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5 Best CBD Oil for Pain & Inflammation: 2022 Update

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All in all, CBD oil has many applications that can benefit patients suffering from chronic pain and other debilitating conditions. It is safe, non-addictive, natural, and can be used for a variety of ailments based on what we’ve read in customer reviews and other scientific studies online. Now that you know a little more about CBD oil, we’ll dig deeper into this topic to help you better understand why you should try the best CBD oils for pain & inflammation in 2022.

With millions of users and dozens of brands, it can be difficult to determine who is providing the highest quality CBD oil out there. We’ve compiled a list of the five best CBD oil companies in the industry to help you make an informed decision.

5 Best CBD Oils for Pain & Inflammation in 2022

We didn’t create this top 5 list lightly. There are many factors that went into choosing these top 5 best CBD oils for pain & inflammation in 2022. If you’re curious how we came to the conclusion that the above brands are the best CBD oil for pain & inflammation, then continue reading below for what helped us determine the best options.

Testimony from Experts

We searched high and low for expert testimonials from CBD oil users. We used these testimonies as part of our decision-making process to choose only the best CBD oils for pain & inflammation this year.

Product Reviews

We looked at dozens of product reviews from popular CBD oil review websites like High Times, Consumer Lab reviews, and CBD Insider reviews. This helped us determine the best products out there.

Price

The next factor we took into consideration was the price. If you’re on a budget or simply looking to make your dollar stretch as far as it can, then you need to know which CBD oil brands offer the best value for your money.

Customer Support

No matter how great a company’s products are, there will always be people who have less-than-positive things to say about them. So we took customer service into consideration when creating our top 5 list of the best CBD oils for pain & inflammation.

Brand Audits

We also conducted a thorough brand audit on each CBD oil brand to determine their reputation in the cannabis industry.

Product Testing

We put in hours of research and testing to determine which CBD oil brands consistently produced the highest quality products. We also looked at product taste, texture, consistency, potency, and ease of use.

When you’re dealing with a chronic pain condition like arthritis or lupus, it can be difficult to find relief from your symptoms. The best CBD oils for pain & inflammation in 2022 can help relieve some of your pain and give you a better quality of life.

1. Colorado Botanicals

Image courtesy Colorado Botanicals

Colorado Botanicals is a top CBD oil for pain & inflammation in 2022 and offers some impressive products. Their CBD oil has no THC (the compound responsible for getting “high” from smoking weed) and their hemp plants are grown without pesticides.

All Colorado Botanicals’ products are non-GMO, vegan friendly, and tested by third-party laboratories to ensure safety. The company uses CO2 extraction when making its CBD oil to maximize potency and purity. This method also preserves all the terpenes in the hemp, which is beneficial for your health and can enhance the quality of sleep.

Colorado Botanicals’ CBD oil comes in a variety of strengths such as 150mg, 750mg, or 1,500mg per bottle. The best part is that the company offers free shipping on all orders over $74 across the United States.

2. Penguin CBD

Image courtesy Penguin CBD

Whether you like penguins or not, we’re confident this is by far the best CBD oil for pain and inflammation in 2022. Also, if you don’t like penguins then you should start liking them right this minute.

All joking aside, Penguin CBD does offer a variety of options to get your daily CBD oil intake. You can take their oil in a capsule or add it to your morning smoothie. They also offer a 1,000mg CBD oil bottle, which provides around 70 servings.

The company offers a 100% satisfaction guarantee on all of its products and has been reviewed by hundreds of customers online. If 1,000mg of CBD oil seems a little too much, Penguin CBD has other strengths such as their 250mg, and 500mg bottles of CBD oil. Their CBD oil bottle goes up to 5,000mg for all you long-term users out there.

3. R+R Medicinals

Image courtesy R+R Medicinals

R+R Medicinals is another top CBD oil for pain & inflammation in 2022. This company offers two varieties of full-spectrum CBD oils, including a 1,000mg version and a 2,000mg. We recommend going with the larger dosage if you’re going through severe pain or have a lot of daily stress that needs relief.

R+R Medicinals’ CBD oil is non-GMO and is also vegan and gluten free. The company uses coconut MCTs to enhance the bioavailability and absorption of CBD oil.

All of R+R Medicinals products are lab-tested for purity, potency, and consistency. The company offers a money back guarantee on all its products to ensure customer satisfaction. As an added bonus, they offer free shipping on all domestic orders.

4. BATCH CBD

Image courtesy Batch CBD

BATCH CBD is a hemp-derived CBD oil that comes in five different strengths ranging from 250mg to 5,000mg. The company offers one of the strongest lines of products on the market with their 10,000mg version containing up to 50% CBD concentration.

BATCH CBD uses CO2 extraction when making its full-spectrum CBD oil to preserve all the beneficial terpenes found in hemp. BATCH CBD’s non-GMO, vegan friendly oils are free of pesticides and herbicides and are 100% THC FREE.

BATCH CBD offers a money back guarantee on their products. Plus they offer free shipping on orders over $15 across the US.

5. Verma Farms

Image courtesy Verma Farms

Our next CBD oil for pain & inflammation in 2022 is Verma Farms. This company specializes in CBD oil for pain relief, anxiety, depression, chronic fatigue syndrome (CFS), and more. Plus their products can be used by both humans and pets. Their unique tincture allows the product to absorb under the tongue for quick results.

Verma Farms offers a variety of CBD oil products including pet treats, tinctures, and salves. Their full-spectrum hemp oil is made from organically grown hemp plants that don’t require any pesticides or herbicides to grow. Plus they have a guaranteed 3rd party laboratory test on each product, so you know exactly what you’re getting.

Verma Farms’ organic oils are free of pesticides and synthetic fertilizers, so you can rest assured that what you’re ingesting is 100% natural. To reduce the chance of any negative side effects, Verma Farms recommends starting with a low dose first.

6. Bonus: cbdMD

Image courtesy cbdMD

Last, but not least for oil for pain & inflammation in 2022 is cbdMD. They offer full-spectrum CBD oils and come highly recommended by thousands of customers online.

cbdMD’s line of products includes soft gels, topical salves, and oral tinctures that you can take sublingually. Find them at your local vitamin store. The company promises the best quality CBD oils around, with an emphasis on getting their products tested by third-party laboratories to ensure potency and purity.

cbdMD offers a variety of full-spectrum oil for pain & inflammation in 2022 products including 1,000mg, 2,500mg, 5,000mg, or 10,000mg per bottle. Plus they have a full line of pet products for your furry friends in need of pain relief.

But wait, there’s more! We didn’t want to leave you with just the 5 best CBD oils for pain & inflammation in 2022, rather we just had to give you a couple of BONUS options to choose from .

7. Bonus: FOCL

FOCL is a premium CBD brand based out of Los Angeles and Denver. Their ultra pure CBD Drops (AKA tinctures) are delicious, highly effective, and get rave reviews from loyal customers. They have an excellent reputation for high quality ingredients, amazing flavors, and fair pricing.

FOCL CBD Drops are made with organic ingredients, non-gmo, vegan, and THC-free, so you can relax, recover, and focus with peace of mind.

In terms of taste, they are hands down one of the best we’ve tried. They have a variety of flavors and strengths to choose from. In terms of value, we highly recommend their 2000mg CBD Drops .

All FOCL products are made in the USA, GMP Certified, and are extensively tested by third party labs (test results available on FOCL’s website), so you can rest assured knowing that there are no harmful toxins, heavy metals, or pesticides in any of their products.

