Is topical cbd oil or cream better for pain

Do Topical CBD Products Actually Do Anything for Pain?

You don’t need me to tell you that CBD (cannabidiol) is everywhere. You can eat it, you can drink it, you can vape it, you can even bathe in it. And although there’s still plenty to learn about this fascinating little compound, fans of it claim that it has some pretty impressive benefits—particularly when it comes to managing pain.

Personally, I always keep a few jars of it at my desk to help with the shoulder and neck muscle tension inherent in a job consisting mainly of typing and holding a phone next to my face. But it turns out that the research behind these claims is pretty sparse, to say the least. Here’s what you need to know before you give topical CBD a try.

What is CBD?

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.

Both THC and CBD act on a system of receptors in your body called cannabinoid receptors. You have cannabinoid receptors throughout your body and, so far, researchers have identified two major types: CB1 (found primarily in the central nervous system, including parts of the brain and spinal cord) and CB2 (found mainly in immune system tissues). Interestingly, both have been found in skin. Researchers have also found that while THC can bind to and activate both types of receptors, CBD seems to modulate and somewhat block the effects of CB1 and CB2 receptors. So, any effect that CBD has on CB receptors may actually be more related to regulating and even counteracting some of the actions of THC and other cannabinoids in the brain.

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.

If you’re ingesting something that only has CBD in it and no THC, you won’t have significant effects in the brain. This is why CBD is often referred to as being “non-psychoactive,” although that’s clearly a bit of an oversimplification because it does do something to the central nervous system.

More recent research suggests that many of CBD’s effects may occur outside of CB receptors, Jordan Tishler, M.D., medical cannabis expert at InhaleMD in Boston, tells SELF. In fact, according to a recent review published in Molecules, CBD may have effects on some serotonin receptors (known to play a role in depression and anxiety), adenosine receptors (one of the neurological targets for caffeine), and even TRPV-1 receptors (more commonly associated with taste and the sensation of spiciness).

“It actually is a very promiscuous compound,” Kevin Boehnke, Ph.D., research fellow in the department of anesthesiology and the Chronic Pain and Fatigue Research Center at the University of Michigan, tells SELF. “It will bind to receptors in multiple different pathways,” which makes it difficult to know how it might cause noticeable effects.

“Cannabidiol is a super messy drug,” Ziva Cooper, Ph.D., research director of the UCLA Cannabis Research Initiative in the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the department of psychiatry and biobehavioral sciences, tells SELF. “It has lots and lots of targets and it’s not clear how much of its effects on each target contribute to the potential pain relieving effects.”

All of this points to how hard it is to study the specific effects of CBD on its own—which might be why it’s tempting to claim that it’s the cure for everything without a whole lot of research to actually back up all of those claims.

Here’s what the research says about using CBD for pain.

The most common medical reason for which people report using CBD is to manage chronic pain, followed closely by managing arthritis or joint pain. But does it actually work?

When the National Academies of Sciences, Medicine, and Engineering evaluated decades of cannabis research, they concluded that “in adults with chronic pain, patients who were treated with cannabis or cannabinoids are more likely to experience a clinically significant reduction in pain symptoms.”

But that’s not quite as exciting for CBD as it sounds: “We don’t know cannabidiol’s effects on its own,” says Cooper, who was part of the National Academies committee that put together this report. “[The conclusions about cannabis and cannabinoids] were based on what we know about THC or THC plus cannabidiol.”

In fact, the most compelling research they found for using cannabinoids for pain came from a large review and meta-analysis published in JAMA in 2015. For the study, researchers looked at results from 79 previous studies of cannabinoids and various medical conditions, including chronic pain. However, of those studies, only four involved CBD (without THC)—none of which were looking at pain. So although we might assume that CBD is doing something to help address pain—according to the studies involving the whole cannabis plant—we don’t have great evidence to prove it.

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

The studies we do have about CBD for pain are all animal studies. For example, in a 2017 study published in Pain, researchers gave rats an injection into one of their knee joints to model osteoarthritis. Rats then either received doses of CBD or saline directly into an artery in the knee joint. Results showed that, after receiving CBD, rats showed less inflammation in the joint area and fewer pain-related behaviors (like shaking or withdrawing the affected paw or not being able to bear weight in that paw) compared to those that received saline.

Another study published in 2016 in the European Journal of Pain also looked at arthritis in rats but did so with a topical formulation of CBD. After the rats received an injection into one knee joint to model arthritis, they received a gel that contained either 10 percent CBD (in four different total amounts) or 1 percent CBD (the control) on four consecutive days. The gel was massaged into the rats’ shaved backs for 30 seconds each time.

