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Best cbd oil for ankylosing spondylitis

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

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Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic, systemic, inflammatory diseases, primarily in the musculoskeletal system. Pain and fatigue are key symptoms of RA and AS. Treatment presents a clinical challenge for several reasons, including the progressive nature of the diseases and the involvement of multiple pain mechanisms. Moreover, side effects of pain treatment pose an implicit risk. Currently, no well-controlled studies have investigated how medical cannabis affects pain and cognitive functions in RA and AS. The present study aims to evaluate the efficacy and safety of medical cannabis in the treatment of persistent pain in patients with RA and AS with low disease activity.

Methods and analysis

A double-blinded, randomised, placebo-controlled study of cannabidiol (CBD), followed by an open label add-on of tetrahydrocannabinol (THC) with collection of clinical data and biological materials in RA and AS patients treated in routine care. The oral treatment with CBD in the experimental group is compared with placebo in a control group for 12 weeks, followed by an observational 12-week period with an open label add-on of THC in the primary CBD non-responders. Disease characteristics, psychological parameters, demographics, comorbidities, lifestyle factors, blood samples and serious adverse events are collected at baseline, after 12 and 24 weeks of treatment, and at a follow-up visit at 36 weeks. Data will be analysed in accordance with a predefined statistical analysis plan.

Ethics and dissemination

The Danish Ethics Committee (S-20170217), the Danish Medicines Agency (S-2018010018) and the Danish Data Protection Agency approved the protocol. The project is registered in the European Clinical Trials Database (EudraCT 2017-004226-15). All participants will give written informed consent to participate prior to any study-related procedures. The results will be presented at international conferences and published in peer-reviewed journals.

Keywords: rheumatoid arthritis, ankylosing spondylitis, chronic pain, treatment with medical cannabis

Strengths and limitations of this study

The randomised, double-blind and placebo-controlled design aims to determine outcome data (on the defined endpoints) and, thus, reduces the risk of bias, especially selection bias.

Recruitment in routine care is expected to appropriately reflect the patients and conditions in the two diagnostic groups.

The performance of a controlled study demands the use of medical cannabidiol, and tetrahydrocannabinol instead of plant extracts, that is, tea or herbal preparations.

There is no clinical evidence for the optimal dosage and application ranges. Thus, the treatment regimens for the drugs used are an extrapolation of expert knowledge.

Both primary and secondary endpoints are based on patient-reported outcome measurements and may be influenced by bias.


The treatment of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) has improved significantly over the last three decades. 1–3 Chronic pain and fatigue are symptoms typical of these major inflammatory rheumatic disorders. 4–6 Cognitive dysfunctions, such as concentration and memory problems, are also often reported in patients with chronic pain. These cognitive dysfunctions can be related to pain itself, sleep problems or reflect a side effect of the pharmacological treatment. 4 6 RA affects the small joints of the hands and feet, but can also involve the larger joints. 7 AS mainly affects the spinal and sacroiliac joints and is characterised by back pain and stiffness. 8 Pain may involve nociceptive and non-nociceptive components and is based on the interaction between peripheral inflammation and central sensitisation. 9 10 The immediate pain is triggered by the inflammation of the synovial tissue and/or consecutive oedema of the subchondral bone, and leads to a sensitisation of the peripheral nociceptors. 11

Thus, chronic pain is likely to be due to peripheral joint and central neuropathic pain mechanisms at various stages. 11–16

Treatment of moderate to severe chronic pain is difficult to overcome, for several reasons: heterogeneity of the patients in a given diagnostic group, the progressive nature of the disease, involvement of multiple pain mechanisms and the presence of comorbidities, particularly in elderly patients. 17 The rheumatologist is likely to pay full attention to the anti-inflammatory treatment. This approach implies the fact that chronic pain associated with increased mortality can be overlooked. 18 19

There is a lack of knowledge about the effect of cannabinoids in rheumatic diseases. Based on a Cochrane meta-analysis, the authors concluded that the existing clinical studies of c annabidiol (CBD) applied in monotherapy are of such poor quality that there is insufficient data to draw any conclusions about the effectiveness and/or long-term security of the compound. 20

