CBD for Pain Relief: What NC Consumers Should Know in 2026

Pain is the #1 reason Americans use CBD. A Gallup poll found that 40% of CBD users take it for pain, ahead of anxiety (20%) and insomnia (11%) (Gallup, 2019). An Arthritis Foundation survey of 2,600 patients found 79% were currently using, had used, or were considering CBD for their condition (Arthritis Foundation).

But the clinical evidence is more nuanced than most brands want you to believe. CBD has real pharmacological mechanisms for pain — it acts on TRPV-1 receptors, 5HT-1A serotonin receptors, and the endocannabinoid system. The question isn't whether CBD can affect pain. It's how well, for which types of pain, and at what doses.

This guide cuts through the marketing to show you what systematic reviews of clinical trials actually say — and how to use CBD for pain responsibly if you decide it's right for you.

TL;DR: A 2024 systematic review found 7 of 11 human clinical trials showed positive pain-reducing effects for CBD (PMC, 2024). However, the most authoritative 2025 AHRQ review found oral CBD alone "may not" outperform placebo — combination CBD+THC products showed better results (NCBI, 2025). Topical CBD for osteoarthritis shows the most consistent evidence. Neuropathic pain may respond best, with one study showing a 94.8% response rate. CBD is not FDA-approved for pain. NC has ~4,380 opioid deaths in 2023 (NC DHHS).

What the Clinical Evidence Actually Shows

Let's start with the most authoritative source: the 2025 AHRQ Living Systematic Review, which analyzed 29 RCTs and 15 observational studies on cannabis products for chronic pain. Their headline finding:

Oral CBD alone "may not be associated with improved pain and function versus placebo" (moderate evidence). However, CBD+THC combination products in comparable ratios "are probably associated with small improvements in pain severity" (NCBI, 2025).

This is the most rigorous evidence available. It doesn't mean CBD doesn't work for pain — it means the evidence for CBD alone as an oral supplement is weaker than the evidence for CBD+THC combinations.

A broader 2024 systematic review of 40 studies (11 human clinical trials) found that 7 of 11 trials showed positive pain-reducing effects, with pain reduction ranging from 42–66% in positive studies (PMC, 2024). Three studies found no significant improvement.

Which Types of Pain Respond Best?

Neuropathic pain

The strongest evidence. A 2025 study found a 94.8% response rate in neuropathic pain patients with a 75.5% average pain reduction, compared to just 24.9% response for mixed pain types (PMC, 2025). This makes sense pharmacologically — CBD's action on TRPV-1 and 5HT-1A receptors is most relevant to nerve-related pain signaling.

Osteoarthritis (topical)

A 2024 clinical trial of 4% transdermal CBD gel applied 3 times daily for 4 weeks showed significant reductions in current pain (-1.91), average pain (-1.92), and maximum pain (-1.97) on a numeric scale, all with p < 0.0001 (Nature Scientific Reports, 2024). Importantly, systemic absorption was confirmed via urine metabolite detection, suggesting transdermal CBD does enter the bloodstream — not just a local effect.

Fibromyalgia

Mixed but interesting data. A 2021 study found that 53% of fibromyalgia patients substituted CBD for opioids, with 70–94% of those substitutions resulting in stopped or reduced medication use (ScienceDirect, 2021). This is patient-reported data, not a controlled trial, but the pattern is consistent across multiple surveys.

Topical vs. Oral CBD for Pain

This distinction matters more than most consumers realize:

Topical CBD (creams, gels, patches) — Applied directly to the skin at the site of pain. Avoids first-pass liver metabolism. The transdermal CBD gel study showed systemic absorption at doses of 0.6–6.2 mg/day with linear plasma concentrations (PMC, 2024). Best evidence for localized joint and muscle pain.

Oral CBD (tinctures, capsules, edibles) — Systemic effects but low bioavailability (6–14%). The AHRQ review found oral CBD alone may not outperform placebo. Oral CBD+THC combinations fared better. More suitable for widespread or centralized pain conditions.

Bottom line: If your pain is localized (a specific joint, muscle group, or area), try topical first. It has better evidence and fewer drug interaction concerns. If your pain is widespread or neuropathic, oral CBD (ideally with some THC) has stronger support.

CBD vs. Traditional Pain Relievers

CBD isn't a replacement for proven pain treatments. But its safety profile is notable: a review of clinical evidence found CBD "appears exceptionally safe with very few concerns even at doses >300–400 mg" (PMC, 2023). There is no fatal overdose risk and no physical addiction potential — properties that matter in the context of NC's opioid crisis.

The NC Opioid Context

North Carolina had approximately 4,380 opioid overdose deaths in 2023 — about 12 people per day, the state's peak year. The death rate reached 40.1 per 100,000, double the 2018 baseline of 20.4 per 100,000. Fentanyl and synthetic opioids were involved in 78% of those deaths. Over 1.3 million North Carolinians live with a substance use disorder (NC DHHS, 2025; NCIOM, 2025).

The rate declined 35% from April 2024 to April 2025 — a positive trend — but remains 25% above the 2018 baseline.

Against this backdrop, a 2020 study found that 53% of chronic pain patients reduced or eliminated opioids within 8 weeks of adding CBD hemp extract, with 94% reporting quality of life improvements (Postgraduate Medicine, 2020). This doesn't mean CBD replaces opioids for severe pain — but it suggests CBD may play a complementary role for some patients in reducing reliance on higher-risk medications.

Important: Never stop or reduce prescribed pain medications without consulting your doctor. CBD is a supplement, not a substitute for medical care.

How to Dose CBD for Pain

Clinical dosing guidance from a consensus review in the Journal of Cannabis Research:

Start: 5mg CBD twice daily (10mg total)

Titrate: Increase by 10mg every 2–3 days

Target range: 20–40mg per day for most chronic pain conditions

Topical: Apply 4% CBD gel/cream 3 times daily to affected area

Higher clinical trial doses (up to 1,500mg/day) exist in the literature, but most consumer products and practical approaches fall in the 20–150mg range (Journal of Cannabis Research, 2021).

For more on CBD types, bioavailability, and label reading, see our comprehensive CBD oil guide.

Drug Interactions for Pain Patients

If you're taking other pain medications alongside CBD, drug interactions are a real concern. CBD inhibits CYP3A4 and CYP2C9 — the same enzymes that metabolize many common pain drugs:

• NSAIDs (ibuprofen, naproxen) — Theoretically increased levels, but clinical significance is unclear
• Acetaminophen — Both processed by the liver; monitor for liver function if combining high doses
• Gabapentin/pregabalin — Limited interaction data, but both cause drowsiness — expect additive sedation
• Opioids — CBD may alter opioid metabolism; never adjust opioid doses without medical guidance
• Blood thinners (warfarin) — Documented dangerous interaction; INR monitoring essential

For a full list of drug interactions, see our CBD oil guide.