Complementary treatments and arthritis – from turmeric to cannabis oil
Why do people use complementary medicines?
People use complementary medicine for many different reasons, including:
- wanting to use more natural treatments
- their symptoms aren’t fully controlled by conventional medicine.
Read more about practical complementary therapies which can help to ease the symptoms of arthritis, from yoga to meditation.
Are they right for me?
As with all complementary treatments, different things work for different people and it isn’t possible to predict which might be the most useful or effective.
There are some key points to consider if you’re thinking about using any complementary treatments.
- What are you hoping to achieve? Pain relief? More energy? Better sleep? Reduction in medication?
- What are the financial costs?
- Is there any evidence for their effectiveness?
Are complementary medicines safe?
Complementary medicines are relatively safe, although you should always talk to your doctor before you start any new treatment.
In specific cases they may not be recommended, for example, if you are pregnant or breastfeeding, or they may interact with certain medication.
A starter for five
Here we share a spotlight on the most popular complementary medicines that people call our helpline about.
It’s thought that turmeric can possibly reduce inflammation, which could help people with arthritis.
People with knee osteoarthritis who took part in a research trial (2009) reported improvements to their pain levels after taking turmeric. The evidence is limited however, as it is from just one trial. What evidence there is suggested that people only had minor side-effects after taking turmeric.
Turmeric can be bought from health food shops, pharmacies and supermarkets in the form of powder.
Glucosamine sulphate and glucosamine hydrochloride are nutritional supplements. Animal studies have found that glucosamine can both delay the breakdown of and repair damaged cartilage.
The results for the use of glucosamine for osteoarthritis are mixed and the size of the effect is modest. There’s some evidence that more recent trials and those using higher-quality methods are less likely to show a benefit.
Capsaicin is taken from chilli peppers. It works mainly by reducing Substance P, a pain transmitter in your nerves. Results from randomised controlled trials assessing its role in treating osteoarthritis suggest that it can be effective in reducing pain and tenderness in affected joints, and it has no major safety problems. Evidence for its effectiveness for fibromyalgia is related to a single trial.
Other names: Axsain®, Zacin®, chilli, pepper gel, cayenne
Capsaicin is licensed in the UK for osteoarthritis and you can get it on prescription in the form of gels, creams and plasters.
There are no major safety concerns in applying capsaicin gel/cream. A review of capsaicin applied to the skin to treat chronic pain (not specifically related to osteoarthritis, rheumatoid arthritis or fibromyalgia) concluded that around one third of people experience a reaction around the area where the treatment is applied. It’s important to keep capsaicin away from your eyes, mouth and open wounds because it will cause irritation. There have been no reported drug interactions.
Fish oils are rich in omega-3 essential fatty acids, which have strong anti-inflammatory properties. Fish liver oil is also a rich source of vitamin A (a strong antioxidant) and vitamin D (which is important for maintaining healthy joints).
Evidence suggests that fish body oil can improve the symptoms of rheumatoid arthritis. Unconfirmed evidence also suggests a combination of fish body and liver oils might also be useful in the long term, particularly in reducing the use of non-steroidal anti-inflammatory drugs (NSAIDs). There isn’t enough evidence for the use of fish liver oil for osteoarthritis.
Omega-3 fatty acids also play a role in lowering cholesterol and triglyceride levels in your blood, so they can reduce the risk of heart disease and stroke in people with inflammatory arthritis.
In the UK, dietary guidelines recommend eating two portions of fish a week, including one oily. Fish oil is considered to be well tolerated at this dose.
At the correct doses, side-effects are usually minor and uncommon.
Cannabis oil (CBD)
CBD is type of cannabinoid – a natural substance extracted from the cannabis plant and often mixed with an oil (such as coconut or hemp) to create CBD oil. It does not contain the psychoactive compound called tetrahydrocannabidiol (THC) which is associated with the feeling of being ‘high’.
Research in cannabinoids over the years suggests that they can be effective in treating certain types of chronic pain such as pain from nerve injury, but there is currently not enough evidence to support using cannabinoids in reducing musculoskeletal pain. We welcome further research to better understand its impact and are intently following developments internationally.