Currently, only very few studies have investigated how medical cannabis affects cognitive functions, such as concentration and attention. 21 A few studies have investigated the impact of illegally obtained cannabis in RA. 20 Furthermore, studies that have assessed medical cannabis did so mostly in the context of multiple sclerosis. 20 22 23 In contrast to studies of recreational cannabis, the studies in persons with multiple sclerosis indicate that medical cannabis does not negatively affect cognition and could improve sleep quality. Given the limited data and the lack of a proper control condition, no definite conclusions of the potential cognitive impact of medical cannabis could be drawn. 20 24

Hence, concerns about potential negative side effects of medical cannabis on cognition have led the Danish health authorities’ attention on a patient’s ability to drive safely. 20 23 Furthermore, in the treatment of rheumatic diseases, there is no established routine nor rheumatological competence to prescribe medical cannabis. Consequently, there is considerable uncertainty and caution towards the use of medical cannabis, even in the North American countries, where it is already legal to prescribe these compounds for rheumatological conditions. 23 24 This can lead to patients resorting to self-medication with cannabinoids. 20 24 25 Thus, there is a strong need for high-quality studies of the efficacy and side effects of cannabinoids.

The overall aim of the study is to investigate the effect of medical cannabis on pain in patients with RA and AS, to elaborate on the potential dosage of CBD and tetrahydrocannabinol (THC) and to explore if and how the test compounds affect patients’ cognitive functions and sleep.

Materials and methods

Setting and study design

The study is an investigator-initiated, double-blinded, randomised, placebo-controlled intervention study of CBD, followed by an open label add-on of THC. It is designed to evaluate the efficacy and safety of medical cannabis, either as CBD or in the form of the combination treatment of CBD and THC as ‘add-on’ treatment for chronic pain in RA and AS. The patient-reported outcome measurement (PROM), 26 a pain visual analogue scale (VAS) score 27 at a value of at least 50 are the key inclusion criterion. The score range is from 0 to 100; a higher score indicates greater pain intensity. Thus, the null hypothesis, H 0 , is that receiving the active treatment with cannabis derivatives does not improve the pain situation in clinical assessment after 12, 24 and 36 weeks.

Clinical data and outcomes are registered in an electronic Case Report Form (eCRF), based on the Reuma-eCRF system available within the Danish nationwide registry DANBIO. 15 28 DANBIO contains actualised data on ongoing treatment regiments, which therefore easily can be monitored.

Biological samples are collected via the Danish Rheumatologic Biobank. 29 Patients are recruited from four Danish university hospital departments. Patient inclusion is planned to start in November 2018 and is expected to continue for 14 months.


The study population consists of the following:

Patients with seropositive RA 1 currently treated with either conventional disease modifying antirheumatic drugs (cDMARDs) or biological disease modifying antirheumatic drugs (bDMARDs), and without clinical signs of arthritis, as assessed by a 40-swollen joint count.

Patients with AS, according to the modified New York criteria, 2 currently receiving either non-steroidal anti-inflammatory drugs (NSAIDs) and/or bDMARD, who show an absence of clinical signs of axial and peripheral arthritis and enthesitis, and who have an Ankylosing Spondylitis Disease Activity Score (ASDAS)

Inclusion criteria

Ongoing treatment or earlier attempt to treat with paracetamol or NSAIDs without clinical signs of arthritis or spondyloarthritis.

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Exclusion criteria

Comorbidities, more specific competitive rheumatological disorders, such as systemic lupus erythematosus, scleroderma, polymyositis or chronic pain condition based on a further clinical detectable aetiology (eg, fibromyalgia).

Evidence of serious uncontrolled concomitant cardiovascular, pneumological, neurological, endocrinological, gastroenterological, urogenital, nephrological or hepatic impairment.

Uncontrolled disease states, such as asthma, psoriasis or inflammatory bowel disease, where flares are commonly treated with oral or parenteral corticosteroids.

Evidence of active malignant disease, malignancies diagnosed or treated within the previous 2 years, including haematological malignancies and solid tumours.

Actual or previous harmful use of alcohol or drug abuse, in accordance with the WHO definition, 30 within the previous 2 years.

Ongoing treatment with opioids and/or cannabis products and/or neuroleptics, or treatment terminated

Suspected for, or evidence of, active schizophrenia, other psychotic illness in the family history (first degree relatives), other significant psychiatric disorder or treated depression associated with underlying condition.

Experimental treatment

The treatment starts with oral CBD 10 mg or placebo before bedtime, and increases after 2 weeks to 10 mg two times per day. Finally, and in case of lack of effect (VAS-pain reduction <20) from the beginning of the fifth week, the treatment increases to 10 mg three times per day.

