CBD vs THC for Pain: First Pick and Options
THC and CBD both come from cannabis. They act on the body in different ways. THC binds CB1 and CB2 receptors. CBD has low affinity for those receptors. CBD acts on TRPV1 and 5-HT1A receptors. For pain, THC has stronger clinical evidence. CBD evidence is mixed.
First Pick
For pain, start with a 1:1 THC:CBD tincture. This ratio pairs THC pain relief with CBD anti-inflammatory effects. Clinical trials use THC 2.5 to 10 mg and CBD 200 to 1500 mg per day. Start with 2.5 mg THC and 2.5 mg CBD. Wait 2 hours. Increase dose as needed.
Options
- THC-dominant: 10 to 20 mg THC. For severe pain. Higher psychoactive effects.
- CBD-dominant: 25 to 50 mg CBD. For mild pain or daytime use. Minimal intoxication. Evidence weaker than THC.
- 1:1 THC:CBD: Balanced ratio. For chronic pain and neuropathic pain.
- Topical: For localized pain. Low systemic absorption. Little intoxication.
Evidence
The National Academies 2017 report found substantial evidence for cannabis in chronic pain. Cochrane 2018 found moderate-quality evidence for cannabis-based medicines in neuropathic pain. JAMA 2015 found moderate-quality evidence for cannabinoids in chronic pain. FDA has not approved CBD or THC for pain.
cannabidiol for pain management
Side Effects
THC side effects: dizziness, dry mouth, rapid heart rate, cognitive impairment. CBD side effects: fatigue, diarrhea, liver enzyme changes at high doses. CBD can interact with blood thinners. Talk to a doctor.
Legal Status in the US
THC cannabis is legal in 38 states for medical use. It is legal in 24 states for adult use. CBD hemp is legal under federal law if THC is below 0.3%. State laws vary. Check your state.