Arthritis affects millions of people. In the United States alone, there are around 54 million adults and 300,000 children who have been diagnosed with this disease. When you factor in those who have not been diagnosed, the total count could go as high as 91.2 million individuals. The Arthritis Foundation (AF) expects that number to grow by 49 percent by the year 2040.
The most common symptoms of arthritis are severe pain, stiffness, and limited movement around the joints. As the disease progresses over time, arthritis can also cause psychological symptoms such as anxiety and depression. If you have other medical issues such as heart disease, obesity, or diabetes, arthritis can make life extremely difficult for you.
How to treat arthritis
Arthritis treatment involves reducing pain and improving joint movement. You may need to try a combination of different treatments to determine the one that works for you.
Doctors prescribe medication according to the type of arthritis that needs treatment. The most common arthritis medications include:
- Analgesics reduce pain but do not treat inflammation (acetaminophen, tramadol, oxycodone, hydrocodone)
- Non-steroidal anti-inflammatory drugs (NSAID) reduce both pain and inflammation (ibuprofen, naproxen sodium)
- Counter-irritants are creams and ointments that contain menthol or capsaicin
- Disease-modifying anti-rheumatic drugs (DMARD) stop the immune system from attacking your joints (methotrexate, hydroxychloroquine)
- Biologic response modifiers are genetically engineered drugs that target protein molecules in the immune response (etanercept, infliximab)
- Corticosteroids reduce inflammation and suppress the immune system (prednisone, cortisone)
The problem with NSAIDs is that they can cause stomach irritation. Some might even increase your risk of heart attack or stroke. Counter-irritants may interfere with the transmission of pain signals.
Some types of arthritis require physical therapy. Special exercises are designed to improve range of motion as well as strength muscles around the affected joint. The therapist may prescribe splints or braces in some cases.
Along with medication and therapy, lifestyle changes can help mitigate the symptoms of arthritis.
Exercise. You can keep your joints flexible with regular exercise. Jogging, running and lifting can add more stress to your joints but swimming and water aerobics allow you to keep moving while the buoyancy of water minimizes weight.
Lose weight. If you are obese and suffering from arthritis, the best way to reduce symptoms is to lose weight. Staying fit increases mobility and prevents future joint injury.
Implement assistive devices. Canes, walkers, raised toilet seats, and other assistive devices can help protect your joints as you perform routine tasks.
Pain medication can be addictive, which is why many people turn to alternative remedies when treating arthritis. These include:
- Tai chi
CBD – a compound from the cannabis plant – has been hyped as the next big thing in alternative medicine. It has shown great promise as a therapeutic solution for almost everything, from migraines to chronic pain to anxiety and depression. Is it really effective in reducing arthritis symptoms?
What is CBD?
Hemp and marijuana are variations of the Cannabis Sativa plant. They both produce chemical compounds called cannabinoids. The most dominant of these cannabinoids are tetrahydrocannabinol (THC) and cannabidiol (CBD).
While marijuana may contain some CBD, it is primarily grown for its THC content which is around 5 to 35 percent of the plant. Hemp, on the other hand, has plenty of CBD and less than 0.3 percent of THC.
CBD is not the same as weed – it will not get you high. THC is the compound that is responsible for the euphoric, mind-altering effects of cannabis.
While THC and CBD are plant-derived cannabinoids, the human body also produces similar compounds called endocannabinoids. Recent research suggests that the interaction between CBD/THC and endocannabinoid receptors may cause pain relief.
CBD and arthritis pain relief
According to the Arthritis Foundation, arthritis is the leading cause of disability in the United States. There are two common types of arthritis: rheumatoid arthritis (RA) and osteoarthritis (OA).
What is rheumatoid arthritis?
Rheumatoid arthritis causes joint pain throughout your body. It is a symmetrical disease, which means that symptoms occur on both sides of your body at the same time. If you feel pain in the joint of your right arm or leg, you will probably feel the same pain in the joint of your left arm or leg. This is one way for doctors to distinguish rheumatoid arthritis from other types of inflammatory disease.
As an autoimmune disorder, rheumatoid arthritis causes joint damage not because of normal wear and tear but because the body is attacking itself. Rheumatoid arthritis makes the body interpret the soft lining around the joints as a threat. It then reacts to it accordingly – by attacking it just like a virus or bacteria.