CBD oil can be legally bought as a food supplement in the UK from heath food shops and some pharmacies. However, CBD products are not licensed as a medicine for use in arthritis by MHRA (Medicines and Healthcare products Regulatory Authority) or approved by NICE (National Institute for Health and Care Excellence) or the SMC (Scottish Medicines consortium).
We know anecdotally from some people with arthritis, that CBD has reduced their symptoms. If you’re considering using CBD to manage the pain of your arthritis, it’s important to remember it cannot replace your current medicines, and it may interact with them, so please do not stop/start taking anything without speaking to a healthcare professional.
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Find out more about complementary medicines and the top five that people contact us about.
CBD for Osteoarthritis – April 2021
Does CBD Work for Osteoarthritis?
- Cannabidiol ( CBD ), a compound in Cannabis sativa plants, has anti-inflammatory properties that may alleviate arthritis-related symptoms (1) .
- In a study from the Proceedings of the National Academy of Sciences of theUnited Statesof America , CBD showed anti-arthritic benefits in murine collagen-induced arthritis (2) .
- A study published in Neuroscience Letters noted that CBD may reduce the inflammatory pain of arthritis in rats by affecting how pain receptors respond to stimuli (3) .
- Evidence of CBD ’s pain-relieving benefits in arthritis-related symptoms mostly comes from animal studies . More research is needed to explore CBD ’s potential benefits in osteoarthritis .
Why People Are Turning to CBD for Osteoarthritis
According to the Centers for Disease Control and Prevention, 54.4 million adults in the United States have arthritis, and 1 in 4 children get the disease (4) .
Osteoarthritis is the most common arthritis. Other types of arthritis are rheumatoid arthritis , fibromyalgia , and gout (5) .
Osteoarthritis is characterized by joint degeneration and loss of range of motion because of a loss of protective cartilage in a joint. While osteoarthritis may affect any joint in the body, it often occurs in the most active joints, like the knees, hips, and hands.
Osteoarthritis symptoms include pain or aching, stiffness, swelling, and decreased range of motion or flexibility. Osteoarthritis may also cause reduced function and disability, and failure to perform daily tasks or work.
However, a preliminary study of Sativex, a drug combined with CBD and THC , showed benefits in alleviating pain caused by rheumatoid arthritis (6) . According to the National Institutes of Health ( NIH ), Sativex may also help spasticity and neuropathic pain management for multiple sclerosis (7) .
A 2017 study on rats examined whether CBD ’s anti-inflammatory properties could prevent the development of osteoarthritis pain and joint neuropathy (8) . Results revealed that CBD’s local administration may block the pain and prevent the development of pain and nerve damage in these joints.
These findings suggest that CBD may be a safe and useful therapy for osteoarthritis joint neuropathic pain (9) .
In another study, topical application of CBD showed therapeutic potential for relief of arthritis pain -related behaviors and inflammation without evident side effects (10) .
A study published in Neuroscience Letters also highlighted that CBD may reduce inflammatory pain in rat models by affecting how pain receptors respond to stimuli (11) .
However, the Arthritis Foundation only noted anecdotal evidence of CBD for noticeable pain relief , sleep improvement, and anxiety reduction (12) .
Moreover, available data on the potential benefits of CBD in arthritis and joint pains are mostly from animal studies. Thus, more research is needed to examine CBD ’s effects on humans.
How CBD Oil Works to Alleviate Symptoms of Osteoarthritis
CBD interacts with the endocannabinoid system (ECS), responsible for performing different biological functions, such as pain management , immune response, sleep, mood, appetite, metabolism, and memory (13) .
The ECS is composed of two types of receptors: CB1 and CB2 receptors.
CB1 receptors are located in the brain and central nervous system, lungs, liver, and kidneys. These receptors are responsible for bodily functions, like memory processing, motor regulation, appetite, pain sensation, mood, and sleep.
Meanwhile, CB2 receptors are located in cells within the immune system and its associated structures. Once activated, CB2 receptors elicit a response that helps fight inflammation, reducing pain and minimizing damage to tissues.
These anti-inflammatory effects are beneficial in treating inflammation-related conditions, including arthritis, Crohn’s disease, and inflammatory bowel syndrome (14) .
A 2019 study published in the Current Opinion in Rheumatology showed that cannabinoids lead to the production of anti-inflammatory effects by activating CB2 receptors (15) .
