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how cbd topicals work

Strain-specific topicals attempt to harness certain terpenes and cannabinoids in a chemical profile similar to that of Blackberry Kush, Permafrost, Blueberry, or whatever other strains the processor wishes to imitate. Along with THC, CBD, THCA, and other cannabinoids, topical producers may also select ingredients and essential oils for additional relief, like cayenne, wintergreen, and clove.

Cannabis-infused lotions, salves, oils, sprays, and other transdermal methods of relief work by binding to cannabinoid receptors. These receptors are found throughout the body and are activated either by the body’s naturally-occurring endocannabinoids or by cannabis compounds known as cannabinoids (e.g., THC, CBD).

What are topicals?

A THC-rich rub infused with cooling menthol and peppermint is a perfect way to wind down from a brutal workout or hike. For intense localized pain, you may try a warming balm that combines the deep painkilling properties of cannabinoids with a tingling, soothing sensation. Inflammation symptoms may require a different chemical profile, as Cannabis Basics’ CEO Ah Warner explains:

New methods of cannabis consumption are bringing us further away from the notion that marijuana belongs solely in a bong or joint – or that it has to get you high, for that matter. Cannabis-infused topicals are an example of how new modes of consumption are revolutionizing perceptions of marijuana as their accessibility, safety, and efficacy invite even the most unlikely patrons into the world of medical cannabis.

Topicals are cannabis-infused lotions, balms, and oils that are absorbed through the skin for localized relief of pain, soreness, and inflammation. Because they’re non-intoxicating, topicals are often chosen by patients who want the therapeutic benefits of marijuana without the cerebral euphoria associated with other delivery methods. Other transdermal innovations are fast arriving in the cannabis market, including long-lasting patches and tingly lubricants for patients and recreational consumers alike.

The placebo effect is likely behind some reports of CBD topicals’ efficacy. Given that they can cost twice as much as conventional topicals, it’s understandable that you’d be more inclined to believe they’ll work.

Placebos are grounded in belief, not deception. There’s ample evidence that physiological changes can happen if the person receiving a treatment believes it will help. Take, for example, the effectiveness of rinsing and spitting with a sports drink. The practice shouldn’t work, because no fuel enters your bloodstream, yet it has consistently been shown to improve performance, most likely because your brain thinks sugar is on the way. Or consider the many athletes who have a performance breakthrough soon after joining a new team or getting a new coach: barring doping, those athletes are unlikely to be physically different than they were two weeks before, but it’s the belief in the new setup that underlies their improvement.

Right about now, you’re probably thinking, It’s all just a placebo effect. That may be true, but it’s not as damning an indictment as you think.

Placebo Isn’t a Four-Letter Word

The usual explanation for CBD topicals’ potential effectiveness is that, once the substances penetrate the outer layer of skin, they bind with cannabinoid receptors. These receptors can be thought of as locks on the surface of cells, causing cellular changes when they’re unlocked. In this metaphor, cannabinoids are the keys to the locks, and those keys can be either the body’s own endocannabinoids (which play a role in exercise euphoria) or an external source of cannabinoids, such as a CBD topical.

The first step in answering these questions is to examine whether topical solutions of any sort do anything. Topical nonsteroidal anti-inflammatories (i.e., ibuprofen, diclofenac, and the like) are available as both prescription medications and over-the-counter products. Given the FDA’s approval, there’s evidence that this general class of products works. As when you take anti-inflammatories orally, the goal is to reduce pain and lower inflammation and swelling. By applying anti-inflammatories directly to the affected area, you’re theoretically increasing the product’s effectiveness.

What exactly happens as a result of this unlocking remains a matter of discussion in medical circles. It’s logical to think that reduced pain can result from activating the same cannabinoid receptors that contribute to a runner’s high. There’s also a theoretical basis for CBD lowering inflammation by inhibiting the same enzymes targeted by popular nonnarcotic pain medications such as ibuprofen and naproxen.

Anecdotally, CBD topicals seem to work best in managing flare-ups of the chronic low-grade problems most endurance athletes live with. Aggravated iliotibial band from running on slanted roads? Check. Shoulder strain from too much time riding an indoor trainer? Check. Torn ACL or ruptured Achilles? Not so check.

But some studies have found essentially zero side effects of high-dose CBD (900mg) and those that researchers do see—like drug interactions—aren’t considered to be issues when CBD is used topically.

Why does the body have receptors for compounds in cannabis? Well, it doesn’t exactly. Cannabinoids like THC and CBD are similar enough to compounds that your body naturally makes, called endocannabinoids, that they can interact with this system. Normally, the endocannabinoid system is thought to play a role in a variety of functions in the body, helping to regulate things like parts of the immune system, the release of hormones, metabolism, and memory.

The only thing that comes close is a Phase 2 clinical trial using a proprietary CBD transdermal gel (meaning it’s meant to go through the skin into the bloodstream) in 320 patients with knee osteoarthritis over 12 weeks, which has not been peer-reviewed to date. Unfortunately, in almost all of the study’s measures of pain, those who received CBD didn’t have statistically different scores from those who got placebo. But “they found some reductions in pain and improvements in physical function,” Boehnke says.

So…is CBD cream just an expensive placebo?

Cannabidiol, commonly referred to as CBD, is a cannabinoid, a type of compound found in cannabis (marijuana). Unlike the more well-known cannabinoid THC (tetrahydrocannabinol), CBD does not produce a high.

“It might be that cannabidiol by itself is helpful for pain, but at this point we don’t know that,” Cooper says.

Nevertheless, how do we account for all the people out there (like me) who use these products and feel like they’re doing something? Beyond the placebo effect, it’s possible that something else in the cream could be doing the heavy lifting here. These products don’t just contain CBD, Dr. Tishler points out. In fact, many of them also come with ingredients like arnica, menthol, or camphor, which may all provide a more immediate sensation of soothing or pain relief. So it could be those ingredients (or just the act of massaging the balm into your skin) that makes you feel better.

It’s also important to remember that, although generally benign, side effects have been reported with some forms of CBD. For instance, oral CBD taken in the large amounts that have shown some limited promise in helping with anxiety issues may come with side effects, such as diarrhea, reduced appetite, fatigue, and interactions with other drugs you might be taking, specifically blood thinners, Cooper says.