The clinical assessment after 12 weeks defines how to proceed during the following 12 weeks: in case of a sufficient response, that is, a VAS-pain reduction of ≥20, the established treatment continues randomised and without any further adjustment.

Figure 1 presents the consort flowchart and figure 2 the treatment flowchart.

Presents the consort flowchart. TMT, Trail Making Test; VAS, visual analogue scale.

Presents the treatment flowchart. CBD, cannabidiol; THC, tetrahydrocannabinol.

Randomisation procedure

Patients are stratified by diagnosis and by recruiting centre. Patients are randomly allocated to one of the two treatment arms—CBD or Placebo—by random permuted blocks. Randomisation is blinded to the treatment allocation. Allocation is not known to anyone other than Glostrup Pharmacy, who produces and dispatches drug packages on request to each site. Sites receive a sealed, opaque envelope for each patient with the treatment allocation ready to be revealed, should this be required. Treatment is initiated within 2 weeks after randomisation. Measurements of effect are carried out at baseline before randomisation, and postintervention at 12, 24 and 36 weeks postrandomisation. Data analysis and statistical programming are blinded. The randomisation procedure and data analysis are performed by an independent statistician at the Department of Regional Health Research (IRS), University of Southern Denmark, Gråsten, Denmark.

Designated outcomes and clinical data

Primary outcome is the number of patients achieving an improvement of pain-VAS (Δ VAS-pain ≥20) after 12 weeks of treatment.

Secondary outcomes

The fraction (%) of RA and AS patients that achieve an improvement in VAS-pain, as assessed by the reduction of Δ VAS ≥20 and outcome of the PainDETECT Questionnaire, 10 31 after 24 and 36 weeks.

The fraction (%) of RA and AS patients that achieve an improved quality of life (QoL) situation, as assessed by Global-VAS with Δ VAS reduction ≥20 and by the Short Form (36) Health Survey (SF-36), 32 after 24 and 36 weeks.

The fraction (%) of AS patients that achieve a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)

A characterisation of AS and RA patients’ cognition and sleep quality, as assessed by the Trail Making Test (TMT), 34 the Digit Symbol Substitution Test (DSST) 35 36 and the Pittsburgh Sleep Quality Index, 37 performed at baseline and after 12, 24 and 36 weeks.

A characterisation of the patients’ expectation for the treatment effect, as assessed by the Credibility/Expectancy Questionnaire (CEQ) and by performing semistructured interviews 38–42 at baseline and after 12 weeks.

The outcome measures include parameters recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) paper. 43

Clinical data

At baseline, and after 12, 24 and 36 weeks, respectively, data are collected in the DANBIO Reuma-eCRF system. Furthermore, two additional nurse consultations are performed after 4 and 16 weeks, to obtain safety information and VAS-pain and to possibly perform a treatment increase from the beginning of the 5th and/or 17th week, respectively, as presented in the Experimental treatment section. The following data are collected at the time points as presented in figure 3 .

Clinical measurements, that is, in RA the Disease Activity Score 28-joints (DAS28-CRP), 44 45 Health Assessment Questionnaire and, in AS, the ASDAS and Bath Ankylosing Spondylitis scores for disease activity (BASDAI), function and measures are registered. 46 47 In both patient groups, additional PROMs are obtained: VASs for pain, fatigue, patient’s global QoL score SF-36 and pain-score PainDETECT. 10 31 Furthermore, the effect of intervention on attention and concentration is investigated using the TMT and DSST. 34–36 Additionally, sleep quality is evaluated with the Pittsburgh Sleep Quality Index. 37 The expected effect of treatment is measured with the CEQ and semistructured interviews.

Exposures, that is, all concomitant treatment, especially current treatments with cDMARDs, bDMARDs and/or analgesics, including dosing schedule and treatment onset.

Patient demographics, for example, diagnosis, age, gender, height, weight, body mass index, disease duration, smoking status, educational level, marital status, sick leave, occupation and ethnicity are obtained at baseline.

The schedule of assessments and procedures. AE, adverse event; ASDAS, Ankylosing Spondylitis Disease Activity Score; BAS, Bath Ankylosing Spondylitis; BP, bloodpressure; CEQ, Credibility/Expectancy Questionnaire; DAS, Disease Activity Score; DSST, Digit Symbol Substitution Test; SAE, serious adverse event; TMT, Trail Making Test; VAS, visual analogue scale.