CBD also activates TRPV1 and GPR55 receptors, which help mediate pain perception and inflammation (16-17) .
A 2019 study showed that CBD may reduce anxiety through 5-HT1A serotonin receptor activation (18) . The “happy chemical,” serotonin, plays an essential role in mood, anxiety levels, appetite, and cognitive functions.
Another study indicated CBD ’s potential ability to trigger the ECS to produce more natural cannabinoids , like anandamide, responsible for regulating emotions (19) .
The Pros and Cons of CBD Oil for Osteoarthritis
- Chronic use and a high dosage of up to 1,500mg CBD per day are generally well tolerated by humans (20) .
- CBD has anti-inflammatory properties that provide pain relief for arthritis-related symptoms (21) .
- A 2017 animal study showed CBD as a safe therapy for osteoarthritis joint neuropathic pain (22) .
- Topical application of CBD has therapeutic potential for relief of arthritis pain -related behaviors and inflammation without evident side effects (23) .
- CBD does not give users a euphoric feeling, unlike the psychoactive compound tetrahydrocannabinol ( THC ).
- Current data on CBD use and arthritis-related symptoms are mostly animal studies . There is a lack of clinical evidence on CBD ’s effectiveness in humans.
- The Food and Drug Administration ( FDA ) does not yet approve the use of CBD oil to treat osteoarthritis .
- Despite its analgesic and therapeutic benefits in medical conditions , like schizophrenia, multiple sclerosis , and anxiety, CBD has corresponding side effects , such as drowsiness, diarrhea, fatigue, and weight changes (24) .
- CBD may interact with other medications. These drug interactions alter how the body breaks down particular medications (25) .
Given the limited studies available, CBD ’s effectiveness in treating arthritis in humans cannot be concluded.
Although CBD is generally well-tolerated by humans and users may start with low doses, a consultation with a healthcare provider is essential to ensure safe and proper use.
How CBD Oil Compares to Alternative Treatments for Osteoarthritis
Prescription medications that provide pain-relieving benefits for osteoarthritis symptoms include acetaminophen, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), and duloxetine (26) .
Acetaminophen and NSAIDs, like ibuprofen, are recommended pain relievers for mild to moderate cases. Generally used as antidepressants, duloxetine is approved to treat chronic pain .
However, these drugs cause side effects that include upset stomach, stomach ulcers, cardiovascular problems, liver damage, and bleeding problems.
Meanwhile, CBD is a natural treatment option with few side effects , like drowsiness, fatigue, and dry mouth (27) .
How to Choose the Right CBD for Osteoarthritis
CBD oil tincture is an effective form of CBD for osteoarthritis because of its fast absorption into the system. Thus, CBD ’s effects may be felt faster and last for an extended period.
Topical CBD , like creams and lotions , may also be beneficial in providing site-specific relief for joint pain and other arthritis symptoms .
Still, users may opt to use other CBD forms , like gummies and vaping products, depending on their needs and preferences.
Before buying any of these CBD products , users should know the different CBD types: full-spectrum, broad-spectrum, and CBD isolates.
Full-spectrum CBD contains a complete range of cannabinoids or compounds in cannabis plants , including CBD , THC , terpenes , flavonoids, and other minerals.
Terpenes are responsible for cannabis plants ’ unique aroma, while flavonoids are responsible for their vivid colors.
Once all compounds interact, they create a synergy called the “entourage effect,” suggesting that they are more efficient working together than individually (28) . Thus, full-spectrum CBD oil is often preferred due to the compound’s maximum benefits.
However, those who do not want the euphoric effects of THC may use broad-spectrum CBD . Broad-spectrum CBD also contains all the compounds in cannabis plants , excluding THC .
Like full-spectrum CBD , broad-spectrum produces the “entourage effect.” However, users may also choose CBD isolates, which are pure CBD extracted in isolation from all other compounds.
While CBD isolates do not produce the entourage effect, users may choose these CBD products to ensure that they get CBD’s optimal benefits without the euphoric high.
Regardless of the CBD product type that users choose, they must perform the following steps:
- Research on the state laws regarding cannabis products’ legality.
- Verify whether the CBD product uses organic, GMO-free hemp. Know the extraction methods applied to the CBD product , and check if it provides disclaimers and avoids unsupported health claims.
