Oral Cannabidiol for Acute Post-Extraction Pain: A Randomized Pilot Study

<b>Introduction/Objective</b>: Dental extractions are among the most common oral surgical procedures worldwide, with postoperative pain representing a significant clinical concern. Cannabidiol (CBD), a non-intoxicating phytocannabinoid with analgesic and anti-inflammatory properties, has recently gained attention as a potential adjunct for managing acute dental pain. To explore its clinical utility to generate preliminary feasibility, we conducted the Simple Tooth Extraction with Analgesic Phytocannabinoid (SWAP) pilot trial to evaluate the preliminary efficacy and safety of oral CBD at two concentrations (17 mg/mL and 37 mg/mL) compared with placebo and standard ibuprofen/acetaminophen therapy following simple extractions. <b>Materials and Methods</b>: Eight adults were randomized equally to four arms (<i>n</i> = 2 per arm) CBD 17 mg/mL, CBD 37 mg/mL, placebo, or treatment-as-usual (TAU; ibuprofen/acetaminophen). CBD/placebo groups received 0.5 mL every 4-6 h as needed for 7 days, while TAU followed the non-opioid regimen. The primary endpoint was pain intensity (0-10 Numeric Rating Scale) captured via ecological momentary assessment (EMA) over 72 h. Secondary endpoints included worst pain, rescue medication use, adherence, tolerability, and qualitative feedback. <b>Results</b>: All participants completed follow-up with >75% EMA adherence. Because of the very small sample (<i>n</i> = 8), results are descriptive only. Baseline imbalance was observed; the CBD 17 mg/mL group reported substantially lower pre-extraction pain than other groups, limiting interpretability. Pain trajectories diverged by group: CBD 37 mg/mL showed the lowest ratings, paralleling TAU; CBD 17 mg/mL and placebo showed limited efficacy. <b>Conclusions</b>: This pilot suggests that higher-concentration CBD (37 mg/mL) may provide analgesia comparable to standard non-opioid therapy. Within this small feasibility cohort, higher-concentration CBD (37 mg/mL) appeared to produce pain patterns qualitatively similar to standard non-opioid therapy. Findings should be interpreted as exploratory only. A fully powered randomized trial incorporating biomarker endpoints and a taste-matched placebo is warranted.