Biological samples

Blood samples are obtained at baseline, and at 12, 24 and 36 weeks. In addition to routine blood tests, blood samples are collected in one EDTA tube (9 mL), two serum tubes (2×9 mL) and one PAXgene blood RNA tube (2.5 mL, Becton & Dickinson, Lyngby, Denmark), as described previously. 48 These are collected for definition of drug concentration of CBD and THC, that is, monitoring of compliance, possible adverse events (AEs) and for further future analyses.

Statistical analysis plan

The power calculation is based on the following assumptions for the primary outcome.

An expected proportion with a response of 50% or more in the CBD group and expected 20% in the placebo group (OR=4). Response is defined as a reduction in VAS-pain of at least 20 (range 0–100) after 12 weeks of treatment.

This setup gives a statistical power of 0.98 for the primary outcome. The power is reduced if the true difference between the groups is less than the expected 30 percentage points, and if more than an expected 10% of the patients drop out of the experiment. Balanced groups of 45 patients will yield a power of 83% for two-group comparisons on binary outcomes, such as the primary outcome. Slight deviations in sample sizes might occur because of block randomisation.

The primary outcome is tested by a z-test in a logistic regression model. The main parameter estimates the ratio of the odds of response for the intervention group relative to the control group. All tests are two-sided. Secondary outcomes are analysed using logistic and linear regression, depending on the data type. In the case of deviations from the normality assumption, a non-parametric proportional odds model will be used. The secondary outcomes measured at baseline and postintervention, 12, 24 and 36 weeks (follow-up) will be analysed using mixed-effects models, controlling for time of measurement. The random-effects parameter is estimated for the clustering of repeated observations within patients. Analysis for the direct effects of CBD, THC and the interaction between those will be carried out separately, with placebo as the reference group for CBD.

Patient and public involvement

King Christian X’s Hospital for rheumatic diseases involves patients with inflammatory rheumatic diseases actively in both quality assurance projects, research projects and in the development of educational programmes. Furthermore, a user council was established in 2013 in the research department. The project is a consequence of rheumatic patient’s pain reality and the idea of the project was originally presented to the user council back in autumn 2017. Since then, two patients have been involved in the processing of the project. So far, the patient information brochures have been developed based on the integration of the patient’s perspectives. PROMs, especially the patient’s pain VAS, are the main focus of the outcome measurements. Thus, both the burden and consequence of the intervention and the results of the given intervention are transparent.

Meetings with the projects patient representatives will be arranged two times per year and the progress of the project is presented continuously for the user council.

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Ethics and dissemination

All patients receive verbal and written information and give their written consent before enrolment, in accordance with Danish Ethics Committee guidelines. Online supplementary appendix 1 presents the projects consent statement in English. All patients are informed that they can withdraw from the study at any time. Although this would lead to the termination of project medication, patient withdrawal will have no consequences for regular course of treatment. In case of withdrawal, no subsequent patient-related registrations will be obtained.

Supplementary file 1

The two cannabis derivatives used in this study are comparable to the authorised compounds in the drug Sativex, which is a registered drug in DenmarK. 49 The patients will receive the information that efficacy of the applied test compound, as well as potential side effect may be comparable to Sativex. The patient’s rheumatologist will provide relevant project information in an outpatient setting. Chronicity of the chosen diseases and the inclusion criteria implies the typical project patient to be well known with a serious burden of disease. Investigators and study nurses are specialists in the rheumatic field.

The treatment consists of CBD tablets and THC herbal capsule preparation, which are produced based on natural raw materials by Glostrup Pharmacy’s laboratory. The drugs are manufactured according to quality-ensured standardised procedures specifying the exact ingredients in milligrams. This makes dosage and monitoring of the therapy safe according to Danish national Good Clinical Practice (GCP) guidelines. The side effects, are well known and well described. 50 The study subjects are patients who are already associated to one of the four participating outpatient clinics. The blood samples at baseline, after 12 and 24 weeks, respectively, will be realised in connection with routine blood tests, in accordance with an a priori arranged outpatient visit and thus will not pose increased risks. At all visits, participants will asked about events and/or reactions. Based on this information, the investigator will assess whether there is an AE, an adverse reaction, a SAE or a suspected unexpected serious adverse reaction. The GCP unit of the University of Southern Denmark monitors the study independently.

