Does CBD help with arthritis pain?
If you have chronic arthritis pain, you may be wondering about cannabidiol (CBD) as a treatment. CBD, along with delta-9-tetrahydrocannabinol (THC) and other chemicals, is found in marijuana. But unlike THC, CBD is not “psychoactive” — that is, it does not cause the intoxication or high associated with marijuana use.
There’s a good chance you’ve tried it already: according to a Gallup poll in August of 2019, about 14% of Americans report using CBD products, and the number one reason is pain. The Arthritis Foundation conducted its own poll and found that 29% reported current use of CBD (mostly in liquid or topical form), and nearly 80% of respondents were either using it, had used it in the past, or were considering it. Of those using it, most reported improvement in physical function, sleep, and well-being; of note, a minority reported improvement in pain or stiffness.
Perhaps you’ve been tempted to try it. After all, most types of arthritis are not cured by other treatments, and CBD is considered a less addictive option than opiates. Or maybe it’s the marketing that recommends CBD products for everything from arthritis to anxiety to seizures. The ads are pretty hard to miss. (Now here’s a coincidence: as I was writing this, my email preview pane displayed a message that seemed to jump off the screen: CBD Has Helped Millions!! Try It Free Today!)
What’s the evidence it works? And what do experts recommend? Until recently, there’s been little research and even less guidance for people (or their doctors) interested in CBD products that are now increasingly legal and widely promoted.
But now, there is.
A word about arthritis pain
It’s worth emphasizing that there are more than 100 types of arthritis, and while pain is a cardinal feature of all of them, these conditions do not all act alike. And what works for one may not work for another. Treatment is aimed at reducing pain and stiffness and maintaining function for all types of arthritis. But for certain conditions, such as rheumatoid arthritis, conventional prescription medications are highly recommended, because these drugs help prevent permanent joint damage and worsening disability.
In addition, individuals experience pain and respond to treatment in different ways. As a result, it’s highly unlikely that there is a single CBD-containing product that works for all people with all types of arthritis.
What’s the evidence that CBD is effective for chronic arthritis pain?
While there are laboratory studies suggesting CBD might be a promising approach, and animal studies showing anti-inflammatory and pain-relieving effects, well-designed studies demonstrating compelling evidence that CBD is safe and effective for chronic arthritis pain in humans do not exist. A randomized trial of topical CBD for osteoarthritis of the knee has been published, but in abstract form only (meaning it’s a preliminary report that summarizes the trial and has not been thoroughly vetted yet); the trial lasted only 12 weeks, and results were mixed at best. One of the largest reviews examined the health effects of cannabis and CBD, and concluded that there is “substantial evidence that cannabis is an effective treatment for chronic pain in adults.” But there was no specific conclusion regarding CBD, presumably because definitive studies were not available.
Of course, there is anecdotal evidence and testimonials galore, including reports of dramatic improvement by people who tried CBD in its various forms (including capsule, liquid, topical, and spray) for their pain. But we are still waiting for well-designed, scientifically valid, and rigorous clinical trials (such as this one in progress) that are so badly needed to answer the question of just how helpful CBD may be to people with chronic arthritis pain.
Are there downsides to CBD treatment?
As with any treatment, there can be downsides. CBD is generally considered safe; however, it can still cause lightheadedness, sleepiness, dry mouth, and rarely, liver problems. There may be uncertainty about the potency or purity of CBD products (since they are not regulated as prescription medications are), and CBD can interact with other medications. For pregnant women, concern has been raised about a possible link between inhaled cannabis and lower-birthweight babies; it’s not clear if this applies to CBD. Some pain specialists have concerns that CBD may upset the body’s natural system of pain regulation, leading to tolerance (so that higher doses are needed for the same effect), though the potential for addiction is generally considered to be low.
There is one definite downside: cost. Prices range widely but CBD products aren’t inexpensive, and depending on dose, frequency, and formulation, the cost can be considerable — I found one brand that was $120/month, and health insurance does not usually cover it.
Are there guidelines about the use of CBD for chronic arthritis pain?
