Older Asian woman holding her hand on her shoulder with expression indicating pain.

Looking for Alternatives for Chronic Pain?

Medically reviewed by Katherine Golden, RN, and Eloise Theisen, NP
Written by Denise Gonzalez-Walker

If you’ve ever dealt with chronic pain, you know that relief can be elusive. Popping an aspirin rarely resolves the issue. However, many long-term prescription medications used to manage chronic pain are problematic, with concerning side effects.

Have you ever thought about giving cannabis a try when dealing with chronic pain? If so, you’re not alone.

Keep reading to learn how increased knowledge about plant-based medicine, along with expanding availability of fully-tested legal products, is making it easier than ever to find a hemp CBD or a higher THC product that can provide targeted relief that fits your lifestyle.

Also, consider watching a replay of our July 2021 Leaf Learning Series event, Exploring Cannabis for Chronic Pain, on the Leaf411 YouTube channel at this link. You’ll instantly access Dr. Dustin Sulak’s discussion on how both cannabinoids and opioids work to reduce pain, along with insights on how cannabis serves as a safe alternative for chronic pain for many people.

Chronic pain is a major health issue in the United States

The Centers for Disease Control (CDC) reported that in 2019, over 20% of U.S. adults had chronic pain, and that percentage is increasing among all age groups. Chronic pain encompasses a wide range of conditions, including:

  • Cancer pain
  • Arthritic pain
  • Neuropathic pain
  • Migraine headaches
  • Post-surgical pain
  • Psychogenic pain (associated with psychological factors)
  • Post-traumatic pain

Many people try to tough it out, but the documented long-term effects of chronic or persistent pain can be serious, including anxiety, depression, insomnia and chronic fatigue.

Prescription pain pills next to opioid prescription bottles.

Opioid therapy for chronic pain: An imperfect solution

While the causes of chronic pain are far ranging, solutions have been limited until recently, relying heavily on opioid-based pharmaceutical painkillers.

Prescription opioids have therapeutic value in the short term, but may become problematic with long-term use, with side effects including constipation, brain fog and reduced functionality for daily living.

Ironically, in some people, long-term opioid therapy may even lead to increased sensitivity to pain, also called opioid-induced hyperalgesia (OIH), and increasing tolerance that requires higher doses of opioids for relief.

Long-term and larger doses of opioids also increase the risk of opioid-use disorder (addiction) and overdose, according to a 2015 systematic review of research).

Physician in background pointing to cannabis flower in foreground as a recommendation for pain.

Growing recognition of cannabis as a safe alternative for pain

Despite the ongoing status of cannabis as federally illegal which limits research, an increasing number of medical professionals are taking a fresh look at the plant as a safe alternative for managing chronic pain conditions.

In a recent conversation with one of our Leaf411 supporters, Takoma Wellness Center medical cannabis dispensary owner Stephanie Kahn, BSN, noted that some D.C.-area pain clinics were beginning to recommend medical marijuana to their patients as an alternative to pharmaceutical pain relief.

Within the pain specialist community, practitioners are sharing information on cannabis’s potential for treating chronic pain, but there’s an ongoing education need for both clinicians and patients on how to use cannabis for effective pain relief.

Fortunately, organizations like Radicle Health and Leaf411 are stepping up to collect and share the latest research, with education geared toward consumers and practitioners.

Screenshot from previous Leaf Learning Series, where nurse Natali Murdock, BSN, RN, explains how to use cannabis flower as medicine.

Screenshot from previous Leaf Learning Series, where nurse Natali Murdock, BSN, RN, explains how to use cannabis flower as medicine. Watch the full video at this link.

Patient resources on cannabis and pain

Are you a patient or consumer who’s interested in learning more about using cannabis to manage pain? We suggest starting with our two-part series:

How Cannabis May Help with Different Types of Pain

Finding the Best CBD:THC Ratios and Products for Pain

Our Leaf Learning Series events are also a great resource. Check out the recorded sessions on our Leaf411 YouTube channel.

Of course, we recognize that you will have specific questions, from asking about the cannabis products available where you live to concerns about integrating cannabis into your existing pain management regimen. That’s why our free, RN-staffed hotline exists—to help with your unique situation and questions!