The patients will be contacted and informed regarding the overall study results if they indicate interest in this, and in accordance with the patient study consent form and as directed by the Danish Ethics Committee guidelines. The physician in charge of the project at each participating outpatient clinic is responsible for conducting the study in accordance with the fifth edition of the Helsinki declaration. Study participation does not affect the established anti-inflammatory treatment course of individual patients.

Results will be presented at international conferences and published in international and peer-reviewed medical journals. Negative, positive as well as inconclusive results will be published.

Discussion and potential limitations

The project’s focus is on chronic pain, which cannot be attributed to inflammatory activity.

Conventional and bDMARDs possess the potential to treat inflammation sufficiently. Thus, a treatment situation characterised by inflammatory disease activity should be treated according to the existing guidelines, that is, by adjusting the treatment to an adequate DMARD regiment. 1 2 Consequently, the absence of inflammation is a major inclusion criteria. Potential participants are well known as the study demands that their course of treatment has taken place for at least 2 years. Thus, we assume that alcohol or drug abuse, as well as information about ongoing opioid and/or cannabis treatment are accessible information for the involved investigators. Furthermore, the demand of a disease duration of at least 2 years is supposed to ensure the presence of chronical pain.

CBD and THC are two of >80 active compounds in the marijuana plant. 51

In contrast to THC, CBD does not exhibit a narcotic effect and/or intoxication. 52 53 The biochemical effect of the cannabinoids is explained by the compounds’ interaction with specific receptors; the Cannabinoid receptor 1 (CB-1) receptor is located on neurons and glial cells in different parts of the central nervous system, whereas the Cannabinoid receptor 2 (CB-2) receptor is found in structures of the immune system. The stimulating and narcotic effects of THC are considered to be caused by activation of CB-1 receptors. CBD has a very low affinity for these receptors. 51 Thus, CBD binding to the CB-1 receptors causes little to no narcotic effect. New studies show evidence that CBD affects autoimmune signalling pathways and that these mechanisms may be relevant to CBD’s therapeutic profile. 52 53

The effect of CBD is studied in a placebo-controlled design, whereas the effect of a combination of CBD and THC is an open label continuation of the study. The scientifically ideal solution would have been a randomised study comparing both CBD, THC and placebo, for instance, in a cross-over design. Such a design would be characterised by the implicit risks of THC for all patients during the entire study period and it would require a significantly larger study. The actual design represents the balance between a wish to assess the effect of both CBD and THC correctly, while recognising risks, including traffic safety issues, especially due to the THC treatment. Also, the possible negative effect on cognitive functioning can have a large impact on job functioning. Therefore, a more definite answer as to whether medical cannabis negatively affects cognition is important in relation to job functioning and autonomy. We feel our design will provide important information on THC, despite the design, and it has the advantage that we know when THC is applied, and thereby can take the necessary precautions.

The trial population is monitored regularly at the participating outpatient clinics and the individual longitudinal treatment is registered. DANBIO is the nationwide clinical quality database for rheumatology. 16 29 All adult patients treated with biological drugs are registered. Furthermore, patients with AS and RA are registered, regardless of treatment. Thus, the DANBIO based Reuma-eCRF system provides particularly good conditions for the collection and monitoring of validated data.

CBD Hemp Oil for Ankylosing Spondylitis

Arthritis is a prevalent chronic health problem in Canada, with around 6 million Canadians currently suffering from this condition. It’s been estimated that by 2040, 24 percent of Canada’s population will have arthritis. It doesn’t target a specific age group, but your chances of getting the disease increases as you grow older.

There are over 100 known types of arthritis today. All of them cause joint inflammation and stiffness which can lead to permanent damage if left untreated for too long. What makes this disease highly problematic is that once you have it, it stays with you for the rest of your life.

Other kinds of arthritis can even cause problems to the eyes, heart, or lungs. One of these more dangerous types is Ankylosing Spondylitis.

What is Ankylosing Spondylitis?

Ankylosing Spondylitis or AS mainly affects the spine. Given enough time, it will slowly fuse parts of the vertebrae together until you are hunched. It’s not unusual for the pelvis to be affected as well. In more severe cases, this disease can also spread to the shoulders, ribs and other joints in the body.

