CBD oil and joint pain
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- Research overview
- The studies
- Patient perspectives
- What the experts say
- Bottom line
Joint pain affects millions of people around the world and is associated with a wide range of conditions and ailments. Some of the most common reasons for joint pain are musculoskeletal conditions and inflammatory diseases, yet few studies have addressed these.
Currently, treatment typically consists of drug therapy, including the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and weak opioids. Non-pharmacologic treatment plans include cognitive behavioral therapy, stress management, and patient education in self-management programs.
Based on the ways in which CBD oil impacts key brain receptors, it shows promise for those seeking an alternative treatment option in the hopes of reducing pain and inflammation. It may also address conditions related to chronic pain, including anxiety and sleep disorders.
While studies are limited in regards to the effect of CBD oil on joint pain, researchers have identified a clear relationship between the two. Scientists have found that CBD appears to inhibit or activate key compounds which influence the ECS, including anandamide. This compound is associated with pain reduction, and CBD helps reduce its absorption. As CBD levels increase in the bloodstream, the amount of perceived pain may lesson. This means that CBD may help the body use the ECS more effectively.
In animal studies, CBD has been shown to reduce inflammation and relieve joint pain without inducing significant side effects. However, human studies are limited, and the results are mixed. More comprehensive studies are required.
While studies are limited, researchers have identified a relationship between CBD and joint pain. Photo by: Gina Coleman/Weedmaps
A 2016 study, published in the European Journal of Pain, examined the efficacy of topical CBD in rats. It was found that the application of CBD significantly reduced joint swelling, as well as limb posture scores as a rating of pain. It was concluded that topical CBD offers therapeutic potential for pain-related inflammation and behaviors associated with arthritis.
Another study, published in the journal Pain, focused on CBD pain prevention in relation to rat osteoarthritis. Upon studying osteoarthritis in rats, it was found that CBD blocked joint pain in a dose-dependent manner. In addition, prophylactic CBD administration prevented the future development of nerve damage and associated pain in the arthritic joints. The researchers concluded that CBD may be a safe treatment option in mammals, targeting pain while blocking the inflammatory responses that drive disease progression.
Billy Evans, 34, has been using CBD oil, as well as CBD creams and salves, in order to address his joint pain and muscle spasms. “I currently live in the United States and am in need of a shoulder replacement,” Evans told Weedmaps News. “Upon using CBD oil, I was able to get off of three different muscle relaxers, as well as some of my pain medications.”
Kayleigh Shanna, 31, is both a patient and industry expert, working as a cannabis sommelier, consultant, and master grower. “I originally began taking CBD oil in order to better treat my symptoms of depression and anxiety,” Shanna said. “However, I also suffered from pain and sleep disturbances as a direct result of my mood disorder, both of which significantly improved after I began taking CBD oil daily.”
People use CBD Oil and CBD creams and salves to ease joint pain. Photo by: Gina Coleman/Weedmaps
Brendon James, 30, first became a medical patient in 2010 following a major car crash. After severely damaging his foot, he was living in constant pain. “I was given everything from pain medications to nerve suppressants and opioids, but the side effects made me seek alternatives,” James said.
He continued, “Today, I have been taking high-CBD strain cannabis and oil derivatives for nearly a decade. This treatment option has helped considerably with the pain, as well as my ability to cope with life alterations associated with nearly losing my foot. The pain will never fully go away, but CBD has helped reduce the associated inflammation. There have been no notable side effects and I am in no way addicted to it. I am now in control of my pain — not the other way around.”
What the experts say
Dr. Bonni Goldstein is a medical adviser to Weedmaps.com, author of Cannabis Revealed, and Medical Director of Canna-Centers in California. She says CBD can help reduce inflammatory discomfort. “CBD is a potent anti-inflammatory and can decrease joint pain in patients with arthritis and other conditions that cause joint inflammation. Patients often report better mobility and an ability to decrease the use of NSAIDs with CBD use.
CBD is a potent anti-inflammatory and can decrease joint pain in patients with arthritis and other conditions that cause joint inflammation.
“An elderly woman was brought to my office by her adult daughter. The elderly lady was experiencing pain from osteoarthritis in her knees that began to affect her mobility. The patient began taking a 25:1 CBD:THC ratio edible, resulting in almost complete resolution of pain and improved mobility,” Goldstein said.