Until recently, little guidance has been available for people with arthritis pain who were interested in CBD treatment. Depending on availability and interest, patients and their doctors had to decide on their own whether CBD was a reasonable option in each specific case. To a large degree that’s still true, but some guidelines have been published. Here’s one set of guidelines for people pursuing treatment with CBD that I find quite reasonable (based on recommendations from the Arthritis Foundation and a recent commentary published in the medical journal Arthritis Care & Research):
- If considering a CBD product, choose one that has been independently tested for purity, potency, and safety — for example, look for one that has received a “Good Manufacturing Practices” (GMP) certification.
- CBD should be one part of an overall pain management plan that includes nonmedication options (such as exercise) and psychological support.
- Choose an oral treatment (rather than inhaled products) and start with a low dose taken in the evening.
- Establish initial goals of treatment within a realistic period of time — for example, a reduction in knee pain that allows you to walk around the block within two weeks of starting treatment; later, if improved, the goals can be adjusted.
- Tell your doctor(s) about your planned and current CBD treatment; monitor your pain and adjust medications with your medical providers, rather than with nonmedical practitioners (such as those selling CBD products).
- Don’t make CBD your first choice for pain relief; it is more appropriate to consider it if other treatments have not been effective enough.
- Don’t have nonmedical practitioners (such as those selling CBD products) managing your chronic pain; pain management should be between you and your healthcare team, even if it includes CBD.
- For people with rheumatoid arthritis or related conditions, do not stop prescribed medications that may be protecting your joints from future damage; discuss any changes to your medication regimen with your doctor.
The bottom line
If you’re interested in CBD treatment for chronic arthritis pain or if you’re already taking it, review the pros, cons, and latest news with your healthcare providers, and together you can decide on a reasonable treatment plan. Depending on the type of arthritis you have, it may be quite important to continue your conventional, prescribed medications even if you pursue additional relief with CBD products.
We may not have all the evidence we’d like, but if CBD can safely improve your symptoms, it may be worth considering.
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Medical Marijuana: Facts about cannabis, THC, and CBD
Exploring medical cannabis means becoming a highly educated consumer. You need to learn as much as you can from a variety of sources. This guide is intended to help you make a more-informed decision. This guide can’t tell you whether medical cannabis will alleviate your health conditions or symptoms. But it will provide basic information to help you consider whether medical cannabis is right for you, ideally working openly with your physician and other health care providers.
Osteoarthritis of the Knee Pain Study Using a CBD and THC Sublingual Tablet
This study is a prospective Phase 2, drug controlled, open-label study to evaluate the safety and efficacy of Pure Green sublingual tablets for the treatment of pain associated with osteoarthritis of the knee.
|Condition or disease||Intervention/treatment||Phase|
|Osteoarthritis, Knee Pain||Drug: Test Article||Phase 2|
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||30 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Official Title:||Osteoarthritis of the Knee Pain Study Using CBD and THC in Rapidly Dissolvable Sublingual Tablet|
|Estimated Study Start Date :||April 20, 2020|
|Estimated Primary Completion Date :||June 30, 2020|
|Estimated Study Completion Date :||July 15, 2020|
Subjects will take 2 tablets daily, one in the morning and one in the evening, and are able to take up to 2 additional tablets per day as needed for pain.
Impact of Pure Green sublingual tablets on pain due to osteoarthritis of the knee using a daily self-reported pain scale score. [ Time Frame: 30 days ]
To evaluate the safety and efficacy of Pure Green sublingual tablets for the treatment of pain due to osteoarthritis of the knee by having patients evaluate their daily pain scale score reported as 0-10 where 0 is no pain and 10 is the worst pain possible as self-reported with every dose taken by the patient in the smart phone app. The objective is to reduce the patients average daily pain scale score to less than 4.
Impact of Pure Green sublingual tablets on general health and well-being of Osteoarthritis of the knee patients. [ Time Frame: 30 Days ]
To evaluate the impact of Pure Green sublingual tablets on the general health and well-being of osteoarthritis of the knee patiens. The objective is to examine quality of life metrics: overall quality of life and general health, physical health, and knee pain as measured on a 1-5 scale before and after the study
The Pittsburgh Sleep Quality Index will be used to compare pre and post Pure Green sublingual tablet study on sleep changes. Patients will be asked questions before beginning of the study and after completion.
