If you have chronic arthritis pain, you may have been tempted to try cannabidiol as a treatment, or you may have tried it already. But is there any evidence that it works? Studies are finally addressing this question, and the results are just starting to come in. You may be wondering if marijuana may ease the pain and discomfort from rheumatoid arthritis. Here’s what to know. CBD, a compound derived from hemp, can help soothe joint pain. Here’s how to find a product that works for you.
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.
Follow me on Twitter @RobShmerling
About the Author
Robert H. Shmerling, MD , Senior Faculty Editor, Harvard Health Publishing
Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio
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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.
Medical Marijuana, CBD Oil, and Rheumatoid Arthritis
Researchers still don’t know a lot about how marijuana affects your body. But there is substantial evidence that it can help relieve long-term pain. And pain is a major symptom of rheumatoid arthritis (RA).
Here’s what’s known so far about how medical marijuana and a marijuana extract called CBD (cannabidiol) might affect RA.
Benefits for RA
The Cannabis sativa plant has more than 100 chemicals that can affect your body and mind. The two that scientists know the most about are THC and CBD.
THC, or delta-9-tetrahydrocannabinol, is what gets you high when you smoke, vape, or eat marijuana. CBD doesn’t affect your brain that way. For that reason, some people prefer CBD for medical uses.
Rheumatoid arthritis is an autoimmune disease that can make your joints stiff, tender, and painful. RA also can affect your lungs, eyes, skin, and other body parts.
The federal ban on marijuana and CBD means studies on humans have been few. So researchers don’t know for sure that cannabis eases RA symptoms. But the results from several very small studies suggest that in people with rheumatic diseases, including RA and osteoarthritis, it may help:
- Curb morning pain (but not the overall level of pain)
- Improve sleep
- Lower inflammation in joints (but not joint stiffness)
Some lab testing suggests that cannabinoids may help tamp down the body’s immune response. But the studies have been limited to animals, not humans.
Doctors will need more proof before they can recommend cannabis products to treat rheumatic diseases. For example, we know very little about the effects on RA from smoking marijuana or other uses of herbal marijuana.
Is Cannabis Right for You?
The best way to answer this is to ask your doctor. They can tell you about possible side effects and drug interactions, legal considerations, and which form and at which dose may help you the most.
More than half of the states have legalized marijuana for medical use. More than a dozen other states allow limited medical uses of CBD.
The FDA doesn’t regulate marijuana or CBD, so you might not know exactly what’s in the products you buy. One batch of pot or edible marijuana may have a much higher or lower amount of THC than another, or affect you differently. CBD also can be unpredictable.
Cannabis can affect you mentally and physically. THC can impair driving, so you shouldn’t get behind the wheel for at least 8 hours after you take it. Smoking or vaping (inhaling) marijuana will hit you more quickly than if you eat it. It’s also not good for your lungs or respiratory system.
If you use marijuana regularly, it could make you more likely to get anxiety, depression, and other mental illnesses.
CBD side effects are usually mild or moderate. They can include:
Medical marijuana has similar side effects, that may include:
Where to Get It
Depending on your state, you may need to buy medical marijuana and CBD at specific dispensaries or pharmacies from approved vendors. Your doctor may need to certify that you have a condition that may benefit from marijuana.
Marijuana is available in many forms, like pills, prepared foods, teas, nasal sprays, and as something you smoke or vape.
In some states, CBD is sold at many all-natural food stores and online. It can be taken by mouth as oil or extracts, or applied to your skin.
Chemistry & Biochemistry: “History of Cannabis and Its Preparations in Saga, Science, and Sobriquet.”
Mayo Clinic: “Mayo Clinic Q and A: Treatment with medical cannabis,” “Marijuana,” “What are the benefits of CBD — and is it safe to use?” “Rheumatoid arthritis.”
News release, The National Academies of Sciences, Engineering, and Medicine: “The Health Effects of Cannabis and Cannabinoids.”
Dialogues in Clinical Neuroscience: “Cannabis, Cannabinoids, and Health.”
Arthritis Care & Research: “Efficacy, Tolerability, and Safety of Cannabinoid Treatments in the Rheumatic Diseases: A Systematic Review of Randomized Controlled Trials.”
Nature Reviews Rheumatology: “Cannabinoids for the treatment of rheumatic diseases — where do we stand?”
U.S. Drug Enforcement Administration: “Drug Scheduling.”
Cannabis and Cannabinoid Research: “Cannabis and Pain: A Clinical Review.”
Journal of Medical Toxicology: “Medical Marijuana and Driving: A Review.”
National Center for Complementary and Integrative Health: “Marijuana and Cannabinoids.”
Using CBD for Arthritis: Tips for How to Get Started
Enthusiasts of cannabidiol (better known as CBD) rave about the substance’s health benefits. Some small studies have shown that CBD could be a remedy for anxiety and help children with post-traumatic stress disorder get to sleep. The substance was even FDA-approved last year as a prescription drug to manage rare, severe forms of epilepsy.
So naturally, you might be wondering: Can CBD help people with arthritis and related diseases cope with pain? Anecdotal reports from patients and some preliminary research suggests yes, but the science is still emerging and more research is needed.
Here’s what you need to know right now about how to use CBD to ease arthritis symptoms, how to find a high-quality CBD product, and how to work with your doctor to incorporate CBD into your arthritis treatment plan.
