If a child falls in the woods and no one is there to see it, does it hurt?
Pain and pain management are big problems in the US. According to data from The Institute of Medicine of The National Academies, over 100 million Americans suffer from chronic pain. One hundred million! That’s nearly one in three Americans! Let that sink in for a second. If you walk by two people on the street, odds are one of you suffers from chronic pain. Of course, with every action there is an opposite and equal reaction, and the picture gets even worse when we bring in stats about opioid abuse. The National Institute on Drug Abuse reports that more than 115 people in the United States die after overdosing on opioids every single day. Granted, not all of those deaths are from prescription pain medication, but the same report shows that about 80% of people who use heroin first misused prescription opioids. One way or another, the opioid epidemic in this country is closely related to our problem with pain. This is exactly why it’s so important that we find different, safer options for people dealing with pain and pain management. Luckily, early studies seem to be pointing towards CBD as a viable option for treating pain. In this post, I’m going to try and explore what pain actually is and also look at a few ways CBD might help treat it. As I quickly discovered, this isn’t such a straightforward task. So, prepare to get nerdy, and let’s dive in!
What is pain?
It’s a simple question, right? What is pain? It’s something that all of us have experienced at some point in our lives (with a few outliers excepted), and on the surface it seems like it can’t be too complicated. Clearly, it appears to be a mechanism that motivates us to either cease some dangerous activity or otherwise to escape a situation that is causing us harm, but the mechanics of it are actually much more convoluted than you might think. Here is the basic picture that people usually have in mind. Let’s say you step on a nail. That nail punctures the bottom of your foot, and in doing so it causes some tissue damage to your skin or maybe some deeper, underlying tissue. The pain nerves around that damaged tissue pick up on this and send a pain signal up to your brain, which then gives you the sensation of pain in proportion to the strength of that pain signal. The more damage the stronger the signal, the stronger the signal the more pain. Seems like a pretty easy to understand process. Unfortunately, that doesn’t seem to be how it actually works, and the real story is one that is far more interesting and crazy. To properly understand it, we need to take a brief detour.
Having a brain is sort of like being in your own personal Matrix.
I don’t mean to sound too much like your college room mate who just got done taking his first philosophy class, but consciousness is SUPER weird. In a very real way, everything you experience, from the things you see and hear to the things you taste and touch, is created by your brain. In fact, you don’t actually have any direct contact with anything in the world around you. Rather, things like your eyes and ears pick up information from the world and send that information up to your brain, and then your brain sifts through that information and puts it together into an experience for you. It’s almost like you are trapped inside of a spaceship with no windows and are only fed information through cameras and sensors on the outside. Where it gets even crazier is that you aren’t receiving the direct, whole feed of information from your senses. Instead, your brain takes that information and puts it together using all sorts of rules of thumb, shortcuts, and assumptions. Here, take this photo of the Adelson checker shadow illusion as an example: I know you won’t believe me, but squares A and B are the same color. No, really, they are! Try using your hands to cover up the areas around the squares and you can actually start to see it. Better yet, do a google search for the checkerboard shadow illusion and you will find a number of videos and pictures that prove the colors are the same. So, what in the world is going on here? Well, it turns out your brain factors a lot of things into account when it interprets the information your eyes send it. For one, the brain puts an image into a context and uses past experiences to figure out what is going on. Most of us have experience with checkerboard patterns, so our brains anticipate that square B will be lighter than square A. Also, since we live in a 3D world where shadows are common, our brains account for the “shadow” that appears to be cast by the green cylinder. Even though the wavelength of light that hits the eyes from each square is the same, the brain processes that information in such a way that you experience them as looking different, and it’s all based on things like expectations, past experience, and context. Want more proof that your brain isn’t just reporting exactly what your nerves tell it? I imagine you probably carry a cell phone with you most of the time. Have you ever felt your phone vibrate in your pocket only to discover that you didn’t even have your phone in your pocket at all? Yeah, that’s called phantom vibration syndrome, and it’s your brain receiving some sort of sensory input, maybe from your clothes rubbing against your skin or from a muscle contraction, and then assuming it must be your phone vibrating since you have a past history of phones vibrating in your pocket. Your brain makes a guess based on the circumstance and past experiences and makes you FEEL like a phone is vibrating in your pocket, when it actually isn’t. Trippy, right?
What does this have to do with pain?
The point of all this is to try and show you that pain is just like every other conscious sensory experience you have. The brain doesn’t just report directly what your nerves tell it. Instead, the brain takes that signal and puts it together with a lot of other information to decide whether that signal should be experienced as pain or not, and if so, how strong that sensation should be. For an awesome (and funny!) explanation of this, check out this TED Talk by Lorimer Moseley. The bottom line seems to be this: the beginning of the basic picture I mentioned before is right, but it gets a lot more complicated after that. There really are nerves that really do send signals to the brain, but once that information gets there the brain does a whole lot of magic with it before that signal turns into the pain you experience. Have you ever noticed that little children sometimes fall and then quickly look around to see how the adults react before starting to cry? If the parents hold it together the kid usually gets back up and goes on her merry way, but if the adults all freak out then the kid starts crying, saying how much it hurts. Maybe the kid isn’t so much trying to manipulate us, but rather has a brain that is trying to figure out what should be painful or not! Now, before anyone jumps down my throat in the comments, I’ll be the first to admit that pain is even more complicated than I am making it out to be here. There are automatic responses to signals that are carried out by the nervous system that sometimes occur before the brain even gets the message. Also, the mechanics of how these signals go from nerve to spinal cord to brain, and how all those messages get passed around in the brain, is extremely complex. All I want to do is try to show in a little more detail how the process works so we can understand how CBD might help.