Then the researchers measured the inflammation in each rat’s knee joint, the level of CBD that made it into their bloodstream, and their pain-related behaviors. They found that the rats that were given the two highest doses of CBD showed significantly lower levels of inflammation and lower pain behavior scores compared to those that got the control. The two lower doses didn’t show much of an effect.

But if you’re reading this, you are probably not a rat, which means these results aren’t directly applicable to your life. Although we know that rats do share much of our physiology—including CB1 and CB2 receptors—these studies don’t really tell us if humans would have the same results with CBD.

“There’s really no substitute for doing proper human studies, which are difficult, expensive, and ethically complicated,” Dr. Tishler says. And we simply don’t have them for CBD and pain.

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?

It’s totally possible (and actually pretty likely) that any effect you get from a commercially available topical CBD product is a placebo effect or related to some other aspect of the product. But there are a few things going on here that are more complex than they seem.

First off, we don’t know much about the correct dose of CBD needed for a pain-relieving effect. The doses in the rat studies that were effective were pretty large (for a rat, obviously). And the human participants in the Phase 2 clinical trial we mentioned received 250 mg of synthetic CBD topically per day—as much as many consumer topical CBD products contain in a single jar.

And even though the lotion was applied topically in the rat study, it wasn’t applied locally to the knee. Instead, the researchers were really using the topical application to get it into the rats’ bloodstream, or what’s called systemic administration. But you’d likely need a different dose for it to be effective locally (if you applied it just to your aching shoulder, for instance) in a human. We have no idea what that dose should look like.

Best CBD Creams Of 2022

Lenore Cangeloso is a board-certified acupuncturist and herbal medicine practitioner based in Oregon.

Commissions we earn from partner links on this page do not affect our opinions or evaluations. Our editorial content is based on thorough research and guidance from the Forbes Health Advisory Board.

When it comes to pain, cannabidiol ( CBD ), can potentially help provide some much-needed relief. Clinical studies note topical products containing CBD, such as creams, balms and gels, can help alleviate pain related to conditions like arthritis , nerve damage and muscle aches. If you’re interested in trying a CBD cream, we sifted through the market and rounded up our top picks below.

To choose the best CBD creams, the Forbes Health editorial team analyzed data on more than 50 CBD cream products made from plants grown in the U.S. All have a certificate of analysis (COA), are third-party tested by ISO 17025-compliant laboratories and contain no more than 0.3 percent THC. From price to potency to special effects, see which CBD cream products stand out as our top picks. Note: Prices listed are accurate as of the publication date.

  • Featured Partners
  • Best CBD Creams of 2022
  • Lazarus Naturals CBD Balm
  • Vermont Organic Science Organic CBD Balm
  • Redeem Therapeutics CBD Pain Cream
  • Medjoy Full-Spectrum Hemp Balm
  • RE Botanicals Menthol Muscle Rub with CBD
  • Plant People Soothe+ Body Balm
  • BATCH CBD Original CBD Balm
  • Appalachian Standard Menthol Salve Full Spectrum Hemp Oil
  • Carmen’s Medicinals Full Spectrum CBD Salve
  • Active Botanical Co. Therapeutic Formulation CBD Topical Salve
  • Methodology
  • What Is CBD Cream?
  • Using CBD in the U.S.
  • Using CBD Cream
  • Best CBD Creams Ratings
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Best CBD Creams of 2022

Lazarus Naturals CBD Balm

The Lazarus Naturals Relax + Unwind CBD Balm is a potent topical with plenty of CBD per application. The balm is geared toward relieving localized muscle pain and inflammation. The balm also passes third-party tests for the exclusion of pesticides, heavy metals and molds.

  • Cruelty-free certified by the Leaping Bunny Program
  • All natural ingredients
  • Two sizes available

Cost: A 2.1-ounce container of Lazarus Naturals CBD Balm containing 3,000 milligrams of CBD costs $42.

Vermont Organic Science Organic CBD Balm

Vermont Organic Science bills this CBD balm as a soothing treatment for sore muscles. The balm is infused with menthol for an additional cooling effect. The balm also includes the non-psychoactive compounds cannabigerol (CBG), which is known for its anti-inflammatory, antibacterial and antioxidant properties, and cannabichromene (CBC), which can have anti‐inflammatory and antinociceptive (pain-blocking) effects.

  • All natural ingredients
  • Strong potency
  • Includes sweet almond, tangerine, frankincense and lavender essential oils

Cost: A 1-ounce container of Vermont Organic Science Organic CBD Balm containing 1,100 milligrams of CBD costs $35.