The team at FOCL (short for Focus) is passionate about wellness and obsessed with producing products that actually work. In addition to their top rated CBD drops, they also have premium CBD gummies, relief cream and unique wellness formulas designed specifically for Focus, Sleep, Pain Relief and Immunity. For extra savings, try one of their 3-pack bundles .

CBD oil is a natural and non-intoxicating substance that can be extracted from the cannabis plant. CBD oils contain concentrated cannabidiol, which when administered orally or through an inhaler, helps alleviate pain and inflammation.

CBD is one of over 100 cannabinoids present in cannabis plants, but unlike THC (the cannabinoid responsible for getting people “high”), it does not produce any psychoactive effects. In fact, CBD has been shown to actually counteract some of the psychotic symptoms caused by THC exposure.

This makes it a useful therapeutic option for patients with severe forms of epilepsy who find relief from their seizures only when given CBD treatments alongside traditional anticonvulsant medications. It also helps relieve chronic pain without causing cognitive or psychoactive side effects.

CBD is also known to be useful in reducing muscle spasms and fighting certain autoimmune diseases. Its anti-inflammatory properties can help sufferers of arthritis reduce inflammation and ease their joint pain. Scientists believe it may also be effective at suppressing the growth of cancer cells.

In addition to being a health-boosting supplement, CBD has been found to have properties that can be used for cosmetic purposes as well. It moisturizes the skin and helps restore calmness in people who suffer from acne flare-ups. Since it helps treat psoriasis and eczema, CBD is also effective at combating dry skin and minimizing the appearance of fine lines.

CBD is a safe, non-addictive substance that can be used to alleviate aches and pains without causing any negative side effects. Patients have found it to be more effective at treating chronic pain than prescription painkillers, which are known to cause more severe withdrawal symptoms.

In addition to being an effective painkiller, it is also known to be a potent anti-inflammatory and can even reduce seizures caused by epilepsy. It works well on its own but has also shown positive results when it’s used in conjunction with traditional treatments for various different health conditions.

Not only can CBD oils help with pain & inflammation in 2022, but CBD products can help soothe skin disorders such as psoriasis, eczema, and acne flare-ups, as well as relieve symptoms of autoimmune diseases. CBD is also effective at minimizing the appearance of lines and wrinkles without causing any psychoactive side effects or cognitive impairment associated with THC.

What is CBD Oil?

CBD stands for Cannabidiol. It’s one of the many chemical compounds found within marijuana known as cannabinoids, which are also found in other agricultural hemp products like hemp seeds and hemp oil. Cannabis is actually a combination of three distinct plants – cannabis sativa, cannabis indica, and a third lesser known plant called cannabis ruderalis.

CBD Oil is not psychoactive because it does not contain tetrahydrocannabinol (THC), which is the main compound responsible for the “high” that comes from smoking marijuana. However, CBD oil can be infused into different types of food, including candy, honey, gummies, and chocolate.

There are many benefits claimed for CBD oil. Some of these include helping with multiple sclerosis symptoms, treating chronic pain and inflammation, treating mental health conditions like stress and anxiety, fighting acne due to its anti-inflammatory properties, helping cancer patients with nausea and loss of appetite, improving heart health, and promoting better REM sleep.

Many people claim that CBD oil can be used as a natural pain reliever, antidepressant, stress reducer, and even as a potential cancer treatment. However, there aren’t many scientific research studies that back up these claims and the FDA has not approved the use of CBD oil for any medical condition. Currently, CBD oil is used as a food supplement that can be easily purchased online or from most health stores.

What’s the Difference Between CBD Oil and Hemp Seed Oil?

CBD oils made from hemp plants are rich in omega-3 fatty acids, other fatty acids that act as binding agents to help your body absorb more cannabinoids, other plant compounds such as terpenes, and vitamin E.

Hemp seed oil doesn’t contain CBD and is instead extracted from the seeds of hemp plants. This product has a higher ratio of omega-6 to omega-3 fatty acids than its CBD oil counterpart.

Hemp seed oil also contains high levels of the antioxidant compound vitamin E, but little cannabidiol. Hemp seed oil is best suited to cooking or topical applications.

Is CBD Oil Legal?

CBD oils are legal in all states and territories, provided the products contain less than 0.3 percent THC. As the laws surrounding cannabis continue to change, experts recommend checking the federal laws on cannabis-derived compounds like CBD oil before making any purchases.

Hemp-based CBD oil is legal in most countries worldwide, but THC-free marijuana-derived CBD oil may not be legal in some territories. Customers who want to purchase hemp-derived CBD oils should check their country’s laws before placing an order or traveling across the U.S. border to a different state with stricter laws on such products.

What does CBD oil do?

CBD oil works by activating the body’s serotonin (anti-depressant effect), vanilloid (pain relief), and adenosine (anti-inflammatory effect) receptors, while also antagonizing the CB1 and CB2 cannabinoid receptors. Because of the way CBD oil interacts with the brain’s natural chemistry, it’s said to have more of an effect on relieving chronic pain rather than just masking the symptoms like some pain medications do.

Many experts suggest that you start with a small dosage of CBD oil and remain consistent in taking it every day before you notice any effects. It’s also not recommended to stop taking your blood pressure medication, antidepressants, or anti-inflammatory medications before beginning CBD oil treatment – that could lead to unwanted side effects.

Where can you find CBD Oil?

You’ll have no trouble finding CBD oil online or in most drug stores across the country. However, you should always purchase CBD oil products from reputable companies that can provide you with lab reports. This is important because they will show the levels of potential contaminants like pesticides, which are normally used on hemp crops.

To avoid these impurities, many of the high-quality CBD oil companies use a supercritical CO2 extraction process that does not produce any significant heat and avoids using harsh chemicals that could damage the CBD molecules.

Once you’ve selected a CBD oil product ensure that you read all ingredients carefully to ensure your safety – some products contain a mixture of hemp oil and other essential oils, which could cause a negative reaction to those who are allergic.

What can I expect from using CBD Oil?

Because CBD oil has only been recently introduced, there aren’t many studies regarding the long-term effects of taking it. However, some individuals have reported feeling lightheaded or having an upset stomach when they first begin using CBD oil.

Some users have also noticed that they become drowsy shortly after taking their dosage, but this is a common side effect of most prescription painkillers like morphine and oxycodone as well.

There are reports of some users suffering from chronic anxiety or depression when they first began taking CBD oil, but the effects diminished over time.

There haven’t been any notable side effects reported for CBD oil thus far, but there are several precautions to take into consideration before using it:

Avoid taking CBD oil within a couple of hours of your bedtime – it may disrupt your sleep cycle.

People who have a family or personal history of psychosis should be especially careful about using CBD oil.

Make sure that you test any CBD oil product before ingesting it – some have been known to contain high levels of THC despite labeling itself as “pure CBD.”

Always purchase your CBD products from reputable stores or online merchants.

To be on the safe side, you might want to speak with your doctor before taking CBD oil.

How do you take CBD sublingually?

This is the ultimate guide to CBD oil for pain & inflammation in 2022, but you may have one more question.

How do I take it?

If you are wondering how to use CBD oil for pain management, here’s a quick reference guide.

Simply place your preferred amount of drops under your tongue and hold the liquid there for 60-90 seconds. Then, swallow what’s left in your mouth and enjoy the rest.

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You should expect to feel results in about 10 minutes, but like we always say. everyone is different. So it may take a bit longer for you.

Do not eat or drink anything 15 minutes before taking CBD, or do so at your own risk.

CBD is not psychoactive, so you won’t get high even if you take too much at once. But why take the chance? Start with a small amount and increase slowly over time to see how your body reacts.