“Plants all over the world have evolved thousands of their own chemicals that just by coincidence are useful in treating human illnesses,” says Dr. Paula Williams, a physician at Apollo Cannabis Clinics, a medical cannabis care center in the Toronto area. “It turns out that the nervous system has neural pathways that use the body’s own cannabinoid receptors. Cannabinoids interact with the CB1 and CB2 receptors in various ways to increase natural pain relief. These are not the same as opioid receptors, which is one reason why cannabis does not tend to be addicting when used for pain relief.”
Williams recommends using CBD and THC in tandem for joint pain relief.
“I’ve been prescribing medical cannabis to patients in my pain practice, hundreds of them, for about 10 years,” Williams says.
“There are many kinds of joint pain, but one of the most common sources of pain is arthritis,” states Adie Rae, Ph.D., a subject matter expert for Weedmaps who has extensively studied the endocannabinoid system. “Both rheumatoid and osteoarthritis patients report using topical CBD oil to manage their symptoms. The true efficacy of these products has not been studied in clinical trials, but in animal models of arthritis, topical CBD effectively reduces pain and inflammation.”
Many patients report using CBD to relieve symptoms of joint pain. Animal models have shown positive effects, especially in relation to arthritis. However, at this time, more scientific research is required in humans to determine dosing and overall safety guidelines.
Rae added, “An important consideration for patients choosing to explore topical CBD for joint pain is the formula or makeup of the product. Some CBD oils are diluted in carrier oils that are not very compatible with the skin, whereas other plant-derived oils can enhance skin penetration (jojoba oil, for example). Also, eucalyptus, rosemary, and citrus oils have been shown to increase the skin penetration of other medications, so topical CBD products that also contain these ingredients could yield better results.”
CBD oil and joint pain Copy article link to clipboard. Link copied to clipboard. Contents Research overview The studies Patient perspectives What the experts say
Is cbd oil good for joint pain
What is CBD? CBD, short for cannabidiol, is an active compound found in the cannabis plant. CBD is not intoxicating but may cause some drowsiness. The CBD in most products is extracted from hemp, a variety of cannabis that has only traces (up to 0.3%) of THC, the active compound that gets people high.
Does CBD work for arthritis? Animal studies have suggested that CBD has pain-relieving and anti-inflammatory properties, but these effects have not been validated in quality studies in humans. Anecdotally, some people with arthritis who have tried CBD, but not all, report noticeable pain relief, sleep improvement and/or anxiety reduction.
Is CBD safe to use? Research evaluating the safety of CBD is underway. At this point very little is known. So far, no serious safety concerns have been associated with moderate doses. CBD is thought to have the potential to interact with some drugs commonly taken by people with arthritis. Talk to your doctor before trying CBD if you take any of the following: corticosteroids (such as prednisone), tofacitinib (Xeljanz), naproxen (Aleve), celecoxib (Celebrex), tramadol (Ultram), certain antidepressants, including amitriptyline (Elavil), citalopram (Celexa), fluoxetine (Prozac), mirtazapine (Remeron), paroxetine (Paxil), sertraline (Zoloft), and certain medications for fibromyalgia, including gabapentin (Neurontin) and pregabalin (Lyrica).
Are CBD products legal? CBD products derived from hemp are no longer considered Schedule I drugs under the federal Controlled Substances Act, but they still remain in a legal gray zone. There are changes underway on federal and state levels that will ultimately clarify the laws and regulations related to CBD-based products and sales. Despite that, they’re widely available in nearly every state and online. People who want to use CBD should check their state laws.
Taking the First Step
Should I give CBD a try? Without quality clinical studies on CBD and arthritis, doctors have not been able to say who might benefit from CBD, at what dose and in which form, who likely won’t benefit and who should avoid it. Still, there is agreement on several points:
- CBD is not a substitute for disease-modifying treatment for inflammatory arthritis.
- Patients who are interested in trying CBD should first talk to the health care provider who treats their arthritis before trying CBD. Together, they can review what has worked or not worked in the past, whether there are other options to try first, how to do a trial run, what to watch for and when to return for a follow-up visit to evaluate the results. Keep a symptom and dose diary to track effects.
- Quality CBD products can be expensive, especially when used for prolonged periods. To avoid wasting money, be completely sure that the product is truly having a positive effect on symptoms.
What type of product should I consider? CBD-based products can be taken orally, applied to the skin or inhaled. There are pros and cons for each.