Some of AS’ symptoms are as follows:

  • Pain and stiffness in the lower back, pelvis, legs, or shoulders
  • Increased pain in the morning or after being inactive for long periods of time
  • Blurry vision and heightened sensitivity to light

AS can lead to other complications, such as

  • Inflammation in the eyes
  • Restricted breathing
  • Increased likeliness of cancer
  • Heart impairment

It is a rare condition that is more likely to occur in men. Unlike most forms of arthritis which are more commonplace in older people, young adults are more susceptible to this disease.

But like most other arthritis types, Ankylosing Spondylitis doesn’t have a known cure yet. However, there are medications that you can take to prevent its symptoms from getting worse or at least slow its progress down.

If you’re looking for something else aside from opioids and other pharmaceuticals, one of the most popular natural options is CBD oil.

How CBD Oil Can Help With AS

In recent years, CBD oil use has become commonplace among Canadians looking for an alternative to medical cannabis. This is because CBD & CBD hemp products don’t induce the psychoactive effects that cannabis does, thanks to the lack of tetrahydrocannabinol or THC.

CBD’s Health Benefits

The benefits of CBD can include:

CBD’s famous pain-relieving and anti-inflammatory properties have made it attractive to people who need help with pain management.

CBD and the ECS

To understand how CBD, or cannabidiol, can relieve arthritis pain, we must first know about the endocannabinoid system or ECS, which we are all born with.

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CBD helps your body by interacting with your ECS, which has receptors that receive chemical signals and assist your cells in responding to different stimuli in the body. While the ECS can send pain-relieving signals without the help of CBD, the substance enhances the effects that it has on you.

We offer all Canadians free phone and video appointments with one of our healthcare practitioners where they can inquire about obtaining a medical cannabis prescription.
If you would like to book your free appointment, you can here.

CBD’s Special Anti-Inflammatory Effect

For a long time, it was assumed that CBD’s effectiveness at reducing inflammation was thanks to its interactions with the ECS receptors. However, there’s a recent study by the Brain and Spine Institute in France that reveals that CBD didn’t need the receptors. The chemical already has inherent antioxidant properties and suppresses an enzyme that stimulates inflammation in the body.

For people with Ankylosing Spondylitis, which has severe inflammations, this property is immensely helpful in slowing down its symptoms.

Consult a Physician First

If you are interested in CBD oil for relieving your Ankylosing Spondylitis symptoms, it’s safer to consult a trusted physician first on proper dosages and to make sure that it is not conflicting with any ongoing medications and treatments you have. Your healthcare provider should always be updated on your progress and any side effects you may be feeling.

Apollo’s Cannabis Clinic physicians are here and offer free appointments to all Canadians, 7 days a week.

To get safe and high-quality CBD, be sure to buy tested and certified products from trusted sources. Book an appointment with our dedicated doctors today and find out more about how Apollo can help.

Cannabidiol reduces inflammation and pain associated with AS (Ankylosing Spondylitis).

CBD as a treatment for the chronic pain of ankylosing spondylitis (AS) is gaining ground as a pain management alternative. Current treatments, such as the nonsteroidal anti-inflammatory drugs (NSAIDs) naproxen and indomethacin, are the medications doctors most often recommended for ankylosing spondylitis. However, there may be undesirable side-effects: bloating and gas, gastrointestinal bleeding, ulcers, vomiting, diarrhea, or constipation.

Unresolved pain can result in conscious and unconscious reflex responses that are far from optimal. Unrelieved pain also impacts health, social and occupational interactions, mental and emotional states.

What is ankylosing spondylitis?

Ankylosing spondylitis is a type of spinal arthritis and an autoimmune disease. As with rheumatoid arthritis, AS pain is an overactive inflammatory response to the disease itself, which leads to damage to healthy tissue. Over time, AS can cause vertebrae to fuse, leading to the distinctive hunched posture, and loss of spinal flexibility. It can even affect the ribcage, leading to difficulty in breathing deeply.

AS occurs more often in men than women, with symptoms beginning in adulthood (17 – 45). However, onset has been noted in children and the elderly.

Signs and symptoms typically begin in early adulthood. They may include pain and stiffness in the lower back and hips, neck pain, and fatigue. It’s also common for AS to cause eye inflammation or inflammation in other areas of the body. AS also affects areas where tendons and ligaments attach to bones, primarily along the spine, as well as the Achilles heel tendons and the cartilage between the breastbone and ribs.

There is no cure for ankylosing spondylitis. Treatment can help manage symptoms and perhaps slow the progression of AS.

