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 ā 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 2019 Gallup poll, 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.
You may have felt tempted to try it. After all, most types of arthritis aren’t cured by other treatments, and CBD is considered less addictive 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.
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 aims to reduce pain and stiffness and maintain function for all types of arthritis. For certain conditions like rheumatoid arthritis, doctors highly recommend conventional prescription medications 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 and psoriatic arthritis found that CBD was no more effective than placebo. Small, short-term or survey-based studies suggest that CBD is potentially helpful for arthritis pain, but these are far from convincing. 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 and arthritis pain, presumably because definitive studies were not available.
Various forms of CBD, including capsules, liquids, topicals, and sprays, showcase dramatic pain relief in numerous anecdotal accounts and testimonials. We still await well-designed clinical trials to determine CBD’s effectiveness in managing chronic arthritis pain, addressing a critical need.
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. CBD products lack regulation like prescription medications, leading to uncertainty about potency and interactions with other medications. There’s concern over inhaled cannabis and lower-birthweight babies in pregnant women; it’s uncertain if this extends to CBD. Pain specialists worry CBD may disrupt the body’s pain regulation, potentially leading to tolerance, but addiction risk is generally low.
There is one definite downside: cost. CBD products vary widely in price, often being costly due to dosage, frequency, and formulation, without coverage by health insurance.
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. Patients and their doctors had to independently determine if CBD was a viable option for their specific case, depending on availability and interest. 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:
Dos:
- When contemplating a CBD product, opt for one independently tested for purity, potency, and safety, like those with “Good Manufacturing Practices” (GMP) certification.
- CBD should constitute a component of a holistic pain management strategy encompassing non-medication solutions like exercise and psychological assistance.
- 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 instance, observing reduced knee pain enabling a walk around the block within two weeks of treatment initiation. Later, if improved, the goals can be adjusted.
- Tell your doctor(s) about your planned and current CBD treatment. Consult medical professionals for pain management adjustments; avoid seeking medication advice from nonmedical sources like CBD product sellers.
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.
- Discuss any medication changes for rheumatoid arthritis with your doctor. Stopping prescribed drugs could risk joint damage without your doctor’s guidance.
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.