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Where the pain societies stand
In 2021 the International Association for the Study of Pain — the body that sets the terms most pain research is written in — convened a task force on cannabis and cannabinoid analgesia and published its conclusion in Pain. It declined to endorse the use of cannabinoids for pain, on the grounds that the evidence was not there to support a recommendation.
That is an unusual statement for a research body to make about something this widely used, and it is the single most useful fact on this topic. It does not say cannabinoids do nothing. It says the studies that would settle the question have not been done to the standard required.
What the systematic reviews found
The Cochrane review of cannabis-based medicines for chronic neuropathic pain in adults pooled the randomised evidence and reached a careful conclusion: the potential benefits may be outweighed by the potential harms, and the quality of evidence was low to very low. Where benefit appeared, it was small, and it was measured mostly in products containing THC rather than CBD alone.
Almost all of the trial evidence in pain is about THC, or about a 1:1 THC and CBD spray. Very little of it is about CBD by itself, which is what is actually being sold. Reading across from one to the other is the mistake most articles on this subject make.
The two CBD-specific results
| Trial | What it tested | What it found |
|---|---|---|
| Danish randomised trial, Pain, 2022 | 136 people with hand osteoarthritis or psoriatic arthritis, oral CBD for twelve weeks | A difference of 0.23 mm on a 100 mm pain scale, with a p-value of 0.96. The groups were indistinguishable. |
| Xu, Current Pharmaceutical Biotechnology, 2020 | 29 people with peripheral neuropathy of the legs, topical CBD oil for four weeks | Lower scores for intense pain, sharp pain and cold and itchy sensations against placebo. |
Those two results point in opposite directions, and the difference between them is worth holding on to: one swallowed a capsule for a joint condition, the other put oil on the skin over a nerve problem. Route, condition and dose all changed at once, which is why one small positive trial does not overturn one larger null one, and why neither settles the question.
Why the topical case is stronger
Swallowed CBD goes through the liver first, and only a fraction of the dose reaches circulation. Applied to the skin it does not, which is the pharmacological reason to expect a local effect where the problem is close to the surface — a nerve in the foot, a small joint in the hand — and not to expect much from a capsule aimed at the same place.
It is also the reason a topical result cannot be used to sell a tincture. They are different routes, tested separately, with different amounts of the compound arriving where it is wanted.
What the format changes
| Format | Typical onset | What it is useful for knowing |
|---|---|---|
| Topical cream or roll-on | Local, if at all | Applied over the painful area. The only format with a positive randomised result of its own. |
| Sublingual oil | 15 to 45 minutes | Held under the tongue, so part of the dose bypasses the liver. The dropper makes the dose adjustable. |
| Capsule or softgel | 30 minutes to 2 hours | Swallowed and processed by the liver first. Fixed dose per unit; this is the route the null arthritis trial used. |
| Gummy | 30 minutes to 2 hours | The same route as a capsule, with sugars and flavouring on top. |
The interaction question
People in persistent pain are frequently taking something else for it, which makes this more than housekeeping. CBD inhibits cytochrome P450 enzymes in the liver, and those enzymes metabolise a long list of commonly prescribed medicines. Inhibiting them raises the level of the other drug in the blood without anything else changing.
This is a conversation with a prescriber or pharmacist, who can answer it for your specific list of medicines. It is not answerable in general, and nothing here is a reason to reduce or stop something that was prescribed.
Why pain trials are hard to read
Pain is measured by asking people about it, which makes the placebo response larger here than in almost any other field — and it has been getting larger. An analysis published in Pain in 2015 looked at randomised trials of neuropathic pain drugs over 23 years and found that placebo responses in United States trials rose steadily across that period, while responses in trials run elsewhere did not. The drugs did not get worse; the comparison got harder.
This is why an uncontrolled report that most people felt better is close to uninformative in pain, and why a trial that fails to beat placebo has not necessarily shown that nothing happened. It has shown that whatever happened also happened to the people who got nothing.
Two practical consequences follow for anyone reading claims about CBD and pain. A study with no placebo arm cannot tell you the compound did anything, however large the percentage quoted. And a null result in a well-run trial — like the arthritis one above — is the strongest kind of evidence available on this topic, precisely because it holds the placebo response constant on both sides.
