How To Use CBD for Arthritis

How To Use CBD for Arthritis

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Dr. Zora DeGrandpre

Written by Dr. Zora DeGrandpre

Updated January 5, 2021

Arthritis is a condition marked by inflammation of the joints. The main symptoms of arthritis are joint pain, redness, tenderness, swelling and stiffness. Many people also have significant stiffness in the joints and a reduced mobility of that joint—this is usually referred to as a decreased range of motion.

350 million people around the world suffer from arthritis, including osteoarthritis, rheumatoid arthritis, and psoriatic arthritis.

  • Osteoarthritis (OA) is due to wear and tear from use and overuse of joints. It affects the cartilage on the ends of the bones of the joints, causing the joints to “grind” against each end. OA increases as we age and is more common in women and can also be associated with obesity, joint injury and overuse.
  • Rheumatoid arthritis (RA) is an autoimmune disorder—the immune system gets “confused” and begins to attack the lining of the joint capsule- the synovial membrane which then becomes inflamed, swollen and painful. RA is more common in women.
  • Psoriatic arthritis is associated with the skin condition, psoriasis. It can affect any joint either on just one side or both sides of the body.
  • Other forms of arthritis—there are over 100—include gout, juvenile arthritis, reactive arthritis, infectious arthritis and ankylosing spondylitis.

The long-term effects of arthritis are degeneration and destruction of the joints. 

While many conventional medications for arthritis are available, they are not always effective and some carry significant adverse side effects.

Many arthritis sufferers are choosing to use medical cannabis for its anti-inflammatory properties, pain management, and because of minimal side effects. CBD is derived from hemp—a cousin of cannabis—and has been shown to have potential benefits for arthritis.

Holding For Hand

The pain associated with arthritis is mainly due to inflammation.  CBD has been shown to reduce inflammation and thus possibly reduce the pain of arthritis.

CBD is non-intoxicating which is a fancy way of saying it will not get you high. Its primary benefit appears to be the anti-inflammatory actions—this action has been shown in several different animal studies to benefit arthritis pain1, 2. While human studies are limited—keep your eye on these pages as more data is published—preliminary evidence indicates that topical application of CBD can directly and positively affect pain in arthritic joints3, 4, 5.

Are there side effects when using CBD for arthritis?

Side effects are always possible and you should always be aware of drug interactions with CBD, especially if you plan to use CBD in high doses (in the hundreds of milligrams).

Side effects which can occur with CBD are drowsiness, upset stomach, diarrhea, sedation, and dry mouth6. Generally, CBD is very well tolerated and most people have  few significant side effects with CBD. 

If you are new to CBD, start with a low dose to assess if you will have any side effects. Then you can start slowly increasing the dose until you reach pain relief.

How does CBD work for arthritis?

CBD is considered an effective anti-inflammatory agent—and inflammation is at the root of arthritic pain. CBD appears to decrease inflammation in the body and at the affected joint so that a person with arthritis will have less pain.

Other important cannabinoids with anti-inflammatory properties include: THC, cannabichromene (CBC), tetrahydrocannabinolic acid (THCA), cannabigerol (CBG), cannabidiolic acid (CBDA), cannabigivarin (CBGV), and cannabigerolic acid (CBGA).

How should I use CBD for arthritis?

Always speak with a doctor before using CBD, especially if you already take other medications.  

CBD can cause drug interactions. It may increase or decrease the blood levels of different drugs—it is best to talk to your doctor and pharmacist about your specific risks for interactions. This may be especially important if you are taking any of the following medications7:

  • Antidepressants
  • Anti-psychotics
  • Macrolide antibiotics such as erythromycin or clarithromycin
  • Anticoagulants or blood thinners
  • Statins
  • Some heart medications including calcium channel blockers (eg. Amlodipine, diltiazem, felodipine, verapamil)

Because of the connection between joint inflammation, arthritis and pain, using CBD for arthritis may reduce the arthritic pain and discomfort.

Most delivery methods all work well for relief from arthritis but for smaller areas, topical may often be best. Other delivery methods can include vaping, tinctures, edibles and capsules.

The fastest relief can come from vaping, using tinctures, and applying topicals to treat local pain. You should be aware, however that while vaping can produce the fastest results, there are still a number of health issues with vaping. While vape products from reputable companies appear to be safe, there is much we don’t know about the effects of long-term or short-term vaping on the lungs.

CBD and THC may work synergistically together for relieving pain. The ratios of CBD to THC most commonly used for pain relief vary from 2:1 (CBD to THC) to 1:2 (CBD:THC). Keep in mind that if you use larger doses of CBD, maintaining those ratios may not be legal in your state. Both cannabinoids are anti-inflammatory. 

If you dislike the psychoactive effects of THC, you can stick to just CBD, or mostly CBD during the day and add in some THC products at night.

Always start with a low dose of CBD and increase it in small, even increments until you reach the desired relief you are seeking.

What are terpenes, and are terpenes beneficial for arthritis?

When CBD is extracted from the hemp plant, another very large class of plant substances—the terpenes—are extracted as well.  Terpenes are currently a “hot research” topic because many have beneficial medicinal properties that may work alongside CBD in what is known as the “entourage effect”.The following terpenes are good to look for because they work synergistically with CBD to provide relief from inflammation8. 

  • β-caryophyllene (beta-caryophyllene)
  • α-Pinene (alpha-pinene)
  • Myrcene
  • Linalool
  • Limonene

What do research studies have to say about CBD for arthritis?