Reach out to us on our free, anonymous hotline at 844-LEAF411 (844-532-3411), or chat us from our Leaf411.org homepage during hotline hours.

Radicle Health’s Cannabinoid Pharmacology education

Radicle Health’s Cannabinoid Pharmacology education available at this link. Check out Radicle Health’s YouTube channel for additional webinars and video blogs.

Cannabis education for medical professionals

If you’re a physician, nurse, physical therapist, occupational therapist or other provider, you’ve likely had patients ask about using cannabis for chronic pain.

We encourage you to share the Leaf411 hotline information with your patients. We are a patient-centered service dedicated to the safe, effective therapeutic use of cannabis and hemp CBD. Calls to the free nonprofit hotline are answered by a fully-licensed RN who has completed additional professional development in cannabis therapeutics. 

As a provider, are you interested in learning more about cannabis so that you can better serve your patients? Our partner Radicle Health offers a range of courses designed for health practitioners, including a two-part series on chronic pain. Visit this link for a full list of available online courses. CEUs are available to California registered nurses.

Mobile devices: phone and laptop

Our Leaf nurses are ready to answer your cannabis questions

Whether you’re a patient or a provider, our fully-licensed RNs are ready to answer your health-related questions on cannabis and hemp CBD. From newcomer questions like “will CBD get me high?” to concerns around dosing and potential medication interactions, our cannabis-trained nurses are uniquely qualified to help. Best of all, our service is available at no cost to you, reflecting our mission to tackle healthcare inequality by providing balanced education and support on the safe use of cannabis for free to everyone.

Call our free Leaf411 hotline at 844-LEAF411 (844-532-3411) or chat with us from our home page during hotline hours, Monday-Friday from 8:00 a.m. to 7:00 p.m. MDT.

The Leaf411 cannabis nurse hotline provides free, anonymous education and directional support to the general public about the safe use of legal cannabis. We partner with select business members who meet our rigorous standards to extend our education and outreach efforts.


Finding the Best CBD:THC Ratios and Products for Pain

How Different CBD:THC Ratios and Types of Products Can Help with Pain

Medically reviewed by Katherine Golden, RN
Written by Denise Gonzalez-Walker

Last week, we overviewed different types of pain and shared how cannabis might help.

When it comes to treating pain with cannabis, both the type of product and the ratio of cannabinoids matter. The two primary cannabinoids are tetrahydrocannabinol (THC) and cannabidiol (CBD), though the cannabis plant contains many other cannabinoids, terpenes, plus other compounds that contribute to its therapeutic effect.

CBD: This cannabinoid is the star player in hemp products which are federally legal. CBD hemp products are required to have below 0.3% THC, which is such a small amount that it’s not intoxicating and won’t get you high. You’ll also find CBD in cannabis products that contain higher levels of THC.

THC: The cannabinoid responsible for the “high,” if used in large enough amounts. Cannabis products containing over 0.3% THC remain illegal at the federal level and can only be legally purchased in states that have legalized recreational or medical marijuana.

Understanding the roles that both CBD and THC play in managing pain can help you find the best product for your needs. If you need a quick refresher on the types of pain that CBD and THC work best on, check out our previous post here.

Timing Your Dose: How Different Cannabis Products Reduce Pain

Whether you’re looking at CBD hemp or cannabis containing higher levels of THC (sold legally in dispensaries), you have several different routes of administration to choose between:

  • Inhalation (smoking, vaping): Takes effect immediately and lasts 2-4 hours. This is a great choice for instant relief and for treating breakthrough pain (a flare-up in pain when you’re already taking longer-acting cannabis products). You can also layer inhaled cannabis with a longer-acting method (more on layering below) to help get you through the night.
  • Transdermal (patches, gels): Extended release option that takes effect quickly, since the cannabinoids are absorbed directly into your bloodstream. The time of onset is rapid, sometimes within 20 minutes. Transdermal products provide a consistent dose of medicine for up to 12 hours. The transdermal patch or gel is used on an area where the veins are near the skin’s surface—like the inside of your wrist or on your ankle.
  • Sublingual (placed under the tongue): Sublingual administration can provide rapid relief, but there are few true oromucosal (sublingual) products on the market. Cannabinoids are fat-soluble and, in their natural state, do not absorb well into the oral mucosa. Moreover, cannabis products are often extracted into oils, and these products are not water-soluble. Patients often expect rapid onset when using tinctures, only to wait 1-3 hours for the dose to take effect. Many products marketed as tinctures will end up being swallowed and absorbed via the digestive system, regardless of how long they are held under the tongue. A true sublingual (a product in which the cannabinoids are formulated to be more water-soluble) absorbs rapidly into the mouth. The effects can be perceived in 15-20 minutes and can last 4-6 hours.
  • Edibles (gummies, capsules): Edibles take effect in between 30 minutes and 2 hours. You’ll feel their effects between 5-8 hours. They provide a discreet, portable long-acting option.
  • Topicals (creams, salves): Topicals provide short-term localized relief. They can take effect within minutes, and may last for up to an hour.

