A new cross-sectional survey published in the journal Pharmacia offers one of the first glimpses into this question in Bulgaria. Researchers from the Bulgarian pharmaceutical community surveyed 55 adult patients suffering from chronic pain persisting for more than three months, dividing them into two analytical groups: 18 patients, or 32.7 percent, with diagnosed neurodegenerative diseases, and 37 patients, or 67.3 percent, with chronic pain but no neurodegenerative diagnosis. Between May and September 2025, participants completed a structured anonymous questionnaire covering demographics, clinical characteristics, pain intensity measured on a 0 to 10 visual analog scale, anxiety levels on a five-point self-reported scale, and their awareness, experience, and openness toward CBD products. All participation was voluntary and anonymous, conducted under informed consent and in line with the Declaration of Helsinki.

The demographic picture reflected the classic epidemiology of chronic neurological disease. Nearly two thirds of respondents, 36 of the 55 participants, were women, and the majority were aged between 46 and 65 years. The cohort was notably well educated, with 74.5 percent holding higher education qualifications and more than half, 52.7 percent, possessing a master’s degree. The symptom burden was substantial: 89.1 percent of participants reported regular use of analgesic medications, and the mean anxiety score of 3.36 with a standard deviation of 1.14 pointed to moderate-to-high emotional distress across the sample. These were not curious bystanders but patients actively managing significant daily symptoms.

The headline finding is striking in its clarity. Although 61.8 percent of participants had heard of CBD products, only 14.5 percent considered themselves fully informed about the therapeutic effects, safety profile, and appropriate use of cannabidiol. Despite this knowledge gap, an overwhelming 85.5 percent said they would be willing to use CBD if a healthcare professional recommended it. Statistical analysis confirmed that prior awareness of CBD was significantly associated with willingness to use it, with a p-value of 0.001, and that participants familiar with CBD were far more likely to have previously tried CBD products, at p < 0.001. In other words, familiarity breeds both uptake and openness, while general awareness alone leaves most patients navigating uncertain territory.

Perhaps the most biologically telling result concerns the relationship between pain and anxiety. Spearman rank correlation analysis revealed a statistically significant moderate positive correlation between pain intensity and anxiety levels, with rho equal to 0.449 and p < 0.001, meaning that patients in greater physical discomfort consistently reported greater emotional distress. This pattern fits the increasingly accepted biopsychosocial model of chronic pain, which treats pain not merely as a sensory phenomenon but as a condition intertwined with impaired emotional regulation, sleep disturbance, reduced physical functioning, and diminished quality of life. In progressive neurodegenerative disease, where disability advances and prognostic uncertainty looms, this feedback loop between body and mind may become even more pronounced.

The comparative analysis between diagnostic groups sharpened this picture further. Patients with neurodegenerative diseases reported significantly higher anxiety levels than respondents without such conditions, at p < 0.05, consistent with international evidence that anxiety is common in Parkinson’s disease, multiple sclerosis, and Alzheimer’s disease and is linked to poorer treatment outcomes and increased caregiver burden. Equally revealing were the motivations behind CBD interest in each group. Neurodegenerative patients primarily hoped CBD might slow disease progression, improve sleep, and reduce anxiety, while those without neurological diagnoses associated CBD chiefly with direct pain relief. Interestingly, participants who were informed about CBD reported significantly higher pain and anxiety scores than the uninformed, suggesting that patients with the most refractory symptoms are the ones actively searching for alternatives beyond conventional pharmacotherapy.

The barriers that emerged are as informative as the enthusiasm. The most commonly cited obstacle was the absence of adequate medical guidance on dosing, safety, and potential drug interactions, leaving many participants uncertain how CBD could be used appropriately. Fear of adverse effects ranked second, and remarkably, some respondents continued to associate CBD with the psychotropic effects of recreational cannabis, despite CBD’s fundamentally different pharmacology. Economic factors compounded the problem, with the high cost of high-quality CBD products identified as a serious limitation for long-term use, particularly among participants older than 65 years. Lack of sufficient information, concerns about drug interactions, legal uncertainty, and fear of psychoactive effects thus combined to form a formidable wall between patient interest and safe practice.

These results align with international surveys, which have similarly documented high willingness among patients to try cannabinoid-based therapies, and they illuminate a persistent paradox of the CBD boom: public perceptions frequently outrun the strength of the underlying clinical evidence. Systematic reviews suggest cannabinoids may deliver modest benefits in chronic neuropathic pain and multiple sclerosis-related symptoms, but significant uncertainties remain regarding long-term safety, optimal dosing, drug interactions, and standardized protocols, given the relative scarcity of large-scale randomized controlled trials. Meanwhile, many participants perceived CBD as a safer and more natural alternative to conventional analgesics and anxiolytics, a view likely shaped by media exposure and commercial advertising rather than clinical data, raising the risk of unrealistic expectations and unsupervised self-medication.

One clinically practical detail concerns formulation preferences. Among available pharmaceutical forms, oral dosage formats such as capsules and tablets were preferred over oils and topical preparations, possibly because they resemble conventional medicines and are perceived as more medically acceptable and easier to administer. This preference may inform future pharmaceutical development and patient-centered formulation design for cannabinoid-based therapies, and it hints that patients may be more receptive to CBD delivered through familiar routes of administration than raw extracts or artisanal products.

The study’s authors are candid about its limitations: the sample of 55 patients is small and limits generalizability, the cross-sectional design cannot establish causal relationships between symptom severity and attitudes, and self-reported data may carry recall bias. Even so, the findings carry a clear message for clinicians and policymakers. Healthcare professionals remain the most trusted sources of therapeutic information for these patients, yet previous research shows that physicians and pharmacists themselves often report insufficient education in cannabinoid pharmacology, indications, and safety monitoring. Closing this informational gap, through improved professional training in the endocannabinoid system, clearer regulation of product quality and pricing, and evidence-based clinical guidelines for chronic neurological conditions, may determine whether the enormous patient enthusiasm documented here translates into safe, supervised, and genuinely effective therapeutic use, or dissipates into unregulated self-medication with products of uncertain quality.

Subject of Research: Patient awareness, attitudes, and willingness to use cannabidiol among Bulgarian patients with neurodegenerative diseases and chronic pain

Article Title: Attitudes toward cannabidiol use among Bulgarian patients with neurodegenerative diseases and chronic pain

Article References: Gesheva, T., Boycheva, N., Todorova, G., & Mihaylova, A. (2026). Attitudes toward cannabidiol use among Bulgarian patients with neurodegenerative diseases and chronic pain. Pharmacia, 73, Article e203129. https://doi.org/10.3897/pharmacia.73.e203129

Image Credits: AI Generated

DOI: 10.3897/pharmacia.73.e203129

Keywords: cannabidiol, CBD, chronic pain, neurodegenerative diseases, Parkinson's disease, multiple sclerosis, anxiety, patient attitudes, Bulgaria, endocannabinoid system, survey study, pharmacology