cbd oil applied for arthritis

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.

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.

Should You Take CBD for Arthritis Pain? A New Guide Aims to Help You Decide

The Arthritis Foundation’s new guidance on CBD use urges caution and awareness of potential drug interactions.

In a nod to the reality that people with arthritis are turning to cannabidiol (CBD) to quell pain and manage other symptoms, the Arthritis Foundation has released guidance to help them better understand this trendy compound and the risks associated with it.

Little research has been done on CBD in humans — and none on people with arthritis, the foundation asserts. Still, they wanted to look closely at this supplement because of its increasing popularity.

“Patients are not waiting for more research. They are using CBD now,” says Marcy O'Koon, the senior director of consumer health at the Arthritis Foundation, in Atlanta. “We realized it was upon us to develop something to help people to be safe, to not fall prey to aggressive marketing and inaccurate claims,” she says.

What Is CBD, and Why Has Its Popularity Soared?

CBD is one of the many chemicals known as cannabinoids that occur naturally in the cannabis plant, which includes both hemp and marijuana. Most of the CBD available in stores and online is made from hemp, a plant that does not contain much tetrahydrocannabinol, or THC, the chemical in marijuana that’s responsible for making people high.

Consumers’ usage of CBD has exploded in recent years. Whereas few people had even heard of CBD a few years ago, now it is poised to become a $22 billion business by 2022, according to the Brightfield Group, an industry analyst. One reason for the growth: The latest Farm Bill finally made hemp legal in the United States, removing it from the prohibited Schedule 1 category of drugs that includes marijuana and ecstasy. And, of course, in states where medical or recreational marijuana are now legal, CBD (with or without THC) can be purchased in dispensaries.

CBD Is Already Widely Used by People With Arthritis

Even without studies showing that it works for arthritis, people with the condition are diving into the marketplace. A survey by California researchers of nearly 2,500 respondents, published in Cannabis and Cannabinoid Research in July 2018, found that chronic pain and joint pain are the top two medical conditions for which people take CBD. The next three — anxiety, depression, and insomnia — also affect many people with arthritis.

The Arthritis Foundation conducted its own online survey this past July, of 2,600 people with arthritis. Because these people elected to be in the survey, the results are not necessarily representative of everyone with arthritis. Still, the survey found that 79 percent of respondents had tried CBD or were considering using it, primarily to relieve pain, the most burdensome arthritis symptom.

Nearly 30 percent of respondents said they were currently using CBD, and three out of four of them reported getting relief. Not only had their physical function and morning stiffness improved, many said it helped them sleep or be less fatigued, or reduced symptoms of anxiety or depression.

Research on CBD Severely Limited

The Arthritis Foundation is clear that its guidelines are not meant as an endorsement of CBD. “The guidance was worded very carefully. We are not trying to suggest that it is effective or absolutely safe. We are projecting the state of knowledge as it is,” O’Koon says.

Unfortunately, that state of knowledge is sparse. As the guidelines note, “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.”

Using CBD Safely When You Have Arthritis

Still, the Arthritis Foundation wants to help consumers navigate this often-fraught marketplace as best as they can. Important advice from their guidelines includes:

Go low and slow. Without adequate research, there are no established clinical guidelines for how much CBD to take. Start with a low dose of just a few milligrams, adding a few more after a week. If that doesn’t help, go up in small increments in the next several weeks. If that brings relief, continue taking that dose twice daily to maintain a stable level of CBD in the blood.

You can currently find CBD in lotions, suppositories, food, edibles, vaping, and other means. The Arthritis Foundation recommends avoiding all these delivery systems. Instead, they suggest swallowing CBD in capsules, or using a spray or tincture under the tongue (known as sublingual delivery) and holding it there for a minute or two.

Don’t shun DMARDs. “CBD should never be used to replace disease-modifying drugs that help prevent permanent joint damage in inflammatory types of arthritis,” the guidelines state. CBD might help with the symptoms of arthritis, but there is no evidence it can alter the course of your disease, O’Koon emphasizes.

And even though your doctor may not know much about this substance, it’s important to keep your medical care provider informed. “CBD use should be discussed with your doctor in advance, with follow-up evaluations every three months or so, as would be done for any new treatment,” the guidelines state.

Beware of drug interactions. One important reason to discuss CBD with your doctor is that scientists have identified many classes of drugs that theoretically might interact with CBD, impacting the drug’s effectiveness.

This doesn’t mean you must avoid CBD if you are on these medicines, O’Koon says, but it’s important for you and your doctor to pay closer attention to symptoms and side effects.

Shop very carefully. CBD is currently sold in all kinds of shops — not just dispensaries but also hair salons, restaurants, health-food stores, spas, and more. Because CBD products are largely unregulated in the United States, the range of quality of these products varies tremendously.

In some cases, CBD products are even mislabeled or, worse, adulterated. A study published in the Journal of the American Medical Association (JAMA) in 2017 found that of the 84 CBD products the researchers bought online, a whopping 43 percent had more CBD than indicated, while 26 percent had less. Eighteen of the products contained unexpected THC.

“There’s a 75 percent chance of getting a product where the CBD is mislabeled,” says Jahan Marcu, PhD, one of the study's coauthors and a cofounder of the International Research Center on Cannabis and Mental Health in New York City. Dr. Marcu also worries about possible contaminants in CBD products made from hemp, because the plant readily absorbs pesticides, heavy metals, and other harmful substances.

The Arthritis Foundation urges consumers to buy from companies that take steps indicating they care about quality. These include following good manufacturing practices established by the FDA for pharmaceuticals or dietary supplements; testing each batch it manufactures and providing a certificate of analysis for each test from a reputable independent lab; and manufacturing its products in the United States, with ingredients grown domestically.

Know when it’s not for you. Good-quality CBD can be expensive, especially if you take it regularly. That’s why the Arthritis Foundation says that to avoid wasting money, “be completely sure that the product is truly having a positive effect on symptoms.”

O’Koon suggests keeping a diary of whether and how your symptoms change. After six to eight weeks, you should notice some differences.

If you don’t, and if you live in a state where medical or recreational marijuana is legal, you might try a marijuana-based product that adds very-low-dose THC to the CBD, the Arthritis Foundation guidelines suggest. This is because some think THC and CBD might enhance one another, boosting their effectiveness.

But if after a few months of trial you’re still not feeling relief, it’s time to throw in the towel. “If you’re not experiencing any benefit, there’s no reason to keep taking it,” O’Koon says.

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.

Turmeric

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

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

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

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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