What are the effects of CBD oil under the tongue?

CBD oil is a versatile product that can be taken in many different ways.

But when you take supplements under your tongue, it takes directly into the bloodstream through tiny capillaries called arterioles. From there, the cannabinoids are transported immediately to the CB1 and CB2 receptors located in every organ of your body.

Constantly recycling, these receptors are responsible for the effects of CBD. They affect pleasure, pain, relaxation, and many other functions that keep your body running smoothly.

CBD has been shown to help with.

Relieving pain and inflammation

CBD oil is a natural anti-inflammatory. It’s known for reducing the intensity of chronic pain as well as several inflammatory diseases, including arthritis.

Easing an anxious mind

If you suffer from anxiety, it can be hard to relax, focus, and sleep. Taking CBD oil for anxiety can help you feel calmer and more relaxed throughout the day.

Promoting healthy cell growth

CBD also has antioxidant properties that slow down the aging process, prevent disease and protect your cells from damage. It even helps with acne by inhibiting bacteria responsible for breakouts.

Fighting nausea and vomiting

If you experience chronic nausea or find yourself throwing up often, CBD oil can help. It’s known to ease stomach pain and regulate your digestive tract.

CBD oil is also becoming more popular for treating conditions like migraines, epilepsy, diabetes, multiple sclerosis, schizophrenia, and even cancer due to its anti-inflammatory properties.

Complete Guide For The Best CBD Oils for Pain & Inflammation in 2022

Now that you know the top 5 brands plus two bonus companies to get your CBD oil from, we wanted to share more about how these work to help you with pain and inflammation.

As always, we want you to consult with your doctor about whether these are safe for you to take. As with most medications or supplements, combining CBD oil with prescription medications or other supplements may not have the desired effect. Your doctor will know best if CBD oil is the right option for you.

What Factors Can Cause Pain and Inflammation?

Before we dive too far into the topic of taking any of these recommended CBD oils for pain & inflammation in 2022, we wanted to share more about what factors can cause pain and inflammation to the human body:

Physical Injury

When you suffer a physical injury, it can cause your body to experience pain and inflammation. The injured tissues become stressed during this time because they are trying to heal themselves.

Chemical Stimulation ​

We also have chemical messages in our bodies that can cause us to feel pain or experience inflammation. These molecules are called neurotransmitters, and they manipulate the communication between our cells to produce pain. If these neurotransmitter levels get too high or too low, this can also cause pain and inflammation in your body.

In today’s busy world, it is not surprising to hear that a lot of people suffer from stress on a daily basis. This can cause chemical stimulation, which can lead to inflammation and pain.

Autoimmune Disorders

Unfortunately, some people may suffer from an autoimmune disorder that causes their body to attack itself. When this occurs, it is possible for the person to experience pain and inflammation as their immune system tries to fight off these attacks.

What’s The Best CBD For Pain & Inflammation?

In short, the best CBD oil for pain and inflammation is a product that works to help your body naturally manage these symptoms. They do this by influencing your body’s hormones, neurotransmitters, and immune system functions.

The key here is finding a brand of CBD oil that actually works for you. Take some time to read reviews and inquire with your doctor before you decide on a CBD oil for pain and inflammation.

If you are considering taking CBD oil for any of these conditions or symptoms, we recommend starting slowly at first so that your body can adjust to the effects. Then, gradually increase your dosage as needed until you find what works best for you.

How CBD can potentially help with pain and inflammation

The cells in our body react to pain or injury by releasing chemicals called cytokines. These cytokines signal the immune system to release proteins that cause inflammation, swelling, and other symptoms related to pain.

By taking CBD oil for pain and inflammation, you can help your natural immune response by stopping these signals before they are sent.

CBD oil can also help reduce your body’s production of cytokines, which will help prevent inflammation and swelling. This reduction in cytokine production is another way to manage pain and inflammation that naturally occur in the human body.

By using CBD for pain management you are also reducing the number of chemicals that can cause inflammation in your body. By improving your immune system’s response to inflammation, CBD oil for pain management has the potential to treat many types of chronic pains.

How to Take CBC Oil for Pain

There are numerous ways that you can consume CBD oil. Here is a list of the most popular:

Capsules & Edibles

This is one of the most popular and easiest ways to take CBD oil. Capsules come in a variety of sizes and strengths, depending on how much CBD you need. Many people also enjoy edibles for their convenience and simplicity.

CBD Tincture

A tincture is one of the quickest and easiest ways to incorporate CBD into your daily routine. These products typically come in small glass bottles with a dropper for easy dosing.

Sublingual

A sublingual tincture can be placed under your tongue for fast absorption. This method allows the CBD to travel directly into your bloodstream, making it effective immediately.

Topical Application

Finally, CBD oil can be applied topically for localized relief. Using a topical ointment or cream has many benefits that go beyond pain management. These areas are often where you experience some of your body’s biggest pains, so apply the oil directly here to reduce inflammation and swelling on the spot.

When Should You Take CBD?

If you are taking CBD oil for pain and inflammation, it is best to take your dosage at regular intervals throughout the day. Many people enjoy using their tincture or vape additive first thing in the morning as a way to start their day off on an elevated note.

Others prefer to use these methods before bed as a way to manage any aches or pains they experienced throughout the day.

What is the Best Dosage for CBD Oil?

The most popular way to take CBD oil is through capsules that are ingested orally. This is the most common dosage for CBD oil, and also the easiest to use if you are not familiar with tinctures.

For acute pain relief, it is best to start at 5-10mg of CBD per day. If this amount does not produce any noticeable changes in your symptoms, then try increasing to 15-25mg.

Lastly, topical ointments and creams should generally be used according to the directions and needs of the user. Topical CBD oil should never be used in place of traditional pain prescriptions.

CBD Oil for Pain: Side Effects & Precautions

While CBD oil is considered very safe, there are a few considerations to keep in mind when taking this or any other supplement. Always buy from a trusted source, and make sure that you are using pure CBD oil with 0% THC.

The use of cannabis is not recommended during pregnancy or while breastfeeding unless absolutely necessary. Furthermore, children should never take CBD oil without the guidance of their doctor.

As always, talk to your doctor before taking any new supplements, especially if you have an existing medical condition.

As CBD is a relatively new supplement, there have not been any long-term studies done on the effects of taking this oil over the course of several years. While it is considered very safe, as with all things you put into your body it’s best to be cautious and informed.

In 2022, the world will know much more about the benefits and uses of CBD oil. As our understanding of this supplement grows, more manufacturers will start making pure CBD products available on a global scale.

While cannabis may still have some legal or social hurdles to overcome in many countries, the use of CBD oil for pain is an exciting and fast-growing market worldwide.

How to Select The Best CBD Oil For Your Pain & Inflammation in 2022

When looking for a CBD oil to help with pain and inflammation, it’s important to select a product that is high quality and has been tested for purity. It’s also important to make sure that the CBD oil has been extracted using a method that allows for fast absorption, such as using carrier oils or vape additives.

It’s best to start with a low dosage of CBD oil and increase gradually if needed until you find the dosage that works best for you. CBD oil can be taken orally, smoked, or applied topically.

There are many ways to take CBD oil, but be sure to follow the directions on your product for optimal results.

As CBD becomes more popular worldwide, manufacturers will develop new products that increase the bioavailability of their capsules or tinctures. This means that you’ll need less CBD oil in each serving size for it to have an impact on your pain and inflammation.