Redeem Therapeutics CBD Pain Cream

This affordable CBD cream targets inflammation, especially in joints and muscles, with its addition of menthol, capsicum and arnica extract. The cream also contains aloe, jojoba oil, tea tree oil and vitamin C to aid absorption and further support skin health. The product passes third-party tests for safe levels of pesticides, heavy metals and molds as well.

  • USDA-certified organic hemp
  • Hemp cultivated from a Good Agricultural Practices (GAP) certified farm
  • 100% THC free

Cost: A 3.4-ounce container of Redeem Therapeutics CBD Pain Cream containing 1,500 milligrams of CBD costs $59.99.

Medjoy Full-Spectrum Hemp Balm

Medjoy’s ultra-concentrated full-spectrum hemp balm is packed with all natural ingredients, including beeswax, coconut oil, soothing lavender and cooling menthol.. It’s ideal for use either before or after exercise, according to the company, and it can be applied as often as you like, based on your personal needs and preferences.

  • Cooling menthol aroma
  • Non-GMO
  • Passes third-party tests for safe levels of pesticides, heavy metals and molds

Cost: A 2-ounce container of Medjoy Full-Spectrum Hemp Balm containing 1,500 milligrams of CBD costs $119.95 .

RE Botanicals Menthol Muscle Rub with CBD

This Menthol Muscle Rub with CBD aims to provide relief from pain and inflammation with the added cooling effect of menthol. The travel-size product is meant to be rolled on for easier application. What’s more, it’s certified by the Detox Project to be free of glyphosate residue, a pesticide chemical that can be harmful in large amounts.

  • USDA-certified organic
  • 1% of RE Botanicals sales donated to support farmer education and regenerative agriculture
  • Passes third-party tests for safe levels of pesticides, heavy metals and molds

Cost: A 3-ounce container of RE Botanicals Menthol Muscle Rub with CBD containing 600 milligrams of CBD costs $34.99.

Plant People Soothe+ Body Balm

The Plant People Soothe+ Body Balm is meant for targeted pain, inflammation and stiffness relief on affected areas of your body. In addition to CBD, the balm contains CBG and CBC, as well as California poppy and arnica flower extract.

  • Made by a Certified B Corporation (a business that meets high standards of verified social and environmental performance, public transparency and legal accountability)
  • USDA-certified organic
  • Levels of pesticides, heavy metals and molds all pass third-party tests

Cost: A 2-ounce container of Plant People Soothe+ Body balm containing 515 milligrams of CBD costs $48.99 .

BATCH CBD Original CBD Balm

Along with CBD, this simple balm contains lavender and tea tree oils to help relieve irritation. It also comes in a twist-up container so you don’t have to get your hands messy while applying it to harder-to-reach areas.

  • Contains jojoba oil for better absorption
  • Non-GMO
  • Paraben-free

Cost: A 2.5-ounce container of BATCH CBD Original CBD Balm containing 1,250 milligrams of CBD costs $49.99.

Appalachian Standard Menthol Salve Full Spectrum Hemp Oil

This menthol salve is meant to relieve sore and tight muscles with several liberal applications daily. The menthol also provides cooling and moisturizing effects alongside the nourishing mango butter base.

  • All natural ingredients
  • Menthol and herbal scent
  • Includes hemp plant terpenes to enhance CBD effects

Cost: A 2-ounce container of Appalachian Standard Menthol Salve Full Spectrum Hemp Oil containing 500 milligrams of CBD costs $40.

Carmen’s Medicinals Full Spectrum CBD Salve

A mix of all-natural essential oils and terpenes, this CBD salve can provide relief for localized aches and pains while also moisturizing the skin. Carmen’s Medicinals recommends use of the salve on your joints, hands and back.

  • USDA-certified organic hemp
  • All natural ingredients
  • Passes tests for safe levels of pesticides, heavy metals and molds

Cost: A 1.7-ounce container of Carmen’s Medicinals Full Spectrum CBD Salve containing 1,000 milligrams of CBD costs $44.95.

Active Botanical Co. Therapeutic Formulation CBD Topical Salve

At the highest price point and with one of the highest potencies on this list, Active Botanical Co.’s Therapeutic Formulation CBD Topical Salve is 99.9% pure CBD isolatecombined with the company’s proprietary terpene profiles to help your body get the most relief from the plant compounds. By using CBD isolate, the salve dilutes the earthy scent often associated with hemp.

  • Strong potency for additional relaxation effects
  • Passes tests for safe levels of pesticides, heavy metals and molds
  • 18-month shelf life

Cost: A 1.35-ounce container of Active Botanical Co. Therapeutic Formulation CBD Topical Salve containing 5,000 milligrams of CBD costs $179.99.