The Hamilton Anxiety rating scale questionnaire will be administered before the study begins and after completion to examine the impact of Pure Green sublingual tablets on anxiety in patients with osteoarthritis of the knee. The scale of 0-4 will be used where 0 is no anxiety present and 4 is very severe anxiety.
To explore the impact of sublingual administration on patient compliance by evaluating the number of tablets taken per day as entered by the patients into the smart phone app.
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
|Ages Eligible for Study:||21 Years and older (Adult, Older Adult)|
|Sexes Eligible for Study:||All|
|Accepts Healthy Volunteers:||No|
- Subject is at least 21 years of age;
- Subject has a diagnosis of a pain related to osteoarthritis of the knee as determined by the subject’s primary care physician or related health care provider.
- Subject has a mean pain scale score of ≥ 4 recorded in the 7 days prior to enrollment.
- If female, the subject is postmenopausal (> 1 year), surgically sterile (> 3 months), had a hysterectomy, or is currently using 2 effective forms of birth control.
- Subject has not taken marijuana (cannabis) in any form, chemicals or extracts or foods or beverages or topical creams, lotions, gels, patches containing marijuana (cannabinoids, or and cannabis derivatives) including synthetic marijuana and/or CBD for at least 14 days prior to this study, and promises to not take marijuana (cannabis) in any form, chemicals or extracts or foods or beverages or topical creams, lotions, gels, patches containing marijuana (cannabinoids, or and cannabis derivatives) including synthetic marijuana and/or CBD while participating in this study.
- Subject has not taken any pain medication, including NSAIDs, for at least 2 days before taking the first dose of study drug.
- Subject is willing to provide his/her written informed consent to participate in the study as stated in the informed consent document.
- Subject is willing to use an electronic diary to enter a pain scale score up to four times a day for 28 days.
- Subject is pregnant or lactating;
- Subject has an allergy to cannabis, the Cannabaceae plant family (e.g., hemp, hops), palmitoylethanolamide, or terpenes;
- Subject has a known allergy to active or inert ingredients of PG-OA-10:10-2020-B tablets;
- Subject is taking a concomitant medication or treatment that would complicate use or interpretation of the study drug’s effects (examples include: Cannabis or any cannabinoid products; Any drug or herbal product that influences the endocannabinoid system (ECS));
- Subject is taking marijuana (cannabis) in any form, chemicals or extracts or foods or beverages or topical creams, lotions, gels, patches containing marijuana (cannabinoids, or and cannabis derivatives) including synthetic marijuana and/or CBD for at least 14 days prior to this study, and does not promise that they will not take marijuana (cannabis) in any form, chemicals or extracts or foods or beverages or topical creams, lotions, gels, patches containing marijuana (cannabinoids, or and cannabis derivatives) including synthetic marijuana and/or CBD while participating in this study;
- Subject is currently being treated with antibiotics for sinus, throat, or lung infections;
- Subject has shortness of breath associated with allergies;
- Subject has uncontrolled asthma;
- Subject has a fever and/or productive cough;
- Subject has unstable angina, uncontrolled hypertension;
- Subject currently or has a history of congestive heart failure;
- Subject has any other unstable medical condition;
- Subject has a personal or family history of schizophrenia;
- Subject has a personal history or currently has suicidal ideation or attempted suicide;
- Subject has a major neurological disorder, such as dementia, Parkinson’s disease, cognitive impairment, epilepsy, history of traumatic brain injury/head injury, and seizures.
- Subject has taken pain medicine of any kind throughout the screening period, or has taken acetaminophen within 2 days of taking the first dose of study drug.
- Subject has an allergy to, or has an intolerance to, acetaminophen.
- Subject is currently taking any form of opioids.
- Subject has a history of alcohol or substance abuse
- Subject has clinically significant illness, including cardiovascular disorders.
- Subject has any condition in which the investigator believes will confound the data of the study or could put the subject at risk of harm.
- Subject does not have access to a smart phone or does not know how to use a smart phone application.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04195269
Complementary treatments and arthritis – from turmeric to cannabis oil
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 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 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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