In 2022, CBD oil will most likely remain a popular choice for easing aches and pains due to its fast-acting, long lasting effects. The demand for CBD oil products will likely increase as more states legalize cannabis and consumers look for a safer alternative to opioid painkillers.

Does Taking CBD Get You High?

No! CBD oil products will not get you high, as they contain almost no THC, which is the chemical responsible for the “high” produced by traditional marijuana use.

Even though it is possible to become psychologically addicted to cannabis use, addiction-related to CBD oil use is extremely rare and unlikely.

What is the Difference Between Hemp-Derived vs Marijuana-Derived CBD Oil?

CBD oils made from marijuana plants are also low in THC. But unlike hemp-derived CBD oil, marijuana-derived CBD products may contain more psychoactive compounds like THC, which could induce feelings of sleepiness and euphoria.

Marijuana-derived CBD oil is best for customers who prefer a product with a high THC content or want to experience a “high.”

What Are The Benefits Of CBD Oil?

CBD oil works similarly to other pain medications, but without the unwanted side effects. Though not widely understood by the public, CBD has been found to have many medical benefits, including reducing inflammation and acting as an anti-inflammatory agent itself.

Topical CBD oils are also available for those who want localized relief from arthritis or other inflammatory conditions.

The most common benefits of CBD oil include:

Anti-inflammatory properties that reduce pain and swelling

Fast acting, providing quick relief from chronic or acute disorders

Can be used in conjunction with other therapies to increase the effectiveness of treatment for certain conditions

CBD Oil Legal Status Worldwide

CBD oil is legal throughout much of the world, but it is still considered a controlled substance in many countries.

In some areas of the United States, CBD oil can be purchased at local health food stores. If you live in a state where CBD is not legal, however, you may have to travel outside your city or state to purchase it.

CBD oil can also be purchased online and shipped to customers in most areas of the United States, Canada, and Australia. If you live outside these countries, ask your local health food store about CBD products or find a shop online that can legally ship CBD oils for pain & inflammation in 2022 to your region of the world.

Is Hemp Oil and CBD oil the same?

Hemp oil and CBD oil are not the same, and hemp oil does not contain significant amounts of CBD.

While hemp oil is rich in omega-3 fatty acids and has many health benefits, it’s best known for its ability to improve skin health by hydrating dry, flaky areas such as the elbows and knees – rather than for treating issues such as inflammation and arthritis.

CBD oil is much more potent than hemp oil and does contain high levels of CBD, though it’s worth noting that the other components in cannabis plants, such as THC and terpenes, can also affect your health when combined with CBD.

Different Types of CBD Oil Extracts Are Available

As CBD oil becomes more popular, manufacturers will create new product types with advanced delivery methods to increase bioavailability and reduce negative side effects.

Full Spectrum

As you explore different CBD oil products, you may notice that many are labeled as full spectrum CBD. This means that the extract contains all of the compounds in the hemp plant, including trace amounts of terpenes and cannabinoids such as THC.

Although not to be confused with CBD isolate, full-spectrum CBD does contain small levels of THC to produce the entourage effect.

Because of this, you may experience mild side effects such as feeling tired or groggy after using full-spectrum CBD oil.

Broad Spectrum

Unlike full spectrum oils, pure CBD oil contains only CBD and is free from THC and other trace compounds found in cannabis plants. Since no extra ingredients are added during production, these CBD oils are ideal for customers who prefer the taste of pure oil. There’s also no risk of feeling tired or groggy.

CBD Isolate

CBD oil products labeled as CBD isolate contain 99 percent CBD and less than 0.3 percent THC, making it ideal for those who prefer a pure extract without any additional active compounds.

Efficacy of CBD Oils

CBD oils work best when they contain both omega-3 fatty acids and other fatty acids that act as binding agents to help your body absorb more cannabinoids.

These fatty acids include monounsaturated oleic acid, palmitoleic acid, and stearidonic acid.

The presence of these binding agents makes CBD oil easier for your body to absorb – which means you’ll need smaller doses to experience the same effects as larger amounts of oils with alternative delivery methods.

CBD oils may also contain added terpenes and a wide range of plant extracts designed to enhance bioavailability and produce additional benefits. While many hemp-derived products have high levels of cannabidiol, you should be aware that these ingredients can also contain trace amounts of THC.

Because some CBD products are produced from cannabis plants, the resulting oils may contain small amounts of THC – even if they don’t contain psychoactive ingredients that would produce a “high.” This is fine for most customers who do not have THC allergies or preferences.

Make Use of The Right Dosage Amount

Different CBD oils have different purposes and effects, so it’s best to buy a small amount of CBD oil to determine whether you feel any positive results. It’s also important not to exceed the recommended dosage as too much CBD can be counter-productive.

The dosages for each product vary by manufacturer and range from as little as 20mg per day to up to 1,000mg per day. Refer to the product’s label for specific dosage instructions and information. You can also read reviews from fellow users of CBD oil products, which will provide you with a wider range of experiences and opinions on each product.

What is the Difference Between Hemp-Derived vs Marijuana-Derived CBD Oil?

CBD oils made from marijuana plants are also low in THC. But unlike hemp-derived CBD oil, marijuana-derived CBD products may contain more psychoactive compounds like THC, which could induce feelings of sleepiness and euphoria.

Marijuana-derived CBD oil is best for customers who prefer a product with a high THC content or want to experience a “high.”

What’s the Difference Between CBD Oil and Hemp Seed Oil?

CBD oils made from hemp plants are rich in omega-3 fatty acids, other fatty acids that act as binding agents to help your body absorb more cannabinoids, other plant compounds such as terpenes, and vitamin E.

Hemp seed oil doesn’t contain CBD and is instead extracted from the seeds of hemp plants. This product has a higher ratio of omega-6 to omega-3 fatty acids than its CBD oil counterpart.

Hemp seed oil also contains high levels of the antioxidant compound vitamin E, but little cannabidiol. Hemp seed oil is best suited to cooking or topical applications.

Is CBD Oil Legal?

CBD oils are legal in all states and territories, provided the products contain less than 0.3 percent THC. As the laws surrounding cannabis continue to change, experts recommend checking the federal laws on cannabis-derived compounds like CBD oil before making any purchases.

Hemp-based CBD oil is legal in most countries worldwide, but THC-free marijuana-derived CBD oil may not be legal in some territories. Customers who want to purchase hemp-derived CBD oils should check their country’s laws before placing an order or traveling across the U.S. border to a different state with stricter laws on such products.

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What Ingredients Should I Watch Out For in CBD Oils?

The FDA does not regulate CBD oil products. But like other dietary supplements, it recommends consulting with a physician before using any hemp-derived CBD oils to treat medical conditions or to determine dosage amounts.

We also recommend checking the ingredient lists for each product you plan on purchasing at your local store and searching for information about how the product might interfere with other medications you’re taking or how it might interact with existing medical conditions.

In all honesty, if you’re searching for CBD oils for pain & inflammation in 2022 then you’ll want to make sure that there is no more than .3% THC in any of the CBD oils you’re buying. This will ensure you’re less likely to get a “high” from the oils, instead you’ll gain the most out of the medical or therapeutical properties of the CBD oils.

How Can I Find the Best CBD Oil?

CBD oil is gaining more and more recognition every day as a potential treatment for many different ailments. In order to determine which product would be best for you, consider your needs and lifestyle before making any purchase.

CBD oil products are available for purchase online through websites, but customers should have a firm understanding of what to look for before making any purchases.

Research and reviews of CBD oil products are also available through online resources such as the Hemp Business Journal, Leafly, and Project CBD.

How Can I Get Started With CBD Oil?