Methodology

To choose the best CBD creams of 2022, the Forbes Health editorial team analyzed data on more than 50 CBD creams products that are:

  • Made from plants grown in the U.S.
  • Have a certificate of analysis (COA)
  • Are third-party tested by ISO 17025-compliant laboratories
  • Are made with all natural ingredients

We then ranked CBD creams based on price, potency and the inclusion of ingredients that provide additional soothing properties.

We considered a standard application size to be .05 ounce of CBD cream but provided full product pricing in addition to a per-application breakdown to help you determine the best daily value, as well as what works for your budget as a whole.

What Is CBD Cream?

CBD cream, which often includes balms and salves, is a topical application of cannabidiol. This cream offers more localized effects rather than systemic ones that edibles or inhalation can provide.

“When CBD is used topically, it does not reach the bloodstream,” says Robert Milanes M.D., founder of Holistic On Call and a doctor with Heally, an alternative medicine telehealth platform.

This application method makes CBD cream a good choice for people who are new to CBD and less comfortable ingesting it, but still want to benefit from CBD’s potential pain relief abilities.

“Because it’s localized, it’s not the best method of delivery for trying to help yourself sleep or for anxiety,” says Steven Phan, founder of Come Back Daily, a CBD dispensary in New York.

How Does CBD Cream Work?

Compared to ingesting CBD, which can take anywhere from 30 minutes to two hours to take effect, applying CBD topically allows you to feel the localized effects pretty quickly, according to Laura Fuentes, a licensed compound pharmacist and co-founder of Green Roads, a major CBD brand.

This quick uptake, paired with CBD’s inherent benefits, makes CBD cream a great option for pain, inflammation, soreness and tightness relief in specific parts of your body, she says.

One 2018 study with over 300 participants with knee pain from osteoarthritis found a transdermal synthetic CBD gel significantly improved patients’ worst pain score and physical function averages [1] Hunter D, Oldfield G, Tich N, Messenheimer J, Sebree T. Synthetic transdermal cannabidiol for the treatment of knee pain due to osteoarthritis . Osteoarthritis and Cartilage. 2018;26:S26. . These patients were treated with 350 milligrams of CBD gel per day for 12 weeks.

Additional research shows topical application of CBD to have significantly reduced pain in some patients with peripheral neuropathy—a set of conditions damaging the peripheral nervous system—and myofascial pain (localized muscle and tissue pain) in respective studies [2] Xu DH, Cullen BD, Tang M, Fang Y. The Effectiveness of Topical Cannabidiol Oil in Symptomatic Relief of Peripheral Neuropathy of the Lower Extremities. Curr Pharm Biotechnol. 2020;21(5):390-402. [3] Nitecka-Buchta A, Nowak-Wachol A, Wachol K, et al. Myorelaxant Effect of Transdermal Cannabidiol Application in Patients with TMD: A Randomized, Double-Blind Trial . J Clin Med. 2019;8(11):1886. .

Using CBD in the U.S.

CBD creams are a popular way to use CBD in the U.S., according to a recent Forbes Health survey of 2,000 U.S. adults conducted by OnePoll. In fact, 53% of respondents who reported having tried CBD used it in lotion form, and 42% used it in a serum or other topical form.

CBD use in general is increasingly common—60% of U.S. adults have tried a CBD product before. Better yet, 60% believe it has medicinal benefits. The same survey reports that the majority of people use CBD in a variety of forms to help relieve pain.

Using CBD Cream

To apply a CBD cream, you rub it into the affected area, such as an achy knee or sore neck. “The cream is absorbed into the skin and then binds to the numerous cannabinoid receptors located in the different layers of the skin,” says Fuentes.

Each topical CBD product may have unique directions, however. Some may instruct you to use a small amount while others encourage using a liberal amount.

Balms and salves have a thicker consistency and often need to be warmed in your hands before applying them to the target area. And some products don’t require getting your hands dirty at all, thanks to roll-on and stick applicators.

Potential Side Effects of CBD Topicals

CBD itself is safe and well tolerated, and it has no risks of abuse or dependence, according to the World Health Organization.

“Additionally, using CBD topically reduces the likelihood of experiencing side effects typically associated with CBD use, such as drowsiness, fatigue and diarrhea,” says Dr. Milanes.

Milanes and Fuentes warn that while CBD itself might be safe, there is a chance you might be allergic or sensitive to another ingredient in a CBD topical, which could cause adverse effects. To avoid unpleasant reactions, they suggest reading ingredient lists carefully.

Phan also recommends talking to your doctor before using CBD if you’re on any medications— especially blood pressure medications because CBD can also lower blood pressure.