Reading a label without being taken in
There is a second problem underneath the evidence question: the product may not hold what the label says. A 2017 analysis in JAMA bought 84 CBD extracts online and tested them, and around seven in ten were inaccurately labelled — some with substantially less CBD than stated, some with substantially more, and some with measurable THC that was not declared.
| What to look for | Why it matters here |
|---|---|
| Milligrams per serving, not per bottle | The number on the front is usually the whole container. Divide it by the servings before comparing anything to anything. |
| Spectrum: full, broad or isolate | Full spectrum carries a trace of THC, broad spectrum removes it, isolate is CBD alone. The trials that found nothing used purified CBD. |
| A batch certificate of analysis | Matching the batch code on your container and recently dated, showing what was found and what was looked for and not found. |
| Menthol, camphor or capsaicin in a topical | All three do something you will feel on the skin, and all three will be doing it whatever the CBD is doing. |
That last row is the reason a topical is the hardest format to judge by feel. A cream that cools or warms on contact has announced itself, and the announcement is not coming from the cannabinoid.
Trying it properly
- Write down a baseline. Two to four weeks of scores before anything changes. Pain fluctuates on its own, and memory is not a measuring instrument.
- Change one thing at a time. Not a new supplement and a new exercise programme in the same fortnight.
- Give it a fair run. The trials above ran four and twelve weeks, not four days.
- Buy something you can check. A batch certificate matching the code on the container, and a dose printed per serving rather than per bottle.
Run that way, a couple of months produces an answer about you that is worth more than anything on this page. Run any other way, it produces a story about the week you started.
The products this page covers
Carried across from the earlier version of this page so the formats can be compared side by side. These are not recommendations: we have not tested them, and the details on each need checking against current listings before anyone acts on them.
Astral Organica
Astral Organica CBD Creme
Budget
- 58MG Ionic Magnesium per .25 oz
- THC-free broad spectrum CBD
- USDA certified organic non-GMO
Providing high quality bio available CBD products you’ll feel relief with Astral Organica’s MG + CBD Crème. The powerful dual-action formula combines Ionic Magnesium with THC-free broad-spectrum Cannabidiol (CBD) to get you back in action. Ionic Magnesium is a critical mineral nutrient for your normal nervous system function and relaxation.
CBD works by stimulating our endocannabinoid system to mediate a variety of biological responses. The formulation is high in antioxidant Vitamin E and essential fatty acids, leaving no oily residue while moisturizing and nourishing skin.
Each half ounce of Astral Organica contains 116MG of Ionic Magnesium and 45MG of broad spectrum THC-free CBD.
FOCL
FOCL Premium CBD Drops
Mid-range
- Made with Organic Ingredients
- Third Party Lab Tested
- 100% plant based
Are you looking for an organic, doctor-created, and third-party verified CBD tincture? FOCL Premium CBD Drops is the answer. The company offers a 30 ml bottle with three different dosages (1000, 2000, and 3000 mg of CBD) so you can fine-tune your dosage to help relax your mind and so
Not only that, but their delicious ingredients are all free of additives and derived entirely from plants – so you know they’re good for you. All of their items are produced in a GMP-certified, food grade factory. Check out their website for additional high-quality goods and place your order for the FOCL Premium CBD
Green Roads Pain Relief Cream
Green Roads Pain Relief Cream - 750mg
Mid-range
- 750mg total CBD
- Pharmacist formulated
- No animal testing
- The potent combination of menthol, rosemary oil and other key ingredients have been boosted to provide even more powerful pain relief.
- Strong dose of 750mg CBD per bottle
Green Roads first-ever OTC (over the counter) pain relieving lotion. Whether you’re suffering from back pains, arthritis, muscular aches and pains, strains or sprains, this cream provides exactly what you need to alleviate your discomfort where it’s most needed.
Ideal for reducing minor pains and aches in muscles and joints caused by arthritis, strains, sprains, simple backaches, and bruises.
R+R Cream
Prima R+R Cream Cooling Recovery Rub
Mid-range
- Petroleum - Free Hemp Extraction
- 750mg per tube
- Hypoallergenic
- it has been doctor formulated
- clinically tested
- Vegan + Cruelty Free
Primas 750 mg CBD Cooling Recovery Rub contains concentrated levels of pure hemp extract. It’s made with a potent brew of tea tree, lavender, rosemary, and peppermint oils to soothe concerns and promote recovery. The menthol and eucalyptus provide a soothing cooling sensation, and the mix is effective in calming tense spots throughout the body.