If you’re considering buying a CBD oil product, the first thing you should do is speak with your doctor to ensure it’s safe for you to use and understand all of the potential benefits of CBD oil.

After speaking with your doctor, you should visit each of the CBD brands’ websites to research more about hemp-derived CBD oils and products available for purchase. Since regulations vary from state to state, make sure to check state laws before making any purchases online.

How do you use CBD oil topically for pain?

CBD oil can be used topically for pain relief in a variety of ways. You can rub CBD oil directly onto the skin where you’re experiencing pain, or you can add it to your favorite lotion or cream to help with absorption.

Another option for using CBD oil topically is to use the CBD oil as a moisturizer or apply it directly to an injury if you’re suffering from joint or muscle pain.

Another reason that people enjoy applying CBD oil topically is because of its soothing effects on the skin and how it can help reduce inflammation. It’s even able to penetrate deep layers of stubborn skin tissue, which can help your muscles and joints better absorb the natural oils.

Each type of CBD oil has its own benefits and offers different possibilities for pain relief. The use, application method, supply, and dosage are all factors that have a bearing on how CBD can help with the pain.

While there are fewer documented cases of side effects from using CBD oil topically, it’s still possible that you could have an allergic reaction or suffer from an unknown irritation while applying CBD oil to affected areas.

Does CBD oil relax muscles?

Many people who use CBD oil and other hemp products believe that the product has a calming effect on the muscles and nerves. While research into how CBD affects connective tissue cells is ongoing, we do know that it interacts at least partially with receptors in the immune system as well as receptors throughout the endocrine and nervous system.

Mast cells make gluten-associated antibodies in response to certain foods like dairy and peanut, which is why some people are highly sensitive to trace amounts of certain foods.

CBD may have a similar effect on mast cells, which can regulate pain and inflammation by stimulating histamine release. By activating or blocking the receptors of neurotransmitters, CBD oil might be able to help reduce inflammation and relax muscles.

How long does it take for CBD oil topicals to work?

The length of time that it takes for CBD oil topicals to start working depends on the application. Creams and lotions will take longer because they need to fully absorb into your skin before you’ll begin to feel their effects, but sublingual tinctures are absorbed into the blood stream almost immediately.

Can I use other pain medications with CBD?

Currently, there aren’t many studies looking at the interaction between CBD and other pain medications. While many people believe that CBD can help relieve some of the pain, it’s important to remember that using any type of new medication without first consulting with your doctor could have serious consequences.

Most doctors will tell you not to mix CBD with other prescription painkillers without first discussing the potential risks. If you’re using both types of medication, ask your doctor if there are any interactions that may be dangerous for your health.

How much CBD should I take?

While it’s possible to take too much CBD oil, the safe upper limit of the product seems to be around 1mg per kilogram of your body weight. While that amount is considered safe for most people, it may still cause problems in smaller or younger individuals.

When taking any type of CBD oil, it’s important to take only the recommended dosage and use the product as directed on the package label. Because everyone’s biochemistry is slightly different, it’s possible that your body may not respond to CBD oil in the same manner as someone else.

If you’re taking any medication other than CBD oil, talk to your doctor about how much CBD you should take and how often you should use it. It’s also important to remember that using other medications with CBD oil may have unexpected consequences.

The same is true of CBD oil and other hemp products such as edibles and extracts, which can alter the effects of either substance on your body when taken together.

CBD seems to be a fairly safe product with few interactions when used properly, but it’s always best to talk to your doctor before beginning to use any new medication or natural remedy.

Recap of the Best CBD Oils for Pain & Inflammation in 2022

Penguin CBD – an extremely popular product that offers excellent value for money.

Verma Farms – another great option that offers full-spectrum CBD oil at a low cost to consumers.

R+R Medicinals – a full-spectrum CBD oil that’s available in the United States and ships to most countries worldwide.

Colorado Botanicals- a popular CBD oil that comes as regular strength and high-potency options.

cbdMD – another popular option that’s available for purchase online but doesn’t ship to Australia.

Bonus: BATCH CBD – a high-quality CBD oil that’s available in nine different strengths.

Bonus: TheraOne – a high-quality CBD oil that’s available in nine different strengths and ships to most countries worldwide.

Final Thoughts

Finally, we hope that you learned a lot of valuable information about how to use CBD oil for pain and inflammation without accidentally getting high from it. We wanted to share more about what factors could potentially cause pain and inflammation to the human body, as well as how CBD oil can be used to help treat these symptoms naturally.

We encourage you to read our other articles to learn more about CBD oil, what it does, how it works, and which brands are the best on the market today. If you have any questions or thoughts for us here, please do feel free to our contact form to reach us.

Cannabis and CBD for Frozen Shoulder

If you’re over the age of 45 and recovering from a recent shoulder injury, you may experience a painful condition called “frozen shoulder.” Whether your shoulder injury occurred after your shoulder muscles were overused, such as from repetitive overhead motion, or an impact injury, frozen shoulder (or adhesive capsulitis) can occur after someone’s arm has been immobilized, perhaps while in a sling, after a surgery or fracture.

It’s called frozen shoulder because, along with the dull or achy pain, you may experience stiffness, making it difficult or impossible to move your shoulder at all. You might also feel the pain in the shoulder muscles that wrap around the top of your arm. You might feel the same sensation in your upper arm. Your pain could get worse at night, which can make it difficult to sleep. Often affecting women more than men, if you experience frozen shoulder in one shoulder there’s a 20-30% chance you will get it in the other shoulder, as well.

Three Phases of Frozen Shoulder

There are usually three phases with a frozen shoulder. Each has its own unique symptoms and timeline.

  1. The freezing stage is associated with pain in your shoulder any time you move it, and some restriction of motion. That can last anywhere from 6 to 9 months. The pain is often worse at night, making it hard to sleep.
  2. Next is the frozen stage, when the stiffness and immobility gets worse. That can last 4-12 months. This is the most disconcerting period because it usually impacts activities involved in daily living, with one arm being of limited use.
  3. Finally, comes the thawing or recovery stage when the range of motion begins to improve. This can take anywhere from 6 months to 2 years.

Frozen shoulder is frustrating for those affected by it because of the extremely long limitation of function and course of recovery. Treatment for a frozen shoulder is focused on relieving pain and restoring the shoulder’s normal range of motion. Standard treatment may include NSAIDs (anti-inflammatory drugs), physical therapy and mild range-of-motion exercises, often starting with barely perceptible movements.

How Can CBD and/or Cannabis Help Frozen Shoulder?

Using CBD, cannabis , or a combination of the two can help your frozen shoulder a lot! CBD and cannabis may help frozen shoulder in three essential ways:

Now, it’s not always the case that pain is treated equally as well by CBD and cannabis, but in the case of frozen shoulder, however, the type of pain, inflammatory pain, is treated well by both due to their effect on the inflammatory “cascade” (the metabolic response to inflammation).

In fact, both CBD and THC have been proven to be as effective as anti-inflammatory drugs, a standard of treatment. It is essential to decrease inflammation as soon as possible in the process of evolution of a frozen shoulder. The shoulder joint will be less likely to progress to “adhesive” capsulitis (frozen) after an initial injury if inflammation is effectively decreased. Even if immobilized, a shoulder can’t have capsulitis without inflammation.

What Should You Take and How Should You Take It?

As far as what to take, both cannabis and CBD products provide internal (such as capsules or tinctures ) and external ( topical lotion or balm ) delivery methods. Using both of these may accelerate recovery time. A typical regimen might be 10 mg of a mixed THC/CBD cannabis (or possibly 50 mg of pure CBD isolate) 3 times per day, as well as a topical applied to the shoulder 3 times per day.

