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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Does CBD Oil Help With RA?
People with rheumatoid arthritis and other pain conditions are trying cannabinoids to alleviate their symptoms. Here’s what you need to know.
There was a time in Ron Lev’s life when the pain from his rheumatoid arthritis (RA) was so bad that he felt like nothing could help him.
“You just sit still because it’s too painful to stand,” says Lev, 44. “Everything you can imagine doing is painful. Even eating is painful. Driving a car, opening a door, turning the ignition.”
After decades of treating his RA with biologic drugs and steroids, Lev was on the verge of accepting the pain as his “new normal.” However, he’d heard of other people with the condition using cannabinoids (CBD) to alleviate their pain and, four years ago, he decided to give it a try, too.
“At that time, I’d been on steroids for 23 years,” he says. Some of the long-term side effects he’d experienced from the medication included thinned skin, bloating, and weight gain, among others. “I tried unsuccessfully to wean off the steroids, but the pain was so bad… that I just kept using them.”
Within months of starting on cannabinoids, with guidance and direction from his rheumatologist, Lev not only weaned himself off the steroids, he was also able to spread out his biologic infusions from every couple of months to every 6 months. Now, he only gets infusions once a year.
After seeing the tremendous pain relief CBD offered him personally, Lev started his own CBD company, Reclaim Labs, in 2018.
Stories like Lev’s are becoming more and more common among people with RA and other autoimmune disorders. According to a 2019 poll from the Arthritis Foundation, 29 percent of people with arthritis report currently using CBD — mainly in liquid or topical form — while nearly 80 percent were either using CBD, had used it in the past, or were thinking about using it.
There’s also growing scientific evidence, including a study published in September 2020 in the journal Cell Disease & Death, that cannabinoids can alleviate pain from RA and act as an effective anti-inflammatory agent, with few, if any, side effects — unlike anti-inflammatory drugs such as steroids or biologics options.
“We’re seeing more organized and well-done research on the benefits of cannabinoids and CBD when treating RA,” explains Anca Askanase, MD, a rheumatologist and associate professor of medicine and director of rheumatology clinical trials at Columbia University Medical Center in New York City. “As a culture we’ve embraced both medicinal and recreational use of marijuana, and we’re seeing that it does help alleviate pain, especially with RA patients.”
Research on CBD in RA Needed
Positive news aside, Dr. Askanase cautions that more studies doesn’t necessarily mean enough studies.
“We’re going about things backwards — it’s been approved before we have all the research there to support it,” she says. “My biggest concern is that we need to understand and use cannabinoids in a more organized and mindful way as opposed to just saying, ‘It’s legal, it sounds like it works, just take some.’”
One reason for the hesitation on the part of Askanase and her fellow rheumatologists is that while cannabinoids may significantly reduce pain and inflammation, they can also trigger other side effects when smoked. For example, people who have RA can have a greater risk of developing lung and heart issues, which can be exacerbated by smoking marijuana, according to the Centers for Disease Control and Prevention.
Another concern, says Askanase, is the potential addictive nature of the drug. “We’ve learned that most of the things that act on the brain like cannabinoids do have some addictive potential,” she explains. “This is something that needs to be further researched.”
The Truth About CBD Oil and RA
Still, there’s no denying that despite the lack of research, people with RA report that CBD has significantly lessened their pain.
A survey published in November 2019 in the Journal of Psychoactive Drugs found that, of the respondents taking legalized cannabis for pain relief, 80 percent described it as “very or extremely helpful.” Among respondents taking over-the-counter pain medications, 82 percent reported reducing or stopping use of those medications. Among respondents taking opioid analgesics, 88 percent reported reducing or stopping use of those medications.
“I tried for years to stop taking steroids and it’s incredibly difficult to do,” explains Lev. “CBD is the only thing that has helped get me off steroids and relieve my pain.”
Additionally, there’s research that shows cannabis has a powerful anti-inflammatory effect, which can help address the inflammation behind RA. According to a review published in May 2019 by the journal Current Opinion in Rheumatology, researchers have found that “cannabinoids show anti-inflammatory effects by activating cannabinoid type 2 receptors, which decrease cytokine production” (cytokines are proteins known to be involved in inflammation).
The authors concluded that cannabis may be a suitable option for treating RA.
While Askanase is among a growing number of rheumatologists who are interested in seeing more research on CBD in RA, she also cautions that it shouldn’t be used as a stand-alone treatment.
“We need to very clearly make an effort to say that cannabinoids are supplementary interventions but should not replace the traditional disease-modifying therapies we currently have available,” she explains. If you’re considering using CBD as a complementary treatment option, she says, you should seek out medical marijuana dispensaries, which have some medical supervision and control over the products and the amount being used.