Understanding CBD:THC Ratios

Most marijuana flower sold at legal dispensaries is THC-dominant, with very little CBD. Of course there are exceptions, such as The Wife strain or even some CBD hemp flower strains. However, odds are that if you’re using flower, you won’t find ratios connected to the strain.

Once you start looking at other cannabis products, including vapes, you’ll notice ratios on many—but not all—product labels. Common ratios include 1:1, 5:1, 10:1, and even 20:1. What do these numbers mean? And how do they help with your pain?

The ratio indicates the amount of CBD compared to the amount of THC.

  • A 1:1 ratio is when the amount of CBD and THC are the same in each dose.
  • On the other hand, if a product has a 5:1 ratio, that means there’s five times as much CBD as THC in each dose.

It’s important to note that the ratio is not the same as the amount of CBD and THC. Our supporting member 1906 makes several different products, including their Midnight drops and Genius drops, that are designed to be swallowed. The ratio of each of these recreational products is 1:1—but the amount of CBD and THC in each is different.

  • The 1906 Midnight 1:1 drops have 5 mg of CBD and 5 mg of THC per dose.
  • The 1906 Genius drops are also a 1:1 ratio; however, they have 2.5 mg each of CBD and THC.

What if a product doesn’t list a ratio? In that case, look closely at the product label. The chances are good that the product either contains all CBD, with little or no THC (legal CBD hemp products fall in this category), or the product contains all THC.

What’s the Best CBD:THC Ratio For Your Pain?

The CBD and THC cannabinoids work individually to target different types of pain. By combining them in different ratios, though, you can achieve different effects to fit your specific needs. 

While everyone is different, the following guidelines work for most people:

1:1 – Equal amounts of THC and CBD. A good option to try for all kinds of pain, including neuropathic pain. Products with a 1:1 ratio can be uplifting but this ratio will most likely cause impairment if using the suggested serving size. Always start low, go slow, to avoid intoxicating effects.

2:1, 4:1, 5:1 – A balanced product that can provide optimized levels of both CBD and THC for medicinal use, based on the fact that higher doses of CBD are often needed for relief. Can be intoxicating. 

10:1 – A high CBD alternative for people who find the 5:1 ratio to be too intoxicating.

20:1 – High CBD levels along with very low THC levels provide a good option for managing inflammation pain. Very rarely intoxicating.

Leaf411’s supporting members offer many different CBD:THC ratios to meet different needs.

Be sure to closely look at the product label to make sure you understand the ratio! While it’s not as common, some manufacturers state the ratio reflecting the THC first and the CBD content second, like our member incredibles 10:1 THC:CBD tincture.

Layering Different Cannabis Products

Have you ever woken up in the middle of the night when your pain medication wore off, and suffered as you re-dosed and waited for the medicine to kick in? Fortunately, with CBD and THC products, you can layer different product types to reduce the changes of this happening.

For example, you might use a shorter-acting sublingual pill or vape to bring instant relief, together with an edible or transdermal patch to get you through the night.

If you’re using products containing THC (the cannabinoid that can be intoxicating and make you feel “high”), you’ll want to be careful with your dosing to make sure you don’t get end up with too much THC. The best approach is to start low and slow.

While you cannot overdose on THC, the feeling of being “too high” can be uncomfortable. Our website provides tips for what to do if you feel too high.

Cannabis as an Adjunct Therapy

Depending on how you use cannabis and other medications, there can be possible medication interactions. Our Leaf411 library offers guidance on specific medication interactions here

We recommend consulting with a clinician before combining cannabis (which includes CBD hemp products!) with pharmaceuticals or over-the-counter pain medications.