Other components of cannabis that are useful for inflammation are the cannabinoids in acid form, such as CBDA (cannabidiolic acid) and THCA (tetrahydrocannabinolic acid). These forms exist in raw, unheated cannabis and are not psychoactive. Since they bind to different receptors than the neutral cannabinoids (CBD and THC), the potential for relief is increased by using a combination of all of the above.

If you’re using a topical, it is best to apply it prior to any physical therapy exercise sessions to decrease the potential inflammation and pain that the session may generate. Pulling the “frozen” tissues apart is not only painful but is made more effective by releasing immobilized tendons. The muscle relaxant properties of cannabis and CBD aids in the release of the frozen tissues, extension of tendons, and increase in mobility of the shoulder.

Finally, if your sleep is impaired due to your frozen shoulder pain, a cannabis sleep product may be helpful. Most often this involves a dose of an indica cannabis strain that contains THC. CBD, unfortunately, is not often sleep inducing. Of course, if inflammation and pain are relieved, insomnia will improve.

Remember, you may have to stay on this modest cannabis or CBD regimen for months, maybe years, for severe cases of frozen shoulder. The earlier in the process you begin, the shorter the recovery time will likely be. After recovery, a maintenance dose of 10 mg once per day may prevent recurrence of shoulder inflammation in the future.

Cannabidiol: A Brief Review of Its Therapeutic and Pharmacologic Efficacy in the Management of Joint Disease

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Cannabis use in the management of musculoskeletal diseases has gained advocacy since several states have legalized its recreational use. Cannabidiol (CBD), a commercially available, non-neurotropic marijuana constituent, has shown promise in arthritic animal models by attenuating pro-inflammatory immune responses. Additional research has demonstrated the benefit of CBD in decreasing the endogenous pain response in mice subjected to acute arthritic conditions, and further studies have highlighted improved fracture healing following CBD use in murine mid-femoral fractures. However, there is a lack of high-quality, novel research investigating the use of CBD in human musculoskeletal diseases aside from anecdotal accounts and retrospective reviews, perhaps due to legal ramifications limiting the enrollment of patients. The purpose of this review article is to highlight the extent of current research on CBD and its biochemical and pharmacologic efficacy in the treatment of joint disease, as well as the evidence for use of CBD and cannabis in patients undergoing joint arthroplasty. Based on available literature relying on retrospective data and case reports, it is challenging to propose a recommendation for CBD use in perioperative pain management. Additionally, a number of CBD products currently available as supplements with different methods of administration, and it is important to remember that these products are non-pharmaceuticals. However, given the increased social relevance of CBD and cannabis-based medicines, future, prospective controlled studies evaluating their efficacy are needed.

Introduction and background

With the ever-growing commercial market for cannabidiol (CBD), a derivative of cannabis, there is no doubt that its proposed therapeutic value merits high-quality and novel research, particularly in the management of joint pain. Osteoarthritis is the most common joint disorder in the United States, affecting approximately 27 million Americans [1]. Furthermore, the volume of total joint arthroplasty procedures in the United States has sustained continuous growth over the past two decades, with a projected increase in total hip and knee replacements nearing 71% and 85% over the next 10 years, respectively [2]. Therefore, in conjunction with other, well-studied non-opioid treatment options, CBD may prove to be a beneficial pharmacologic modality for the treatment of joint pain. CBD is a marijuana constituent that has pharmacologic benefits without the additive psychotropic effect of Δ9-tetrahydrocannabinol (THC), another major cannabis ingredient. Currently, anecdotal accounts citing relief of joint pain after smoking cannabis or using CBD exist in the literature, though these data are not corroborated by regulated clinical trials as the legal ramifications may inhibit enrollment in such studies [3]. The following review relays the currently held views on the biochemical efficacy of CBD for the management of inflammation and joint pain and highlights several previous studies that demonstrate a potential human application for CBD in this regard.

Review

Mechanism of action: cannabidiol

CBD, the major nonpsychoactive component of cannabis, has undergone a bevy of research in murine model organisms, though there is scant, well-vetted evidence of its efficacy in humans. In a study by Malfait et al. in 2000, DBA/1 mice underwent a collagen-induced arthritis (CIA) by immunization with type II collagen (CII) in complete Freund’s adjuvant (CFA) [4]. CBD was then administered after the onset of clinical symptoms, resulting in diminished CII-specific proliferation, IFN-gamma production, and release of tumor necrosis factor. Incidentally, in a separate murine line, the same authors found that CBD was capable of blocking the lipopolysaccharide (LPS)-induced rise in serum tumor necrosis alpha [4]. A subsequent review by Stephen Straus highlighted the aforementioned findings and suggested that CBD is effective when dosed orally or intraperitoneally, noting that it followed a sharp dose-response curve that limits its efficacy range [5]. Thereafter in 2004, Sumariwalla et al. explored the potential antiarthritic effects of a novel, synthetic cannabinoid acid pegged Hebrew University-320 (HU-320). In a prospective manner, these authors immunized DBA/1 mice with bovine CII, injected intraperitoneal HU-320, and assessed the outcomes both clinically and histologically [6]. The results of systemic, daily administration of 1 and 2 mg/kg HU-320 “ameliorated” the established CII-induced arthritis, without any noticeable adverse psychotropic effects [6]. Therefore, these data indicate that cannabinoids such as CBD, in both an anti-inflammatory and immunosuppressive manner, have potent anti-arthritic effects with a subjectively diminished adverse risk profile.

For the literature review, a PubMed Medical Subject Headings (MeSH; MEDLINE) search from 2000 to 2020 was conducted using the following terms: (“Cannabidiol”[MeSH]) and (“Joint Diseases”[Majr]). The search yielded 11 articles, and after reviewing each for accuracy, the focus was narrowed onto eight with the exclusion of those that did not involve CBD. Additionally, Google Scholar was queried using “cannabinoids, joint pain” as key phrases. While the search returned myriad articles from receptor classification to the effects of CBD in animal models, there were no relevant studies regarding any human, clinical data entertaining prospective CBD use and joint pain. In 2006, Blake et al. published an article on the preliminary assessment of the efficacy, tolerability, and safety of a cannabis-based extract called Sativex (GW Pharmaceuticals, Cambridge, UK) used in the treatment of pain from rheumatoid arthritis. Sativex is a cannabis-based pharmaceutical containing THC and CBD, and though a primary limitation of this study was that Sativex was not exclusively composed of CBD, the authors observed a significant analgesic effect with disease suppression following Sativex treatment [7]. In 2011, GW Booz wrote an article on CBD as an emergent therapeutic strategy, attempting to explore exactly how CBD mitigates oxidative stress. His results indicate the endogenous endocannabinoid system acts via CB1 and CB2 G-protein-coupled receptors via lipid ligands, a mechanism that Booz called “ripe for therapeutic exploitation” [8]. Interestingly, the author also notes that CBD has little affinity for the classic endocannabinoid receptor system. In a CB1- and CB2-independent fashion, the actions of CBD on immune cells appear to include the suppression of cell-mediated and humoral immunity. The effect is obtained via blockage of the activation of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, the delayed wave of reactive oxygen species (ROS) formation, and the associated tumor necrosis factor alpha secretion, and p38 mitogen-activated protein kinases (MAPK) activation [8]. Furthermore, through an unidentified mechanism, CBD was reported to suppress pro-inflammatory signaling and LPS-induced microglial cell migration, while distinctly enhancing other anti-inflammatory pathways [9]. Therefore, given its attenuation of various pro-inflammatory responses in cell models, CBD may certainly have a role in the treatment of pain associated with rheumatoid arthritis via its effects on the immune cell.

