in commercially available products.
The only way to know how much THC is in a product is to look at the product Certificate of Analysis (COA), which should list the levels of CBD and THC and other compounds like terpenes. An independent third-party lab should conduct the COA and be specific to the product batch being used. To be safe, check the COA for all CBD products, including CBD isolate and broad-spectrum products.
Even topical products have been found to often be mislabeled.
And second, although hemp-derived CBD is technically legal at the federal level, some regulatory bodies do not permit the use of CBD by massage therapists in practice. Check with your state regulatory body to determine their policies.
In summary, massage and other therapies, such as hemp-derived CBD, are becoming increasingly popular for managing many pain conditions. Both massage and CBD are effective at treating pain and may have complementary effects when used together as part of a pain-management plan.
Author’s note: This content is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of medical advice or treatment from a personal physician. All viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions or before beginning any nutrition, supplement, or lifestyle program. Neither Genevieve Newton, publishers of this content, nor Fringe, Inc. takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement or lifestyle program.
About the Author
Genevieve Newton, DC, PhD, is the scientific director of fringeheals.com. Newton joined Fringe after spending nearly two decades as a researcher and educator in the field of nutritional sciences. A series of personal health crises led her to discover the benefits of cannabinoids, and she soon found herself engrossed in studying the endocannabinoid system and therapeutic applications of cannabinoids in mental health, pain, sleep, and neurological disorders. At Fringe, she “brings the science” that supports education, courses and product development related to many natural healing modalities.