Best Cannabinoids for Chronic Pain

Less than 50 years ago, there were only a few weed strain names to remember. Today, we’re nearing 800 named strains of cannabis. And potency? From the average THC content of cannabis in the 1990s testing at 4%, some strains now reach 30% or more.¹

A large number of cannabis patients use medical marijuana for pain. So many wonder what are the best cannabinoids for chronic pain.

Which Cannabinoids Help Most With Chronic Pain?

Most cannabis research on chronic pain focuses on two main cannabinoids: THC and CBD. Other cannabinoids may also contribute to the analgesic effects of cannabis, including CBDA, CBC, CBG, CBN THCV,  and THCA.² 

Data shows that these minor cannabinoids may work uniquely and synergistically on pain pathways.³ However, THC and CBD are the most widely available and have studies to conclude their effectiveness against chronic pain.⁴

THC works to reduce pain sensations and signaling through a number of pathways, including activation of the CB1 receptor and interaction with opioid receptors and the GABA system.⁵ Additionally, the elevating properties of THC can help alleviate pain by inducing temporary euphoria or other heightened emotional states.⁶

CBD by itself has proven therapeutic benefits, even without the addition of THC. Clinical studies show that CBD may help with psychotic disorders, anxiety, epilepsy, sleep, cardiovascular diseases, and diabetes, as well as chronic pain.⁷ Since CBD is legal on the federal level, this is great news for sufferers who might not have access to medical or recreational dispensaries.

Scientists are honing in on how CBD helps with pain. So far, they have identified two pathways CBD uses to control pain signals. 

CBD activates the CB2 receptors, exhibiting anti-inflammatory effects that dull the function of mast cells and neutrophils, both of which are involved in pain processing. At the receptor end, including the brain and spinal cord, CBD targets receptor GPR2, slowing the pain signals it receives. The interaction of CBD at the serotonin receptors may also play a role in mediating pain.⁷

Prescription opioids used for pain, though effective, can be highly addictive. Patients with ongoing or chronic pain require a long-term approach to pain management. Opioids also come with side effects, including constipation, which may make them uncomfortable to use.

CBD may provide a treatment opportunity to reduce dependency on opioids without sacrificing pain relief. 

One study accepted candidates based on their specific health background: they had chronic pain and had been on an opioid regime for at least one year. The introduction of CBD to these patients resulted in nearly half of the subjects reducing their need for opiates. And 94% of patients cited improvement in quality of life.⁷

Which Cannabinoid Concentrations and Ratios Help Most With Chronic Pain?

Both CBD and THC may reduce pain through their analgesic and anti-inflammatory effect. Clinical studies show that cannabis treatment is generally well-tolerated and safe.

There is no clear consensus on the optimal dose of cannabis for every situation. Patients need to monitor their pain levels and note the dosage level where the pain is lessened or alleviated. 

Some cannabis product labels list a ratio, which indicates the amount of CBD compared to THC in milligrams. For instance, a product with a 1:1 ratio means an equal amount of CBD and THC, with one milligram of CBD for every milligram of THC.

Many people, especially those new to cannabinoids for chronic pain, are more comfortable beginning with high CBD ratios, due to the cannabinoid's low risk of side effects, including impairment. THC can enhance pain relief when added to CBD. However, the euphoric mind and body effects of THC may prohibit its use in some situations. It’s always advisable to check with your physician before starting any new medicine.

Consider these CBD:THC ratios for your pain level.⁸ 

Ratio CBD:THC	Best for:
20:1 or 10:1	Mild or moderate pain
1:1	Neuropathic pain, constant low-grade pain
1:10 or 1:20 or more	Severe chronic pain

Ratios are fixed, and the proportion of CBD to THC in the product is measured. Dosing is the amount of CBD or THC in milligrams you will consume in one serving. Dosing levels of cannabis are easiest to measure with tinctures or gummies. 

Although CBD alone may adequately control pain, studies show the addition of THC may offer a 200-fold increase in low-dose effectiveness. 

The key to finding the correct dosage is to start with the lowest dose and increase in small increments as needed for pain. Higher THC levels do not necessarily equate with additional pain relief. Although there is generally no long-term effect of taking too much cannabis, caution with THC dosing is needed to avoid temporary unpleasant side effects, such as greening out. 

Inflammation aggravates many chronic pain conditions, including autoimmune conditions like neuropathy and arthritis. Start with a low CBD dosage of 5-10 mg once or twice daily. This dose can be increased by 5 mg every few days until symptoms are managed.

Patients with chronic pain who experience difficulty sleeping or have pain at night can add an evening dose of THC. Adding 2.5 mg of THC before bed may further alleviate pain, and the nighttime dosing is well-tolerated with minimal high effects. For elderly patients or those prescribed multiple medications, doctors recommend a lower starting dose of 1 to 1.5 mg of THC.⁶

Prescription Sativex® (Nabiximols) is an oral spray containing 2.5 mg CBD and 2.7 mg THC. Doctors prescribe this medication to manage pain and enhance the quality of life for individuals with multiple sclerosis, cancer, or rheumatoid arthritis.⁴

What if Your Pain Management Includes Opiates? How Do Cannabinoids Affect This Routine?

