Cannabidiol as an Alternative Analgesic for Acute Dental Pain

Abstract

Odontogenic pain can be debilitating, and nonopioid analgesic options are limited. This randomized placebo-controlled clinical trial aimed to assess the effectiveness and safety of cannabidiol (CBD) as an analgesic for patients with emergency acute dental pain. Sixty-one patients with moderate to severe toothache were randomized into 3 groups: CBD10 (CBD 10 mg/kg), CBD20 (CBD 20 mg/kg), and placebo. We administered a single dose of respective oral solution and monitored the subjects for 3 h. The primary outcome measure was the numerical pain differences using a visual analog scale (VAS) from baseline within and among the groups. Secondary outcome measures included ordinal pain intensity differences, the onset of significant pain relief, maximum pain relief, changes in bite force within and among the groups, psychoactive effects, mood changes, and other adverse events. Both CBD groups resulted in significant VAS pain reduction compared to their baseline and the placebo group, with a maximum median VAS pain reduction of 73% from baseline pain at the 180-min time point (P < 0.05). CBD20 experienced a faster onset of significant pain relief than CBD10 (15 versus 30 min after drug administration), and both groups reached maximum pain relief at 180-min. Number needed to treat was 3.1 for CBD10 and 2.4 for CBD20. Intragroup comparisons showed a significant increase in bite forces in both CBD groups (P < 0.05) but not in the placebo group (P > 0.05). CBD20 resulted in a significant difference in mean percent bite force change in the 90- and 180-min time points compared to the placebo group (P < 0.05). Compared to placebo, sedation, diarrhea, and abdominal pain were significantly associated with the CBD groups (P < 0.05). There were no other significant psychoactive or mood change effects. This randomized trial provides the first clinical evidence that oral CBD can be an effective and safe analgesic for dental pain.

Keywords: analgesics; clinical trial; endodontics; non-narcotic; pain measurement; toothache.

Figure 1.

CBD reduced the dental pain and increased the bite force in patients presented with emergency toothache. (A) Median visual analog scale (VAS) pain scores per time point for all groups. Arrows indicate the onset of significant pain score differences from baseline (BL) for the cannabidiol (CBD) groups. Asterisks depict significant differences from the placebo group. Mixed-model analysis, “time point” (P < 0.001), “Group * Time Point” (P = 0.0013), and “Group” (P = 0.55). (B) Median percent change from BL. The dotted line represents a 50% reduction in BL pain. Maximum pain relief occurred at 180 min after CBD administration in both CBD groups, significantly different from the placebo. Placebo also experienced pain relief with a maximum of 33% median pain reduction from BL pain. Asterisks depict significant differences from the placebo group. Wilcoxon test for intergroup comparisons, P < 0.05. (C) Box plots depicting median bite force (Newton) scores per time point for all groups. Both CBD groups noted a significant increase in bite force at 90 and 180 min compared to BL, while placebo group changes were not significant. Mixed-model analysis, “time point” (P < 0.001), “Group * Time Point” (P = 0.28), and “Group” (P = 0.19). (D) Mean percent bite force change normalized to baseline. Asterisks depict significant change in CBD 20 mg/kg compared to the placebo group (t test each pair per time point, P < 0.05).

Figure 2.

The frequency of “Pain Reduced” category significantly increased with time in both CBD groups. Pain intensity assessment for (A) placebo, (B) CBD 10 mg/kg, and (C) CBD 20 mg/kg. Pain categories compared to baseline (BL) pain: “pain increased,” “pain similar,” and “pain reduced,” χ² tests, P < 0.05. (D) Number needed to treat (NNT) for a 50% reduction in BL pain for the experimental groups. CBD, cannabidiol.