Standard treatment regimen of CBD for AS

Treatment for ankylosing spondylitis involves a multi-pronged approach of medication, exercise, and physical therapy. NSAIDs are usually the first line recourse for the management of pain and inflammation. The potential side effects of NSAIDs have been noted above. Practicing good posture and the application of hot/cold packs are other treatment options.

Pain and fatigue are key symptoms. Given the individualized response to treatment, there are clinical challenges. The progressive nature of AS makes it difficult to rely solely on a single medication over the course of the disease. Opioids, in particular, pose grave risks of addiction and overdose.

CBD for ankylosing spondylitis

As an alternative treatment for the chronic pain of ankylosing spondylitis, CBD is a good choice. Studies reported in the Journal of Experimental Medicine showed that CBD reduced chronic pain and inflammation in some subjects.

CBD is a potent anti-inflammatory that inhibits cell proliferation, which basically means the cell production and division that are responsible for the excessive build-up of bone tissue in the vertebrae.

CBD also suppresses cytokine production, responsible for between cells for immune response. Cytokines stimulate responses towards the inflamed sites.

Cannabidiol also induces T-regulatory cell production to combat the adverse effects of an overactive immune system.

Because AS is an autoimmune disease, it begins at a cellular level, and that is where CBD is at its most helpful. In simple terms, CBD calms the immune response and helps to lessen pain and inflammation.

The human body’s endocannabinoid system (ECS) regulates pain and the body’s immune response, among its other functions. Made up of receptors in the central nervous system (CB1) and the immune system (CB2), the ECS promotes and facilitates the production and delivery of the body’s neurotransmitters. The ECS’ role in healing inflamed tissue correlates clinically with preventing and treating inflammation-induced pain.

The National Institutes of Health sponsored an investigation into CBD’s role in reducing chronic pain and inflammation. The research has shown that CBD’s anti-oxidative and anti-inflammatory properties were instrumental in reducing chronic pain. CBD acts on your body’s CB1 receptors to mute the pain signal to the brain through the cellular mechanisms outlined above.

Frontiers in Pharmacology reviewed studies done between 1975 and 2018 into the effects of CBD on pain. In the studies, researchers investigated pain as a symptom of arthritis. The 2018 review concluded that CBD is an effective treatment for pain, with few side effects.

Cannabidiol agonist activity (initiation of a physiological response, combined with a receptor) at CB2 receptors appears to be responsible for its anti-inflammatory properties and its influence on pain perception. Initial human and animal studies support the premise that CBD reduces chronic pain and inflammation.

CBD has another role in improving pain and inflammation related to AS, and that is in improving sleep quality. Poor sleep may be a result of pain, which in turn impacts pain management. Proper rest improves not only pain management efficacy but also mood that can play a part in improving perceived pain.

Many drugs used to treat chronic pain carry a significant risk, not only of addiction but also of breathing-related sleep disorders. Opioids are the most common culprits, especially when combined with central nervous system depressants. CBD, on the other hand, is non-addictive and has few side effects, but as always, consult the doctor before beginning a CBD regimen.

How to use CBD for AS

CBD comes in many forms, but the most common ways to take it are orally or topically. Capsules or tinctures are the most common oral forms. It may take as long as 2 hours for CBD capsules to begin working, depending on stomach contents and digestive health.

Sublingual sprays or tinctures offer better absorption, going directly into the bloodstream. Users hold the liquid under the tongue for 1 – 2 minutes. The CBD should take effect in about an hour.

Usually, it takes time and experimentation to find an effective dose. Most new users begin with two 5 mg doses, taken morning and evening. Every 7 – 10 days, increase each dose by about half until pain relief is effective.

CBD topicals come as lotions, ointments, creams, and balms and are applied directly to the skin where pain relief is desired. Ointments, salves, and balms tend to require fewer applications than lotions and creams. Some early research has shown that topical applications can have better absorption rates than oral rates. Apply generously and frequently for pain relief.

Whether taken orally or used topically, find a provider that can show a third-party testing analysis. The analysis will show the purity and ingredients. The certificate of analysis should also show how much CBD is delivered per dose. The goal is CBD purity of greater than 98%. The remaining ingredients should be other cannabinoids, terpenes, and flavonoids, as well as the carrying agent.

The science into CBD and its potential for conditions such as ankylosing spondylitis is in the very early stages. Preliminary studies, trials, and user reports show that CBD holds great promise for the relief of chronic pain.