Clinical data suggests that cannabis can be a helpful addition to opioid treatments for managing chronic pain. 

By blocking CB1 receptors, cannabis can reduce the pain relief provided by morphine (a common opioid), indicating that the body's natural cannabinoids work with and affect morphine's effectiveness. In preclinical studies, there’s strong evidence that combining cannabinoids and opioids can enhance pain relief.⁸ 

The potential for combined side effects from using both cannabinoids and opioids needs more research, although current evidence shows minimal adverse effects. An observational study of 600 medical cannabis users who were also taking opioids found that 26% stopped using opioids, and 55% reduced their opioid dosage by 30% over six months.⁸ 

So it appears that combining cannabinoids with opioids may enhance pain relief, could potentially reduce opioid usage, and seems to be safe based on current evidence, making it a promising approach for chronic pain management.⁴ However, always consult a physician first before combining any medications with cannabis.

How to Choose Strains for Chronic Pain Based on Cannabinoid Content

Choosing the best cannabis strain for pain begins with knowledge about cannabinoid content and how different strains can affect your symptoms. 

The rule of thumb for cannabis is to start with a low dose. CBD products, like topical CBD pain cream or CBD gummies, won’t produce a high but offer excellent pain relief.  If more pain support with minimal impairment is needed, consider a 20:1 or 10:1 CBD:THC product. 

Research suggests that a 1:1 ratio of CBD to THC is particularly effective for pain.⁴  New users may want to avoid strains high in THC to minimize its intoxicating effects. As tolerated, adding THC may improve the entourage effect for additional pain relief over CBD alone. 

When purchasing cannabis products, always ask for a certificate of analysis (COA). A COA provides a detailed breakdown of the cannabinoid content, helping ensure the product has the desired ratio and concentrations of THC, CBD, and other cannabinoids. In addition, the product should have been tested for contaminants like pesticides and heavy metals, which should also be available on the COA.

Experienced users may find relief from a variety of cultivars. Users often suggest cannabis families such as Kush, Haze, and Diesel for their effectiveness in managing pain. 

Kush varieties are often known for their relaxing pain relief. Haze strains may offer a balance of uplifting and sedating effects, potentially making them helpful in managing daytime pain while keeping you functional. Users report Diesel strains are effective for neuropathic pain and muscle pain.

The 5 Best Strains for Chronic Pain Based on Cannabinoid Content

Several strains rise to the top of the list for patients with chronic pain. We’ve rolled up five popular cannabis strains for pain relief.

Charlotte’s Web

Charlotte’s Web boasts high CBD content, making it a top choice for many seeking relief from chronic pain. Initially developed to treat epilepsy, this strain is said to be helpful for all types of pain. The high CBD levels interact with the body’s endocannabinoid system, potentially reducing inflammation and nerve pain. Charlotte’s Web can be used for mild to moderate pain without cognitive impairment. 

Cannatonic

Cannatonic is a balanced strain known for its low THC and high CBD content. The combination of THC and CBD may help modulate pain signals and reduce inflammation, potentially making it ideal for managing conditions like multiple sclerosis and rheumatoid arthritis. Cannatonic’s balanced effects are reported to offer physical relaxation and mental clarity, with additional pain relief.

Blueberry Kush

Blueberry Kush is a potent strain with a high THC content that is particularly effective for nighttime pain relief. Its reportedly strong sedative effects are said to be beneficial for patients dealing with chronic pain that disrupts sleep. The high THC levels in Blueberry Kush activate cannabinoid receptors in nerve cells, potentially reducing pain sensations and reducing inflammation. Blueberry Kush may also include some CBG, a cannabinoid found to alleviate pain and promote sleep. 

AK-47

AK-47 is known for its balanced effects and versatility in pain management. This strain has a moderate THC content that provides effective pain relief without an overwhelming high. AK-47’s cannabinoid profile includes a variety of terpenes that enhance its analgesic properties, making it recommended by many for managing different types of chronic pain, including nerve pain. AK-47 can be energizing, making it ideal for daytime pain.

GG4 (Gorilla Glue #4)

GG4, also known as Gorilla Glue #4, is a strain famous for its potent pain-relieving properties. With a high THC content, GG4 is said to be helpful in treating severe chronic pain, such as that associated with cancer or significant injuries. The strain’s cannabinoids may work synergistically to provide both physical relaxation and mental euphoria potentially. GG4’s reported analgesic effects may make it an excellent choice for patients who need substantial relief from intense pain and reduced inflammation.

References

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The information in this article and any included images or charts are for educational purposes only. This information is neither a substitute for, nor does it replace, professional legal advice or medical advice, diagnosis, or treatment. If you have any concerns or questions about laws, regulations, or your health, you should always consult with an attorney, physician or other licensed professional.