  • CBD, cannabinoids, and compounds in cannabis decrease inflammation by blocking the formation of pro-inflammatory cytokines. Cytokines are a general term for substances that act as intracellular messengers and are made in response to an infection, injury, or triggered by an improperly working immune system (as in an autoimmune disease)9, 10.
  • Pre-clinical studies—ie. animal studies—have shown that CBD can act through a variety of mechanisms to reduce the inflammatory response thereby reducing pain11, 12, 13.
  • There have been no studies done in humans to date—but watch this space!
  • THC has been shown to be 20 times more anti-inflammatory than aspirin and 2 times more anti-inflammatory than hydrocortisone14.

Recently, the Arthritis Foundation produced a set of guidelines for the use of CBD in arthritis. In the guidelines, they state: “We are intrigued by the potential of CBD to help people find pain relief and are on record urging the FDA to expedite the study and regulation of these products. While currently there is limited scientific evidence about CBD’s ability to help ease arthritis symptoms, and no universal quality standards or regulations exist, we have listened to our constituents and consulted with leading experts** to develop these general recommendations for adults who are interested in trying CBD15.”

References

1Malfait AM, Gallily R, Sumariwalla PF, Malik AS, Andreakos E, Mechoulam R, Feldmann M. The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis. Proceedings of the National Academy of Sciences. 2000 Aug 15;97(17):9561-6. https://www.pnas.org/content/pnas/97/17/9561.full.pdf 

2Hammell DC, Zhang LP, Ma F, Abshire SM, McIlwrath SL, Stinchcomb AL, Westlund KN. Transdermal cannabidiol reduces inflammation and painrelated behaviours in a rat model of arthritis. European Journal of Pain. 2016 Jul;20(6):936-48. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851925/?source=post_page

3Hendricks O, Andersen TE, Christiansen AA, Primdahl J, Hauge EM, Ellingsen T, Horsted TI, Bachmann AG, Loft AG, Bojesen AB, Østergaard M. Efficacy and safety of cannabidiol followed by an open label add-on of tetrahydrocannabinol for the treatment of chronic pain in patients with rheumatoid arthritis or ankylosing spondylitis: protocol for a multicentre, randomised, placebo-controlled study. BMJ open. 2019 Jun 1;9(6):e028197. https://bmjopen.bmj.com/content/9/6/e028197.abstract

4Gusho CA, Court T. Cannabidiol: A Brief Review of Its Therapeutic and Pharmacologic Efficacy in the Management of Joint Disease. Cureus. 2020 Mar;12(3). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176325/

5Boyaji S, Merkow J, Elman RN, Kaye AD, Yong RJ, Urman RD. The role of cannabidiol (CBD) in chronic pain management: an assessment of current evidence. Current Pain and Headache Reports. 2020 Feb 1;24(2):4. https://link.springer.com/article/10.1007/s11916-020-0835-4

6Chesney E, Oliver D, Green A, Sovi S, Wilson J, Englund A, Freeman TP, McGuire P. Adverse effects of cannabidiol: a systematic review and meta-analysis of randomized clinical trials. Neuropsychopharmacology. 2020 Apr 8:1-8. https://europepmc.org/articles/pmc7608221/bin/41386_2020_667_moesm1_esm.docx

7Brown JD, Winterstein AG. Potential Adverse Drug Events and Drug-Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use. J Clin Med. 2019 Jul 8;8(7):989. doi: 10.3390/jcm8070989. PMID: 31288397; PMCID: PMC6678684. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678684/

8Gallily R, Yekhtin Z, Hanuš LO. The Anti-Inflammatory Properties of Terpenoids from Cannabis. Cannabis Cannabinoid Res. 2018 Dec 26;3(1):282-290. doi: 10.1089/can.2018.0014. PMID: 30596146; PMCID: PMC6308289. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6308289/

9Nagarkatti P, Pandey R, Rieder SA, Hegde VL, Nagarkatti M. Cannabinoids as novel anti-inflammatory drugs. Future Med Chem. 2009 Oct;1(7):1333-49. doi: 10.4155/fmc.09.93. PMID: 20191092; PMCID: PMC2828614. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828614/

10Beg S, Swain S, Hasan H, Barkat MA, Hussain MS. Systematic review of herbals as potential anti-inflammatory agents: Recent advances, current clinical status and future perspectives. Pharmacogn Rev. 2011 Jul;5(10):120-37. doi: 10.4103/0973-7847.91102. PMID: 22279370; PMCID: PMC3263046.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263046/

11Mlost J, Bryk M, Starowicz K. Cannabidiol for Pain Treatment: Focus on Pharmacology and Mechanism of Action. Int J Mol Sci. 2020 Nov 23;21(22):8870. doi: 10.3390/ijms21228870. PMID: 33238607; PMCID: PMC7700528. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700528/

12Hammell DC, Zhang LP, Ma F, Abshire SM, McIlwrath SL, Stinchcomb AL, Westlund KN. Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis. Eur J Pain. 2016 Jul;20(6):936-48. doi: 10.1002/ejp.818. Epub 2015 Oct 30. PMID: 26517407; PMCID: PMC4851925. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851925/

13 Philpott HT, OʼBrien M, McDougall JJ. Attenuation of early phase inflammation by cannabidiol prevents pain and nerve damage in rat osteoarthritis. Pain. 2017 Dec;158(12):2442-2451. doi: 10.1097/j.pain.0000000000001052. PMID: 28885454; PMCID: PMC5690292. https://pubmed.ncbi.nlm.nih.gov/28885454/

14Russo EB. Cannabinoids in the management of difficult to treat pain. Ther Clin Risk Manag. 2008 Feb;4(1):245-59. doi: 10.2147/tcrm.s1928. PMID: 18728714; PMCID: PMC2503660. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503660/

15(2019, September 24). Retrieved January 05, 2021, from https://www.arthritis.org/about-us/news-and-updates/cbd

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