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Secondly, a more recent exploration into the role of cannabinoids in the treatment of non-rheumatoid arthritis pain suggests that CBD binds to and activates an atypical receptor system entirely. In their article on a novel endogenous receptor called G-protein coupled receptor55 (GPR55), Schuelert and McDougall investigated whether or not the synthetic GPR55 agonist 0-1602, a CBD analog, alters joint nociception in a rat model subjected to acute joint inflammation [10]. The authors induced acute (24-hour) joint pain by injecting male Wistar rats with intra-articular preparations of 2% kaolin and 2% carrageenan. Using extracellular recordings from afferent nociceptive fibers, they found that peripheral administration of 0-1602 reduced the firing of afferent C fibers in response to mechanical rotation of the knee [10]. Though not explicitly translatable to stress-induced osteoarthritic changes in a human knee, this study highlights the role of cannabinoid receptors in joint nociception and suggests a potential relationship between CBD and relief of joint pain in a non-immune fashion. Further evidence for the anti-arthritic role of CBD stems from additional animal studies that evaluate its route of administration and anti-inflammatory effects. Similar to the work produced by Schuelert and McDougall, Hammell et al. investigated a topical CBD application in an attempt to avoid gastric diminution of the drug, hepatic first-pass metabolism, and to achieve greater plasma drug levels outright. The authors describe a favorable transdermal absorption profile when dosed in 0.6-6.2 mg/day, and note that topical CBD significantly reduced joint swelling, limb posture scores, and thickening of the synovial membrane in a dose-dependent manner. Additionally, immunohistochemical analysis of spinal cord and dorsal root ganglia revealed dose-dependent reductions of pro-inflammatory biomarkers, without a concomitant rise in behavior alteration to suggest a psychotropic effect [11]. In light of these data, there emerges a theme. In rodent models, CBD administration has proven anti-inflammatory effects, with a seemingly sharp dose-response peak, no evidence of neurocognitive side effects, and a histologic regression of arthritis in the short term.

Clinical utility: cannabidiol

Currently recommended pharmacologic treatment options for the symptomatic management of osteoarthritis include non-steroidal anti-inflammatories (NSAIDs), low-dose steroids, and viscosupplementation. However, each of these modalities is fraught with side effects when used for long periods of time, and given the insidious time course of osteoarthritis, CBD may prove a useful drug for those with an aversion to other therapies. Additionally, the evidence for viscosupplementation relies on the results of controversial, randomized-controlled trials, and intra-articular preparations have notable contraindications to therapy. Therefore, it is reasonable to suggest that CBD is a safe, useful alternative or adjunct for the treatment of neuropathic joint pain due to secondary osteoarthritis. Osteoarthritis is a progressive disease that results in subchondral bone loss over the years, accelerated by a variety of environmental and genetic factors. In a study by Philpott et al. in 2017, osteoarthritis was induced in male Wistar rats via intra-articular injection of sodium monoiodoacetate (MIA; 3 mg). In addition to its therapeutic effect caused by a decreased joint firing rate and an increased threshold for weight-bearing, the authors demonstrate a prophylactic benefit of 100-300 mcg of CBD as evidenced by a statistically significant reduction of MIA-induced joint pain at a later time point [12]. Despite a small sample size (n = 8), these data are promising and suggest a possible role in prolonging the time course of osteoarthritis, either to the onset of clinical symptoms or to the need for pharmacologic or operative intervention. Therefore, one practical application of cannabinoids including CBD is in the primary prevention of osteoarthritis, or in its preoperative use. In a 2015 study by Kogan et al., CBD enhanced the biochemical properties of healing rat mid-femoral fractures via stimulation of mRNA expression of Plod1 in primary osteoblast cultures, a mechanism well-understood to be involved in collagen cross-linking and bony stabilization [13]. For this reason, along with the evidence presented herein, the orthopedic community has taken interest in CBD, along with other cannabis products, as a potential adjunct for musculoskeletal disease treatment, both in the preoperative and postoperative period.

Clinical utility: cannabis

Cannabis-based medicines have been employed in the orthopedic practice, though a lack of sufficient data precludes its widespread recommendation. A secondary literature review on cannabis-based therapy in orthopedics was conducted using a PubMed MeSH (MEDLINE) search: (“Cannabis”[Mesh]) and (“Fractures”[MeSH]) OR (“Arthroplasty”[MeSH]). The search yielded nine studies following the exclusion of two that did not meet inclusion criteria or were considered outside the realm of this study (Table 1 ). Additionally, Google Scholar was queried using the key phrases “cannabinoids, arthroplasty”, which yielded one more recent article by Runner et al. (2020) not found in the initial search.

Table 1

MeSH: Medical Subject Headings; OA: osteoarthritis; RA: rheumatoid arthritis; TKA: total knee arthroplasty; TSA: total shoulder arthroplasty; THA: total hip arthroplasty; RTKA: revision total knee arthroplasty; CBD: cannabidiol; BMD: bone mineral density; VTE: venous thromboembolism PROs: patient-reported outcomes; BMI; body mass index

Author, year Design Aims, methods, and endpoints Sample size Importance
Kogan et al., 2015 [13] N/A Whether CBD enhances the biomechanical properties of healing rat mid-femoral fractures N/A CBD stimulated mRNA expression of Plod1 in primary osteoblast cultures and collagen cross-linking
Richardson et al., 2008 [14] Cohort Synovial endocannabinoid expression between healthy and non-healthy (OA and RA) groups N = 45 total patients; 32 patients with a clinical diagnosis of OA, 13 patients with a clinical diagnosis of RA Increased CBD1 and CBD2 RNA levels in synovium suggests target for pain and inflammation associated with OA and RA
Best et al., 2015 [15] Retrospective, National Hospital Discharge Survey Drug misuse outcomes of primary total hip and knee arthroplasty N = 13,163 with no drug history; n = 8,366,327 with a drug history Drug misuse group had higher odds of in-hospital complications
Moon et al., 2019 [16] Retrospective, National Inpatient Sample, 2010-2014 Marijuana use and in-hospital mortality in commonly billed orthopedic surgeries N = 9,561,963 Marijuana use was associated with decreased mortality in patients undergoing THA, TKA, TSA, and traumatic femur fixation
Jennings et al., 2019 [17] Retrospective Self-reports of use in total joint arthroplasty (500 before and 500 after the legalization in Colorado) N = 1,000 Legalization of marijuana has led to more users or more patients willing to report its use
Roche et al., 2018 [18] Retrospective, PearlDiver Medicare database Effects of drug abuse on revision TKA N = 2,159,221 Drug abuse patients, including cannabis, are at increased risk for RTKA
Vakharia, et al., 2019 [19] Retrospective, database retrieval Whether patients with cannabis use disorder undergoing primary TKA have higher rates of VTE, readmissions; and costs N = 18,388 Patients with cannabis use disorder have higher rates of VTE complications, readmission rates, and cost
Jennings et al., 2019 [20] Retrospective Primary unilateral TKA PROs with minimum 1-year follow-up, who self-reported cannabis use N = 71 Cannabis use does not influence (adverse or beneficial) short-term outcomes in patients undergoing primary TKA
Sophocleous et al., 2017 [21] Cross-sectional case control, UK primary care database Heavy and regular cannabis smokers and BMD scores N = 56 moderate smokers, N = 144 heavy smokers; matched to 114 cigarette smokers Heavy cannabis use (>500 lifetime uses) is associated with low BMD, low BMI, high bone turnover, and an increased risk of fracture