Rheumatoid arthritis usually affects smaller joints first – like the bones in your fingers. As the disease progresses, pain will extend to larger joints such as those in the shoulders, knees and ankles. Rheumatoid arthritis can also affect your lungs, skin, eyes, and other body parts.
The symptoms of rheumatoid arthritis include:
- Severe pain
- Stiffness of the joints
- Swelling of the joints
- Loss of joint function
Rheumatoid arthritis is a chronic disease, which means that symptoms happen from time to time over a long period. When pain and inflammation set in, it is known as a flare. When the symptoms go away, the disease is in a period of remission.
What is osteoarthritis?
Similar to rheumatoid arthritis, osteoarthritis comes with stiff and painful joints that make it difficult to move around.
The most common form of arthritis, osteoarthritis is not an autoimmune disease. It is a degenerative disorder resulting from natural wear and tear of the joints. Old age or trauma often causes the cartilage around the joints to break down. When the cartilage that cushions the joint wears thin, the bones begin to rub against each other. This exposes the nerves and can be very painful.
While osteoarthritis is often seen in older adults, it can also happen to younger adults who overuse or injure a particular joint. This is most prevalent in tennis players and other athletes.
Osteoarthritis is not necessarily symmetrical – if you have pain in both of your knees, one side is probably worse than the other.
Osteoarthritis commonly affects the hands and fingers as well as the hips, knees, and spinal column.
Although joints that are afflicted with osteoarthritis do swell after extended activity, the disease does not cause significant inflammatory reaction like redness of the joints.
Both rheumatoid arthritis and osteoarthritis are more common in women than in men. They are also more prevalent in older adults although rheumatoid arthritis can develop at any age.
Rheumatoid arthritis is also known to run in families. If a parent or sibling has the disease, you have a high probability of developing the same condition.
CBD and chronic pain
The human endocannabinoid system has two types of cannabinoid receptors: CB1 and CB2.
CB1 receptors are located in the brain and are responsible for cognitive functions such as mood, memory and appetite.
CB2 receptors are found in the immune system so they affect how the body responds to pain and inflammation.
THC attaches to CB1 receptors, which explains why a person gets high when smoking or ingesting marijuana.
As CBD affects CB2 receptors indirectly, it encourages the body to produce more endocannabinoids and create a positive effect on pain and inflammation response.
Since CB2 plays a role in the immune system, and RA is an auto-immune disease, CBD seems to work more effectively in treating symptoms of rheumatic arthritis.
The anti-inflammatory properties of CBD could also help stop the progression of RA and slow down permanent damage to the joints.
A 2008 review of available CBD research suggested that CBD could play a role in managing chronic pain.
CBD and arthritis: what the science says
Some animal studies have shown that CBD may help treat arthritis pain and relieve associated symptoms of inflammation.
In 2011, a study found that CBD was able to reduce inflammatory pain in rats by modifying the way pain receptors responded to stimuli.
The following year, scientists from the National Institutes of Health (NIH) in Bethesda, Maryland demonstrated how cannabinoids can suppress inflammatory and neuropathic pain without causing tolerance often associated with opioids.
A 2014 review looked into the involvement of the endocannabinoid system in osteoarthritis pain. The researchers concluded that CBD may be an effective treatment for OA.
In 2016, a study was conducted on topical CBD and rats. The findings revealed that CBD gel reduced both joint pain and inflammation without any side effects.
A study published in the European Journal of Pain in 2016 explored the anti-inflammatory properties of CBD. Researchers took a group of mice with arthritis and applied a topical preparation containing 0.6mg, 3.1mg, 6.2mg, and 62.3mg of CBD. After four consecutive days of treatment, there was a significant reduction in inflammation and signs of pain in the affected joints with no reported side effects.
The following year, scientists looked into a group of mice with osteoarthritis and joint neuropathy. They found CBD to be an effective and safe treatment for OA joint pain – reducing joint inflammation and protecting the nerves.
Can CBD help relieve arthritis symptoms?