By mouth. CBD that is swallowed, whether in capsules, food or liquid, is absorbed through the digestive tract. Absorption is slow and dosing is tricky due to the delayed onset of effect (one to two hours), unknown effects of stomach acids, recent meals and other factors.
Capsules can work for daily use after a safe, effective capsule dose has been established. Experts discourage taking CBD via edibles, like gummies and cookies, because dosing is unreliable, and they are appealing to children but do not come in childproof containers. Like any medicine, edibles should be secured out of sight and reach of children.
CBD can also be absorbed directly into the bloodstream by holding liquid from a spray or tincture (a liquid dosed by a dropper) under the tongue (sublingual) for 60 to 120 seconds. The taste may not be pleasant. Effects may be felt within 15 to 45 minutes.
On the skin. Topical products, like lotions and balms, are applied to the skin over a painful joint. Whether these products deliver CBD below the skin is unknown. Topical products may also include common over-the-counter ingredients such as menthol, capsaicin or camphor, making it difficult to determine if a positive effect is due to the CBD or another ingredient.
Inhaled. CBD can be inhaled via a vaporizing, or vape, pen. However, inhalation of vapor oils and chemical byproducts carry unknown risks, particularly for people with inflammatory arthritis. For this reason and because the Centers for Disease Control and Prevention is investigating vaping in association with widespread hospitalizations and deaths from severe pulmonary disease, vaping is not recommended.
How much CBD should I use? While there are no established clinical guidelines, the medical experts consulted by the Arthritis Foundation recommend the following for adults:
- When preparing to take a liquid form, be aware that the CBD extract is mixed with a carrier oil, so there are two measures to know: the amount of the liquid product to take (the dose) and the amount of CBD in each dose.
- Go low and slow. Start with just a few milligrams of CBD in sublingual form twice a day. If relief is inadequate after one week, increase the dose by that same amount. If needed, go up in small increments over several weeks. If you find relief, continue taking that dose twice daily to maintain a stable level of CBD in the blood.
- If CBD alone doesn’t work and you are in a state where medical or recreational marijuana is legal, talk to your doctor about taking CBD with a very low-dose THC product. Be aware that THC, even at low levels, may get you high, creating cognitive, motor and balance issues. Try THC-containing products at home or at night first, so you can sleep off any unwanted effects.
- After several weeks, if you don’t find relief with CBD alone or with a combination of CBD and very low THC, CBD may not be right for you.
- If you experience any unwanted side effects when using a CBD product, immediately discontinue use and inform your doctor.
What to Look for When Shopping
There is good reason to be a cautious shopper. CBD products are largely unregulated in the U.S. market. Independent testing has shown mislabeling and lack of quality control. The biggest issues are strength of CBD (significantly more or less than the label says), the presence of undeclared THC, and contamination with pesticides, metals and solvents.
- Look for products manufactured in the U.S. with ingredients grown domestically.
- Choose products made by companies that follow good manufacturing practices established by the FDA for pharmaceuticals or dietary supplements (a voluntary quality standard because CBD products are not federally regulated under either category) or required by the state where they are manufactured.
- Buy from companies that test each batch and provide a certificate of analysis from an independent lab that uses validated standardized testing methods approved by the American Herbal Pharmacopoeia (AHP), the U.S. Pharmacopeia (USP), or the Association of Official Agricultural Chemists (AOAC).
- Avoid companies that claim their products have disease benefits.
- Be aware that marketers and people behind retail counters are not health professionals; they are salespeople. That’s why your doctor is your best source for guidance and monitoring when using an unregulated product.
Our gratitude to the following experts for their guidance and review:
Kevin Boehnke, PhD, a researcher at the Chronic Pain and Fatigue Research Center at the University of Michigan, focuses on medical cannabis as an analgesic and opioid substitute in chronic pain.
Daniel Clauw, MD, a professor of anesthesiology, rheumatology and psychiatry at the University of Michigan and director of the Chronic Pain and Fatigue Research Center, leads research on arthritis pain and fibromyalgia, and the effects of cannabis, particularly CBD, in pain.
Mary-Ann Fitzcharles, MD, an associate professor of medicine in the Division of Rheumatology at McGill University in Montreal, Quebec, conducts research on pain and rheumatic diseases. She is the lead author of the 2019 Canadian Rheumatology Association (CRA) position statement for medical cannabis.
People with arthritis may consider CBD products for pain relief. Learn what science and experts say about CBD’s benefits, risks, different ways the product can be used and how to be a smart shopper.