CBD acts in a non-endocannabinoid fashion, distinguishing it from THC, the psychoactive ingredient of cannabis. Therefore, cannabis may have a distinct utility profile from CBD. Despite the clinical and preclinical evidence of cannabis-based medicines in combating inflammatory disease, legal ramifications of its use inhibit high-quality, prospective, controlled trials evaluating patient-reported outcomes as a primary endpoint. Retrospective studies have attempted to ascertain the relationship between drug use and postoperative complications following total arthroplasty. In a study by Best et al. in 2015, postoperative total hip and knee patients with a documented history of drug misuse (cocaine, cannabis, amphetamines, and opioids) had greater odds of incurring longer hospital lengths of stay, infection risks, and mortality [14]. Within large database claims such as this, though, cannabis use was likely not the sole culprit for risks of complications, and additional studies have attempted to understand the influence of specific marijuana use on postoperative outcomes in joint arthroplasty. In 2019, Moon et al. conducted a National Inpatient Sample (NIS) database study of 9.5 million inpatients undergoing five common orthopedic procedures: total hip, total knee, and total shoulder arthroplasties, spinal fusion, and traumatic femur fracture fixation. They identified a history of marijuana use disorder in 0.28% of total inpatients from 2010 to 2014, though only within patients undergoing total hip, knee and shoulder arthroplasties, and femur fixation do they describe a decreased odds of inpatient mortality [15]. Needless to say, the association between cannabis use and orthopedic surgical procedures remains unclear. Substance abuse can have a strong negative impact on the outcomes of arthroplasty, though cannabis and CBD both have demonstrated biochemical and therapeutic benefits. Therefore, given its increasing social relevance, prospective, randomized data is needed in this regard.

In orthopedic medicine, the benefit of adjunct CBD and cannabis is likely greatest in an otherwise healthy patient committed to a full, functional recovery, and these data cannot be derived from retrospective database studies. There is no doubt that its recreational use is growing, especially in states where it has been legalized. In a study by Jennings et al. in 2019, 1,000 records of patients undergoing primary total joint arthroplasty (500 consecutive before and 500 consecutive after the legalization of the commercial sale of marijuana in Colorado) were analyzed. The authors describe an increase in self-reported cannabis use from 1% to 11% following its legalization, attributable either to increased use, or increased self-reporting, given the lack of legal ramifications [16]. However, the significance of these results remains unclear. The potential clinical utility of cannabis-based medicines extends from the pre-operative period, following a diagnosis of osteoarthritis, into the peri-operative stage, including postoperative follow-up. No current evidence exists on whether or not cannabis-based medicines including CBD prolong time to total arthroplasty following a diagnosis of osteoarthritis. However, in a Medicare database study by Roche et al. in 2018, patients with a history of drug abuse including cannabis (cannabis use disorder) were at a significantly increased risk for revision total knee arthroplasty than a matched cohort [17]. Furthermore, retrospective studies by Vakharia et al. and Jennings et al. in 2019 note that patients with cannabis use disorder have statistically significant higher rates of venous thromboembolism (VTE) complications and costs, without an increase in postoperative range of motion or a mean improvement in mental and physical scores [18,19]. Similarly, in a prospective cohort of patients undergoing primary, unilateral THA/TKA enrolled in a single institution in California, where THC and CBD are legal, the authors describe a wide variety of usage patterns of THC/CBD; however, they note that between CBD/THC users and non-users, there was no significant difference in the length of narcotic use, narcotic pills consumed, average postoperative pain scores, the percentage of patients requiring a refill of narcotics, or length of stay [20]. In conjunction with sufficient literature that suggests that endocannabinoids have utility in mitigating the anti-inflammatory effects of osteoarthritis, these data highlight the potential pre-operative and preventative use for cannabis-based medicines as opposed to the postoperative utility.

Bone mineral health: endocannabinoids

In an orthopedic practice, joint replacement is quite prevalent, though fracture care is also a potential, high-volume area of interest for the use of cannabis or CBD. Though the current evidence is scant, in the aforementioned animal model study conducted by Kogan et al., THC was noted to potentiate the CBD-stimulated work-to-failure at six weeks post-fracture, followed by attenuation of the CBD effect at eight weeks, which would be a primary indication for use of cannabis in the setting of a fracture. Additionally, in a cross-sectional case-control study by Sophocleous et al. in 2017, heavy cannabis users (>500 lifetime uses) had lower hip and spine bone mineral density, lower BMI, and higher bone turnover, and increased fracture risk than a matched cohort who reported

Study limitations: the present study

The present study represents a brief literature review using MEDLINE (PubMed) and Google Scholar search engines. This review did not satisfy criteria set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and additional databases such as EMBASE and Web of Science were not queried, which may decrease the guarantee of adequate and efficient coverage in the retrieval of articles. A time period from 2000 to 2020 was set forth in the literature review, and studies were excluded if they were not written in English, were duplicated, or lacked relevance to this review. The authors believed that searching MEDLINE and Google Scholar would highlight articles with relevance to CBD and joint pain, though it is possible that human clinical data may be uncovered via other search engines as well. The limitations of the articles within this review are discussed intermittently throughout.

Study limitations: collected articles

While animal-based model studies are important for the classification of endocannabinoids from a biochemical perspective, the preclinical and clinical human data presented herein have several limitations. First, to the knowledge of the authors, there is one study that attempts to prospectively ascertain the effects of CBD on peri-operative arthroplasty. However, in this study by Runner et al., CBD was not standardized among patients, meaning there was a wide variety of reported usage patterns, and the sample size was relatively small (n = 295) [22]. Future studies must prospectively enroll patients with the intent to monitor primary endpoints after standardized CBD doses and how they affect postoperative outcomes. With respect to the collected articles included in the review on cannabis-based medicine and arthroplasty, several limitations arise. six of the nine studies were retrospective in nature. None of the studies enrolled patients to receive CBD or cannabis-based products in a longitudinal manner, either pre-operatively with a diagnosis of osteoarthritis, or postoperatively in addition to their scheduled pain management plan. As mentioned earlier, legal ramifications likely inhibit high-quality prospective studies, and these studies are needed in the future before recommendations on THC/CBD use with arthroplasty can be made.

Conclusions

Cannabis has gained widespread popularity following the legalization of its recreational use in several states. CBD, a major non-neurotropic marijuana constituent that is also commercially available, has shown promise in mouse model studies by attenuating pro-inflammatory immune responses. Additionally, recent research has demonstrated the efficacy of CBD in decreasing the endogenous pain response in mice subjected to acute arthritic conditions, as well as improved fracture healing via collagen cross-linking in a murine mid-femoral fracture cohort. However, there is a lack of high-quality, novel research investigating the use of CBD in human musculoskeletal diseases aside from anecdotal accounts. This review highlights the extent of the current research on CBD and its biochemical and pharmacologic efficacy in the treatment of joint disease, as well as the current evidence surrounding cannabis-based medicine and orthopedic joint replacement. Currently, there are no approved pharmaceutical products that contain CBD alone for the management of pain. Based on available literature relying on retrospective data and case reports, it is challenging to propose a recommendation for CBD use in perioperative pain management. Additionally, a number of CBD products are currently available as supplements with different methods of administration, and it is important to remember that these products are non-pharmaceuticals. However, given the increased social relevance of CBD and cannabis-based medicines, future, prospective controlled studies evaluating their efficacy are needed.

Notes

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