Our Leaf411 cannabis-trained registered nurses can help with questions specific to medications you’re taking, and our service is FREE! Call us at 844-LEAF411 (844-532-3411).

We’re Here to Help!

We realize that it can feel overwhelming when researching cannabis for pain. There are so many options—different types of products and different ratios. 

Research on cannabis as a safe alternative for treating pain continues to grow. As nurses, we’ve heard and seen firsthand the power of this plant-based medicine, and we stay up-to-date on the latest findings and clinical guidelines for using cannabis for pain. 

Our Leaf411 hotline nurses have both specialized training and experience helping people to find the best option for their particular situation. We’d love to share our expertise with you as well! Reach out to us on our free, anonymous hotline at at 844-LEAF411 (844-532-3411).

The Leaf411 cannabis nurse hotline provides free, anonymous education and directional support to the general public about the safe use of legal cannabis. We partner with select business members who meet our rigorous standards to extend our education and outreach efforts.


Cannabis May Help with Different Types of Pain

How Cannabis May Help with Different Types of Pain

Medically reviewed by Katherine Golden, RN
Written by Denise Gonzalez-Walker

We receive many calls on the Leaf411 cannabis nurse hotline from people who are curious to learn how cannabis might help with their pain.

In today’s post, we’ll share some information based on the questions we hear. We also provide suggestions on how to match the right cannabis product to your pain.

Our goal to help callers find a solution allows them to be functional. Of course, you’re always welcome to call our hotline with questions as well!

Much like any other medicine, cannabis is not a magic pill but it’s a tool. From the research and our own experiences working with patients, we believe that the cannabis plant may be an effective alternative to opiates or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and acetaminophen, which can carry unwanted side effects if overused.

Cannabis for Pain: A Powerful Tool

When it comes to pain, everyone is different. How you experience pain, as well as your pain tolerance level, is shaped by a lot of different factors.

In the same way, people respond to medicines differently. That’s one reason why so many different painkillers are on the market today!

Cannabis is emerging as a different option, proving to be a powerful new tool for controlling pain. The cannabinoids in the cannabis plant, especially cannabidiol (CBD) and tetrahydrocannabinol (THC), have been shown to reduce inflammation and pain. Other cannabinoids and plant compounds like terpenes also play a role in reducing pain. (You can read more about terpenes in one of our past posts ).

Federal restrictions in the United States continue to limit research on how cannabis impacts pain; however, other countries such as Israel have completed considerable research on cannabis’s therapeutic benefits.

xray of broken collarbone, a source of acute pain.

Quick Primer on Types of Pain

Understanding the different types of pain and their sources can help you find the best cannabis options.

  • Acute pain usually comes about as the result of an injury, overuse, or medical procedure. While the initial pain can be mild or severe, it gets better over time as your body heals. Slamming your finger in a door results in acute pain. Post-workout soreness, broken bones and surgery recovery also fits into this category.
  • With chronic pain, “the pain itself becomes the disease,” explains Eduardo Fraifeld, MD, in this article. Doctors typically categorize pain lasting over 3-6 months as chronic pain. Chronic pain can be associated with arthritis, migraines, diabetes or multiple sclerosis (MS), among other conditions. It can be a side effect of chemotherapy or other long-term medical treatments. When an injury heals yet the pain remains, that also fits the description for chronic pain.

Pain can also be broken down into the following categories:

Person standing on track with hands on knee highlighted in red to indicate pain from overuse and inflammation.

  • Nociceptive pain: Pain in soft tissues, tendons or joints caused by injury, overuse, stress or illness. Arthritis and other types of inflammatory pain also fit in this category. Nociceptive pain tends to get better over time, except for arthritis. With this type of pain, inflammation triggers nearby nerves, resulting in aching or throbbing pain. 

Close-up of female arms and hands, one hand holding wrist highlighted in red to indicate carpal tunnel syndrome pain.

  • Neuropathic pain: Neuropathic pain, or nerve pain, originates in the nervous system, and is chronic in nature. It often feels like pins and needles, an electric shock, or a burning sensation. Some common causes of neuropathic pain are carpal tunnel syndrome, post-shingles symptoms, sciatica or pinched nerves, diabetes, and chemotherapy treatment. 