How does CBD help with pain?
If it hasn’t already become apparent, I am not a pain specialist. So, know that this should all be taken for what it is: the opinion of one non-expert (I’m actually a philosopher by training) who did a lot of research. That being said, here is what I’ve come up with! As far as I can tell, there are 4 main ways you can combat pain, aside from just not stepping on that nail in the first place! First, you can alter conditions at the source of the injury. Second, you can alter the way signals are sent from the source of the injury. Third, you can alter the way signals are received in the brain. And finally, you can alter the context in which the brain is doing its magical calculations. Luckily, it looks like CBD might be able to help with all 4 of these! Although all of these are important, I think number 4 is the coolest and most unique way CBD can help with pain, and it’s why I spent so much time going over the brain’s role in manufacturing pain.
CBD fights inflammation.
It stands to reason that if there is less for your nerves to get upset about, then fewer signals will be sent along to your brain in the first place that could be turned into the experience of pain. As I talked about in my post on CBD topicals, CBD is particularly effective at combating inflammation, and inflammation can often times lead to pain. In general, inflammation is something your body does to itself as a defense mechanism, like the way your body gives itself a fever to fight infection. However, that inflammation can stimulate or even damage nerves, which then send the distress call up to the brain which results in pain. Also, a lot of conditions like arthritis are the direct result of this inflammation process going a bit haywire. In fact, some researchers think that a lot of health conditions are actually the result of inflammation. So, the more we can combat inflammation, the more likely we are to avoid triggering nerves that go on to cause pain. CBD is great at fighting inflammation, so a little topical CBD at the source of pain, or even CBD taken internally, might help fight that inflammation and lessen your pain.
CBD promotes antinociception.
“Antinociception” is a big, scary word that I didn’t know until I read about it yesterday, but the concept is actually rather simple. “Nociceptor” is basically a fancy word for the specific nerves that send distress signals to the brain that get interpreted as pain. CBD interacts with our CB2 receptors, which in turn releases chemicals that inhibit the function of these “pain nerves.” In a nutshell, CBD causes the nerves that send pain signals to brain to not work as well. Fewer signals being sent to the brain means less pain, and less pain is what we want.
CBD helps regulate neurotransmitters.
Back in my post on CBD and anxiety, I talked about CBD’s ability to regulate certain chemicals that either help or hinder your neuron’s ability to send messages to one another. Specifically, CBD facilitates serotonin binding at some key cites called 1A receptors, which in turn helps regulate the ways in which those nerve signals are picked up in the brain. Admittedly, this part of the CBD-pain-fighting story is rather complex and almost outside of my understanding, but the story seems to be that CBD does a bunch of stuff in the brain that impacts the way it receives and interprets the signals from nociceptors (the pain nerves). Think of it as stealing your brain’s mail so less of it gets through. Fewer messages being received means less pain.
CBD fights stress, anxiety, and depression.
Finally, we are at the big pay off for all that rambling I did about how pain works! Pain signals undeniably play an important role in pain, but they aren’t the whole story. As I described above, the brain takes a lot of things into account when it interprets those signals, which means a lot of things go into your brain’s decision to make you feel pain or not. As it turns out, studies have shown that people suffering from depression and anxiety experience more severe and long-lasting pain than other people. If you are depressed or anxious, your brain is far more likely to interpret signals from your nerves as pain, and far more likely to make you feel that pain more severely. And this sort of makes sense. If pain is meant to act as a motivation, as a stimulus that kicks you into action to avoid some sort of danger, then it makes sense that a brain undergoing anxiety or depression would want to motivate you to change your circumstances. An anxious or depressed brain is in trouble, so it is going to naturally look at everything it is sent as a possible sign of impending doom. Of course it thinks everything is painful! For those of you wanting a more in-depth look at how CBD fights anxiety, go check out my post on that here, but in general, CBD helps you relax and reach a more balanced state. This, I think, is one of the more awesome ways CBD fights pain, and one you can really only understand when you fully understand how pain works. The most exciting part is that this effect might be a way that CBD can help fight chronic pain. Chronic pain is a condition where pain lasts for three months or longer, well after what initially caused the pain has healed. The distress signals from your nerves have stopped being sent to the brain, but the brain keeps making you feel pain anyway. Perhaps CBD can help improve the general situation the brain finds itself in, and thus help it to stop seeing pain where there shouldn’t be any.
As I said when I started this piece, pain and pain management are a huge problem in the United States. The truly exciting thing about CBD is that researchers are showing multiple ways in which it can help fight pain, while simultaneously showing that it has very few side-effects with a virtually non-existent toxicity level. This means you can’t overdose on it, and it won’t destroy your mind and body like so many of the pharmaceutical alternatives. CBD isn’t some magical substance, and I have no doubt that it won’t help everyone experiencing chronic or acute pain, but if even a fraction of the people on opioids can find enough relief to leave those more dangerous drugs on the pharmacy shelves, then maybe we can start turning this opioid epidemic around. That’s my hope, anyway. Let me know about your experiences with pain or CBD below. I would love to hear from you!