Some notable items with the Prima R+R Cream:
Check out the Prima site for this awesome blend of pain-relieving cream and its many other great products! Don’t forget to use code HMJ20 for 20% off!
Lazarus Naturals
Lazarus Naturals CBD Muscle Gel
Budget
- Full Spectrum CBD
- up to 2000mg
- Third-party tested
The Lazarus Naturals CBD Muscle Gel is a fast-acting, long-lasting, and simple-to-apply gel that gives excellent support. CBD Muscle Gel combines high-strength, full-spectrum CBD with functional components like menthol and capsaicin to provide long-term relief. With targeted aid, ease muscular pain, inflammation, and tension. CBD Muscle Gel works effectively, is easy to absorb, and was designed to work as hard as you do.
Lazarus Naturals makes its CBD Muscle Gel in-house using a vertically integrated method that delivers high-quality goods. Extracting CBD from hemp grown on their own Lazarus Farms, create the product. The product comes highly rated with 112 five star rating and rightfully so, because it works.
Mission Farms
Muscle Relief and Recovery
Budget
- Cruelty Free
- Ethanol Extraction Method
- Added Aloe and Lanolin Oil for Extra Moisturization
Hemp-derived CBD provides relief to muscular aches and pains throughout the day, thanks to its soothing aloe vera and moisturizing lanolin oil. Find areas of discomfort and tension and apply them to the affected area for a quick fix.
Highline Wellness CBD is derived from the hemp plant. This promises that you get the best health results with zero THC content. Easy enough to pack in your gym bag and use it as a post-workout massage. Highline Wellness makes all of their CBD using an ethanol extraction process and then combines it with coconut oil. Without THC, their goods provide all of the advantages without any of the “high.”
Also check out their CBD relief roll on for headache and tension relief and the many other great products they provide!
CbdMD
CbdMD Premium Recover Cream
Budget
- Hemp extract contains CBD, CBN, CBG, and terpenes
- 300, 750, 1500, or 3000mg
- Available in tub or pump bottle
A CBD cream rich in painkilling medicine and a variety of soothing herbs can help soothe away joint and muscular pains with Recover, a CBD lotion enhanced with pain relief medicines. Our Superior Broad Spectrum hemp extract combines the soothing health benefits of CBD topicals with histamine dihydrochloride, which generates a pleasant tingling warmth. To that end, there are a variety of arnica pollen extracts, aloe vera leaf juice, MSM, and a comprehensive profile of aromatic oils in a rich, moisturizing base to effectively soothe your pain.
cbdMD’s Premium CBD cream is made with only the highest-quality ingredients, including no artificial fragrances or dyes. They utilize botanical oils and extracts that are free of animal testing and gluten, paraben, and SLS. They then combine their unique line of moisturizing lotions using our Superior Broad Spectrum CBD. They use a proprietary blend of cannabinoids and terpenes that has been carefully developed to assure consistent quality with each batch. CbdMD also conducts in-house testing before sending to a third-party ISO certified laboratory to provide greater security.
NULEAF NATURALS
NuLeaf Naturals
Premium
- Full-spectrum hemp oil
- 900 MG / 30 MG per serving
There are several different kinds of CBD oils out there. NuLeaf Naturals makes the list as one of the best CBD products of 2021 thanks to it’s full-spectrum CBD action.
Not only does NuLeaf Naturals offer a wide variety of dosages, but NuLeaf tinctures are made with full-extract hemp oil.
Unlike isolated CBD, full-spectrum hemp oil also contains beneficial aroma molecules and other phyto-compounds that may work synergistically with CBD.
As close to the hemp plant as an extract can get, full-spectrum hemp oil captures the essence of the plant without excess adulteration.
All of NuLeaf’s extracts are made from organically grown hemp flowers from Colorado farms.
They are also lab-tested to ensure quality, meaning that consumers can trust that NuLeaf Naturals is providing a safe, natural pain reliever!