Man in gray t-shirt standing with his hands on his lower back, highlighted in red to indicate chronic low back pain.

  • Nociplastic pain: A relatively new category for pain that doesn’t fit well into the other two categories. Fibromyalgia, non-specific low back pain, irritable bowel syndrome, and pain associated with and exacerbated by centralized and peripheral sensitization are all examples of nociplastic pain.

THC or CBD? It Depends on the Person and the Type of Pain

Before we jump into the pros and cons of THC versus CBD, we have to mention that to some extent, every human body is different. Cannabis plant compounds (cannabinoids) work on the CB1 and CB2 receptors in your body’s endocannabinoid system (yes, that’s a real thing!). Your body even makes its own cannabinoids.

Everyone’s endocannabinoid system is just a bit different, just like everyone has their own pain tolerance levels. Keep this in mind if your neighbor recommends a specific product that ends up not working for you.

However, we can share some general guidelines for using CBD and THC for pain.

CBD: Many people successfully use CBD products to reduce inflammation-based pain . Full spectrum CBD hemp products containing all the plant compounds, including less than 0.3% THC, tend to be the most effective, since minor cannabinoids, terpenes, flavonoids and essential fatty acids work together synergistically to create the “entourage effect.”

CBD has potent anti-inflammatory properties that can help reduce either acute or chronic inflammation. CBD also works as a muscle relaxant and has been shown to reduce muscle spasms associated with MS and other health conditions.

By reducing inflammation, CBD indirectly helps reduce pain. However, it doesn’t bind directly to the receptors that control pain like an opioid does. For that, you need a different cannabinoid, THC.

THC: We’ve heard a lot of people immediately rule out products with THC because they’re concerned that it will make them act silly or that they’ll get too high.

It’s important to know that small amounts of THC may have minimal intoxicating effects. At the same time, THC—even small amounts—can be a gamechanger when it comes to pain.

THC acts on the same receptors in your body that opiates do; however, you don’t get some of the problematic side effects that opiates can bring—nausea, constipation, and risk of physical addiction.

Close-up of clinician’s hands, with one hand holding cannabis flower and the other holding pills, showing different options.

Cannabis Compared to Opiates

Ironically, long-term use of opiates for chronic pain can make you more sensitive to pain—an effect called opioid-induced hyperalgesia. What’s the recommended protocol in response to opioid-induced hyperalgesia? To wean off of opiates and find a safer alternative for managing pain. Cannabis is showing promise on this front, based on emerging research.

Cannabis does not cause pain sensitization but in fact can help treat it. While THC and other cannabinoids work through the same receptors that opiates do, the way that they reduce pain—their chemical process—is different.

Neuropathic pain is difficult to treat even with conventional pharmaceuticals. Generally, opioid use for chronic neuropathic pain is ineffective. One study considered the risk and benefits of opioids for the treatment of neuropathies and stated that “long-term opioid therapy didn’t improve the functional status but rather was associated with a higher risk of subsequent opioid dependency and overdose.” 

If you are going to try cannabis for your neuropathic pain, many different ratios and cannabinoids may need to be explored before finding something that may ease some of the pain so you need to manage your expectations accordingly.

Group of five young adult friends with two dogs walking across field at sunset, healthy and happy.

The Goal: To Restore Function

We wish that we could tell you that CBD or THC products will completely eliminate all pain; however, that’s not the case. If there were a magic one-size-fits-all cure for pain, the pharmaceutical companies would’ve discovered and patented it by now!

Instead, when we talk to people on the hotline, we always set the goal to reduce pain to a manageable level and restore function. When you restore function, you open the possibility of adding on additional supportive activities such as exercise and relaxation that further promote healing.

In our next post, we’ll take a closer look at the best CBD:THC ratios and products for pain. We’ll also talk about how to layer different products to provide optimal short-term and long-term pain relief. Check back next week for more information!

Can’t wait to get started? Our FREE Leaf411 hotline is available now to answer your questions about using cannabis to manage pain. Call us at 844-LEAF411 (844-532-3411).

The Leaf411 cannabis nurse hotline provides free, anonymous education and directional support to the general public about the safe use of legal cannabis. We partner with select business members who meet our rigorous standards to extend our education and outreach efforts.