What Is CBD, and Can It Help with Arthritis?
CBD is a chemical found derived from hemp. Hemp and marijuana are both types of cannabis plants, but they are very different from each other. They each have different quantities of various phytocannabinoids, which are substances naturally found in the cannabis plant. (It’s sort of like how different kinds of berries contain different combinations of antioxidants.)
- Marijuana contains an abundance of THC (tetrahydrocannabinol), which is the cannabinoid that gets you high.
- Hemp contains less than 0.3 percent THC. It contains CBD, which is a cannabinoid that doesn’t have any psychoactive effects. CBD cannot make you feel high. Instead, CBD works in other ways with your endocannabinoid system, which is a group of receptors in the body that are affected by the dozens of other documented cannabinoids.
“Cannabinoids can inhibit or excite the release of neurotransmitters [brain chemicals] and play a role in modulating the body’s natural inflammatory response, which are the two things we’re concerned about when talking about CBD for arthritis,” says Hervé Damas,MD, a Miami-based physician and founder of Grassroots Herbals, a CBD product company.
CBD is thought to work on pain in two parts of the body: the site of soreness (such as your finger joints) and the central nervous system, which sends pain signals to the brain when it detects certain stimulation or damage to nerves and cells.
The ability for CBD to calm that response is one reason the compound might be a viable pain remedy for people with arthritis. Another is CBD’s anti-inflammatory properties. Inflammation occurs when your body is fighting a perceived infection. In autoimmune diseases such as rheumatoid arthritis, the immune system is attacking healthy parts of your body like your joints.
It’s important to note that while early research on animals has shown promise for CBD, more research is needed before we can draw anything conclusive for humans. However, anecdotal reports from people who have started incorporating CBD into their arthritis treatment are positive. One CreakyJoints member shared on Facebook that topical CBD “helps better than any other ointment I’ve ever used.” CBD could be worth exploring as a potential solution to pain as part of an overall arthritis treatment plan.
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How to Find the Right CBD Product for You
From supermarkets and pharmacies to health food stores and online retailers, CBD can be found just about everywhere. But how do you choose the right CBD product for your health needs?
1. Pick the CBD Formulation You Want to Use
CBD comes in a few different forms. Commonly used ones include:
- Edibles: You eat CBD infused into gummies, chocolates, sodas, baked goods, and other edible items
- Vaporizer: You inhale CBD through a vape pen that heats up the oil
- Sublingual drops: You take a few drops under your tongue of a high-concentrate solution of CBD
- Topicals: You apply creams, lotions, balms and other products with CBD directly to your skin
The different types of CBD take effect in your body at different rates. Here’s how long you can expect different types of CBD products to kick in, according to Dr. Damas:
- Edibles: 30 minutes to two hours
- Vaporizer: Two minutes
- Sublingual drops: 15-30 minutes
- Topicals: 10 minutes
2. Look for Signs of High-Quality CBD
Don’t just buy the least expensive one on the shelf. There are lots of poor-quality CBD products on the market (some of which don’t contain the amount of CBD they claim, per these FDA warning letters).
Dr. Damas recommends looking for CBD products that are made in the United States, use a carbon dioxide-based extraction method (“It’s the cleanest,” he says), come from organically grown hemp, and don’t contain a lot of extra ingredients. Consumer Reports also has a thorough guide to shopping for CBD that can help you find a high-quality product.
3. Pick the Right Dose
As for dosing of CBD oil, the jury’s still out on just how much you should take. Start with a low dose (such as 5 to 10 mg), and gradually work your way up over a few weeks until you notice the effects.
“Usually people find pain relief when they take 20 to 35 milligrams of CBD daily,” says Dr. Damas.
You can take the full dose at once or break it up throughout the day. Experiment with what makes you feel best. You should start seeing improvements shortly after you start supplementing with CBD, with more noticeable effects kicking in after two weeks.
How to Discuss CBD with Your Doctor
You should talk to the doctor who treats your arthritis before you start taking CBD or any other supplement. They can let you know if CBD might interact with any medications you currently take or potentially worsen a chronic condition. For example, “CBD may make it easier to bleed,” says Dr. Damas. “So if you’re going to have surgery, you might want to stop taking it before the procedure.”
Check out this list of potential drug interactions with CBD from the U.S. National Library of Medicine, but you should always check with your doctor about your individual case.
Keep in mind that your doctor’s knowledge of CBD might be limited. There isn’t a lot of research about the benefits of CBD or about ideal dosages or formulations, so your doctor might not be able to be overly specific in terms of their recommendations. However, they still need to know that you’re taking CBD. Chances are, they’ll be interested in hearing about your experience using CBD products and your self-reports on how CBD may be helping to manage your pain or other symptoms.
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CreakyJoints is a digital community for millions of arthritis patients and caregivers worldwide who seek education, support, advocacy, and patient-centered research. We present patients through our popular social media channels, our website CreakyJoints.org, and the 50-State Network, which includes nearly 1,500 trained volunteer patient, caregiver and healthcare activists.
CreakyJoints is a digital community for millions of arthritis patients and caregivers worldwide who seek education, support, advocacy, and patient-centered research. We represent patients through our popular social media channels, our website CreakyJoints.org, and the 50-State Network, which includes nearly 1,500 trained volunteer patient, caregiver and healthcare activists.
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