Most athletes that put a lot of stress on their bodies have experienced persistent pain (Hainline et al. 2017). The most common form of pain relief used by athletes are over-the-counter pain relievers such as ibuprofen and voltaren. While these non-steroidal anti-inflammatory drugs (NSAIDs) are effective, long-term use can cause stomach ulcers, heart attacks or stroke, increased blood pressure, and worsening of asthma symptoms. 

Of greater concern are the use of opioids such as tramadol that not only alleviate severe pain but also allows athletes such as cyclists to train and race better while remaining compliant with anti-doping rules. Opioids are highly addictive, and overdoses are responsible for a large number of deaths worldwide. Given the risks of NSAIDs and opioids, athletes are now considering CBD as a way of achieving safe pain relief and improved sports performance.

The experience of pain can either be from nociceptive or neuropathic origins. Nociceptive pain is the most common type that typically occurs with tissue damage (inflammatory pain). Neuropathic pain usually results from a lesion or disease in the sensory nervous system (Hainline et al. 2017) and is common among para-athletes with spinal cord injuries. Athletes that have had surgery to treat an existing injury or are suffering from repetitive mechanical and/or inflammatory irritation of peripheral nerves (such as in endurance sports) may also experience neuropathic pain (Hainline et al. 2017). 

Cannabidiol is known to reduce the pain response by blunting the activity of nociceptive receptor systems and the perception of pain (Burstein 2015). In the rodent model, it appears that CBD raises the level of anandamide activity (a compound in the body that stimulates CB1 receptors), along with altering pathways involved with nociceptive control (Maione et al. 2011). CBD has also been shown to significantly suppress chronic inflammatory and neuropathic pain, providing further support for its potential as a therapeutic agent (Xiong et al. 2012). The endocannabinoid system may also have an important role in tissue healing (Kozono et al. 2010), creating another exciting avenue for CBD to assist athletes with injury recovery. 

In one of the few human trials to date on a large cohort of professional rugby players (517), the main reasons for using CBD were for improving recovery/pain (80%), with 68% of players reporting a perceived benefit (Kasper et al. 2020). These preliminary data are encouraging and certainly supported by anecdotal evidence from elite athletes currently using CBD to improve their performance.

In summary, the potential for CBD as an alternative to NSAIDs and opioids for pain management, together with tissue healing capabilities has significant beneficial health consequences for the professional and amateur athlete. It is acknowledged, however, that further clinical studies are needed to more clearly establish the potency of CBD as a therapeutic agent.  

WRITTEN BY Dr. Nick Kimber 

References

Burstein S. Cannabidiol (CBD) and its analogs: a review of their effects on inflammation. Bioorg Med Chem 23(7): 1377-85 (2015).

Hainline, B., Derman, W., Vernec, A., Budgett, R., Deie, M., Dvořák, J., Harle, C., Herring, S.A., McNamee, M., Meeuwisse, W., Lorimer Moseley, G., Omololu, B., Orchard, J., Pipe, A., Pluim, B.M., Ræder, J., Siebert, C., Stewart, M., Stuart, M., Turner, J.A., Ware, M., Zideman, D. & Engebretsen, L. International Olympic Committee consensus statement on pain management in elite athletes. Br J Sports Med. 51(17): 1245-1258 (2017).

Kasper A.,M., Sparks S.A., Hooks M., Skeer M., Webb B., Nia H., Morton J.P. & Close G.L. High Prevalence of Cannabidiol Use Within Male Professional Rugby Union and League Players: A Quest for Pain Relief and Enhanced Recovery. Int J Sport Nutr Exerc Metab 30: 1-8 (2020).

Kozono, S., Matsuyama, T., Biwasa, K.K., Kawahara, K., Nakajima, Y., Yoshimoto, T., Yonamine, Y., Kadomatsu, H., Tancharoen, S., Hashiguchi, T., Noguchi, K. & Maruyama, I. Involvement of the endocannabinoid system in periodontal healing. Biochem Biophys Res Commun. 394(4): 928-33 (2010).

Maione, S., Piscitelli, F., Gatta, L., Vita, D., De Petrocellis, L., Palazzo, E., de Novellis, V. & Di Marzo, V. Non-psychoactive cannabinoids modulate the descending pathway of antinociception in anaesthetized rats through several mechanisms of action. Br J Pharmacol. 162(3): 584-96 (2011). 

Xiong, W., Cui, T., Cheng, K., Yang, F., Chen, S. R., Willenbring, D., Guan, Y., Pan, H. L., Ren, K., Xu, Y. & Zhang, L. Cannabinoids suppress inflammatory and neuropathic pain by targeting α3 glycine receptors. The Journal of experimental medicine 209(6): 1121–1134 (2012).