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CBD Oil for Arthritis Pain: Does It Relieve Symptoms?

Cannabidiol oil, known as CBD oil or hemp oil, is all the rage these days, touted as a panacea for everything from cancer pain to depression and anxiety. Some research has indicated that it can relieve the pain of various forms of arthritis as well. CBD oil contains extracts from cannabis plants, which is the same plant family that marijuana (pot) comes from.

But let’s get this out of the way: CBD is not the same thing as pot and it will not get you high. The only thing the two have in common is that they are both derived from members of the cannabis family. Marijuana is the plant that contains tetrahydrocannabinol (THC), the psychoactive substance that induces the “high.”

CBD is not the same thing as pot and it will not get you high.

While marijuana contains some CBD, it is grown for its THC content. The hemp plant is the one that provides the source for the majority of the CBD oil products on the market today. Hemp contains an insignificant amount of THC (less than 0.3 percent); in contrast, marijuana can contain anywhere from 5 percent to 35 percent.

Some people have started using CBD oil to help relieve pain and lower inflammation, but the jury’s still out on whether or to what degree using it can help people with arthritis. Here’s what we know so far:

CBD Oil and Arthritis Pain Relief

The mechanism responsible for CBD’s positive health effects is not entirely understood, but researchers believe that the compound attaches to receptors in the body known as cannabinoid receptors; these may, in turn, cause the body to produce natural cannabinoids.

CBD oil doesn’t affect your brain the same way that THC does. THC interacts with different receptors in the brain than does CBD. According to Healthline, CBD oil interacts with two receptors, called CB1 and CB2, which can help reduce pain and the effects of inflammation.

“These receptors are primarily involved with coordination, movement, pain, emotional output, and the immune system,” explains Faye Rim, MDD, a physiatrist and pain management specialist at the Hospital for Special Surgery in New York City.

CB2’s involvement in immune system could help explain why CBD oil may be helpful in people with inflammatory autoimmune forms of arthritis, like rheumatoid arthritis (RA).

Dr. Rim says some of her arthritis patients have found relief, but she points out that CBD oil is only intended for use as an adjunct to medications, not as a first-line treatment.

How Do You Use CBD for Arthritis Pain?

CBD can be taken as a liquid, a tincture, in capsules, or applied topically. You can take the capsules orally, add the liquid to foods or drinks, or apply creams with CBD to affected joints. Read more about to start using CBD products for arthritis pain.

Mild side effects of using CBD may include sleep problems or nausea. The topical CBD arthritis cream occasionally causes an allergic reaction, so test it on a small area of skin first.

Most studies on CBD and arthritis have been done on rodents, including one published in a 2017 issue of the journal Pain that suggests CBD oil may relieve joint pain in osteoarthritis. A study in a 2016 issue of Arthritis Care and Research found that CBD oil may improve pain relief, sleep, and quality of life in some rheumatoid arthritis (RA) patients, but the sample size was extremely small, making the study mostly insignificant.

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As Medical News Today reports, “there a lack of scientific evidence to prove conclusively that CBD is an effective arthritis treatment for humans.” More research, especially on bigger groups of human participants, will need to be conducted to better understand how CBD oil affects arthritis symptoms like pain, inflammation, and fatigue.

“I find it’s hit or miss,” says Dr. Rim. “[CBD] helps some people and has no effect on others, but I recommend that my patients try it, as there don’t seem to be any problematic drug interactions or major side effects.”

Currently, the FDA has approved CBD oil only for use in people with two rare and severe forms of epilepsy. It is not approved for the treatment of arthritis or chronic pain.

What to Know Before You Buy CBD

Because CBD products are currently unregulated — and often imported — it is very difficult to know exactly what you’re getting, and how much of it, in any given formulation.

This lack of regulation can result in products that vary widely in quality, Marcel Bonn-Miller, PhD, an adjunct assistant professor of psychology in psychiatry at the University of Pennsylvania School of Medicine, told HealthDay News.

Furthermore, CBD is legal in most states, but not all. Make sure you understand your state’s laws before purchasing or taking CBD oil.

When recommending CBD oil to her patients, Dr. Rim says she has no specific dosages or brands in mind. “I generally refer them to a health food store and encourage them to try a small amount at first and to increase if it’s well-tolerated.”

The hope, she says, is that we will have more definitive data on dosages and quality products over time.

You should check with your doctor before trying CBD oil to make sure it’s safe for you and won’t negatively interact with any medications you take.

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!)

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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):

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Dos:

  • 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’ts:

  • 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.

Follow me on Twitter @RobShmerling

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