- Check the product’s certificate of analysis (COA) on the brand’s website. The COA should show the product’s actual CBD content and absence of pesticides and other harmful contaminants.
- Compare product label claims and the COA. High-quality CBD products contain accurate or higher CBD content than their product label claims.
- Seek medical advice , especially if purchasing CBD products for the first time, for proper guidance on CBD use.
CBD Dosage for Osteoarthritis
There are no established guidelines on the right CBD dosage for osteoarthritis . However, medical experts asked by the Arthritis Foundation recommended the following (29) :
- For CBD products in oil form, CBD extracts are blended with a tincture carrier oil. Thus, users should know the amount of oil or tincture to take (the dose) and CBD amount in each dose.
- Start taking CBD in low doses . A few milligrams of CBD in sublingual form or under the tongue twice a day is recommended.
- However, users may increase the dosage by the same amount if relief is insufficient after a week.
- Increase the dose over the next several weeks. However, note that full-spectrum CBD oils may create a euphoric feeling, even if they contain only small amounts of THC .
- Consult a healthcare professional to ensure safety. Discontinue use if no relief or positive effects are evident after several weeks of use.
How to Take CBD Oil for Osteoarthritis
Users may take CBD products orally, apply them to the skin, or inhale them, depending on individual needs.
Taking CBD Orally
Users may take CBD products orally by swallowing or ingesting them through capsules, food, or liquid, which are easy and convenient, especially for beginners.
These forms of CBD are absorbed through the digestive tract. However, according to the Arthritis Foundation , absorption is slow, and dosing is tricky because of the delayed onset of effect (about one to two hours), unknown effects of stomach acids, recent meals, and other factors (30) .
Experts also discourage taking CBD edibles because of unreliable dosing .
Users may take CBD sublingually or under the tongue and hold the liquid for 60 to 120 seconds for CBD to directly absorb into the bloodstream. While the taste may be unpleasant, unlike gummies and other flavored CBD products , results may be experienced within 15 to 45 minutes (31) .
Thus, CBD oil tinctures are suited for those seeking fast results.
Taking CBD Topically
Topical CBD products , like lotions , balms, and creams, are ideal for users experiencing pain in specific parts of their body.
Topical application allows CBD to target localized clusters of cannabinoid receptors instead of interacting with the ECS as a whole, producing fast results.
However, other topical CBD products contain common over-the-counter ingredients, like menthol, capsaicin, or camphor. Thus, it is unclear whether CBD or another ingredient causes positive effects.
CBD hemp oil may be inhaled through a vape pen. Vaping is one of the fastest ways to absorb CBD into the body, as it enters the bloodstream through the lungs without passing through the digestive system.
Effects may show in a few minutes. However, these effects only last for an hour or two.
Moreover, it is hard to determine the exact amount of CBD in each draw. While CBD oil vape products indicate the amount of CBD per inhalation , this amount may vary per person.
Thus, getting the dosage right needs some form of experimentation. Inhaling vapor oils and chemical byproducts also carry unknown risks, especially for those experiencing inflammatory arthritis.
The Centers for Disease Control and Prevention is also investigating vaping concerning widespread hospitalizations and deaths from severe pulmonary disease, which is why vaping is not recommended (32) .
Along with the legalization of industrial hemp, the 2018 Farm Bill considers cannabis plants and derivatives containing no more than 0.3% THC as no longer controlled substances under the federal law (33) .
However, CBD is still a Schedule I controlled substance. Moreover, the FDA regulates “products containing cannabis or cannabis -derived compounds.
The FDA currently approves the use of a few drugs, like Epidiolex, with pain-relieving effects for rare cases of epilepsy .
Thus, CBD users should buy in states that allow the use of recreational or medical marijuana .
Several studies have shown CBD ’s pain-relieving benefits as well as anti-inflammatory and wellness effects. Thus, more people turn to CBD for the effective treatment of osteoarthritis symptoms.
However, available data on CBD use and arthritis pain management focus on animal studies . Thus, more research is needed to confirm CBD ’s effectiveness on humans.
Cannabidiol (CBD), a compound in Cannabis sativa plants, has anti-inflammatory properties that may alleviate arthritis-related symptoms.