Recovery Balm
Miraflora Naturals CBD Recovery Balm
Budget
- Lab Tested
- 250, 500, 1000 mg
- Pesticide free
The calming properties of the Miraflora CBD balm can help you relax and unwind. It aids in reducing muscular discomfort and promoting joint mobility and function, making it ideal for active individuals. For fast comfort, apply this skin-nourishing full-spectrum hemp flower oil sport ointment to your aching muscles and sore joints following a workout.
A regimen that promotes whole-body health has many components, and CBD has been shown to be beneficial. Their recovery balm contains the highest-quality CBD available to help you fall asleep faster and stay asleep longer.
Just Live CBD
Just Live CBD Pain Relief Cream
Budget
- Full-spectrum hemp oil
- 300, 750, 1500mg options
Just Lives fast-acting Pain Relief Cream is a star for quick pain relief where your body needs it! Our Pain Relief Cream is carefully created with a balanced combination of our THC-free, high-quality broad spectrum CBD and a blend of pain fighting, anti-inflammatory botanicals like Arnica Montana, Menthol, Camphor & Argon to achieve the greatest levels of effectiveness available in a topical.
The airless pump applicator dispenses just the right amount of cream every time, making this an ideal addition to your pain fighting arsenal.
The Pain Relief Cream from Just Live combines the cooling effect of menthol with our pure, all-natural CBD. With a Broad Spectrum formula, this light, non-greasy topical helps to relieve muscular pain and improves the likelihood of recovery.
Pure Hemp Botanicals
Pure Hemp Botanicals CBD Pure Relief Warming Balm
Budget
- Lab tested
- 500mg CBD Pure Relief Warming Balm
- Therapeutic Grade Lavender essential Oil
Pure Hemp Botanicals Warming Balm comes in a 500mg CBD concentration and is made with Pure Hemp CBD, Arnica, hydrating plant botanicals, and a relaxing aromatherapy blend. This CBD Warming Balam is designed to comfort and calm aches to provide your body and skin the compassion they deserve.
The therapeutic balm stick is formulated with lavender essential oil and contains potent botanicals and vegan components to instantly relax the body while also nourishing skin. This formula’s foundation is ultra-hydrating, absorbing evenly into the skin, providing long-lasting knots and stress points.
Questions people ask
Does CBD work for chronic pain?
The pooled randomised evidence shows small effects on low-quality evidence, and most of it concerns THC or a THC and CBD combination rather than CBD alone. The international pain society declined to endorse cannabinoids for pain in 2021 on that basis.
Is a CBD cream better than a capsule for a sore joint?
The only positive randomised CBD result in pain used a topical, on peripheral neuropathy of the legs, while the larger arthritis trial that used oral capsules found nothing. That is a reason to take the topical route more seriously, not proof that it works for every kind of pain.
How long should I give it before deciding?
The trials ran four to twelve weeks. Judging it over a weekend mostly measures how your pain was going to behave that weekend anyway, which is what a placebo-controlled trial exists to separate out.
Can I take CBD with my painkillers?
Ask a pharmacist before you do. CBD inhibits the liver enzymes that clear many prescribed medicines, which can raise their levels in the blood, and the answer depends on exactly what you are taking.
Sources
- IASP Presidential Task Force on Cannabis and Cannabinoid Analgesia position statement. Pain. 2021;162(Suppl 1):S1-S2. accessed Sep 18, 2026
- Mücke M, et al. Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2018;3:CD012182. accessed Sep 18, 2026
- Vela J, et al. Cannabidiol treatment in hand osteoarthritis and psoriatic arthritis: a randomized, double-blind, placebo-controlled trial. Pain. 2022;163(6):1206-1214. accessed Sep 18, 2026
- Tuttle AH, et al. Increasing placebo responses over time in U.S. clinical trials of neuropathic pain. Pain. 2015;156(12):2616-2626. accessed Sep 18, 2026
- Xu DH, et al. The Effectiveness of Topical Cannabidiol Oil in Symptomatic Relief of Peripheral Neuropathy of the Lower Extremities. Curr Pharm Biotechnol. 2020;21(5):390-402. accessed Sep 18, 2026
- Bonn-Miller MO, et al. Labeling Accuracy of Cannabidiol Extracts Sold Online. JAMA. 2017;318(17):1708-1709. accessed Sep 18, 2026