The first controlled trial evaluating the application of cannabis-based medicine in RA treatment was conducted in 2006. After a five-week period, researchers concluded that the THC/CBD combination in Sativex produced significant improvements in pain on movement, pain at rest, and quality of sleep with very mild side effects.
A 2008 review of CBD treatment of chronic pain similarly concluded that CBD is able to minimize pain and improve sleep without negative side effects.
While current CBD research has shown great promise, most studies have been conducted on animals. Clinical trials on large numbers of human participants are needed to fully understand how CBD can effectively treat arthritis symptoms.
CBD and other chronic pain conditions
Science has also proven that CBD can help relieve other chronic pain conditions.
Research published in Therapeutics and Clinical Risk Management in 2008 indicated that cannabinoids can be helpful in reducing pain in patients who have been diagnosed with multiple sclerosis, rheumatoid arthritis, neuropathy, and cancer.
In 2011, a study on cannabis use reported positive effects in easing fibromyalgia pain. Participants included 28 fibromyalgia patients who took cannabis and 28 non-users. After two hours of smoking or ingesting cannabis, VAS scores showed a significant reduction of pain and stiffness, enhanced state of relaxation, and increase in feeling of well being. The mental health component summary score of the SF-36 was also significantly higher in cannabis users.
How to use CBD oil for arthritis
CBD is available in oil and powder forms, which makes it possible to mix with creams, lotions and gels for topical application on areas affected by arthritis.
CBD can also be taken as capsule, sublingual tincture, or oral spray. If you do not like the taste of hemp, mix CBD oil with food or water.
With so many CBD products currently sold on the market, choosing the right formula to help ease your arthritis pain can be confusing. It is important to first understand the principle of bioavailability.
Bioavailability refers to the amount of a substance that reaches the target organ or system when introduced through injection, inhalation, ingestion, or skin contact. In other words, it is how much CBD can effectively treat stiff, achy joints based on route of administration.
The bioavailability of intranasal CBD is around 34 to 46 percent. Inhaling vaporized CBD has 40 percent bioavailability. Oral CBD has the lowest bioavailability at 6 percent – a consequence of first-pass metabolism.
First-pass metabolism happens to all drugs that pass through the gut or the liver. When taken orally, some drugs are even destroyed before they reach your blood circulation. This is why CBD in capsule or pill form may result in your body receiving only as little as 6 percent of CBD.
One of the most effective routes of administration for treating arthritis pain is through the skin. According to a research paper published in the European Journal of Pain in 2016, topical CBD application has therapeutic potential for relief of arthritis pain and inflammation without side effects.
Talk to your doctor to find the best dosage for your arthritis pain. Some products contain as little as 2.5mg of CBD per shot while others contain more than 1000mg. Always start with a very small dose and observe how your body reacts. If you do not notice any effects, you can try to gradually increase your daily intake.
Dr. Daniel J. Clauw, director of the Chronic Pain and Fatigue Research Center at the University of Michigan, suggests the following tips for those who are taking CBD for arthritis for the first time.
- Start with a CBD-only formula (CBD isolate)
- Consume 5mg to 10mg twice daily and slowly increase up to a maximum of 50mg to 100mg per day
- Take your CBD dose at night
- The effects of CBD edibles last longer than vaping so make sure you know what CBD strain and dose work for you
- Do not use CBD products that contain THC if you are 25 years old or younger as this age group has the highest risk of addiction and dependency
Is CBD safe?
Unlike marijuana and THC, the risks associated with hemp-derived CBD are extremely low. To date, there has been no single case report of CBD overdose in medical cannabis literature.
The National Institute on Drug Abuse has stated that CBD appears to be safe with no addictive effects.
Although most people tolerate CBD well, small-scale studies have shown mild side effects in some patients. These include:
- Dry mouth
- Trouble sleeping
- Feeling irritable
- Change in appetite
You may also experience drowsiness when taking CBD so exercise caution when driving or operating heavy machinery. If you have been prescribed with insomnia medication, CBD could enhance sleepiness even more. Keep this in mind if you are performing activities that require you to stay alert at all times.
The FDA currently does not approve CBD as a medical treatment for arthritis. The federal agency has only approved CBD for two rare and severe types of epilepsy.
CBD can interact with prescription medications that are metabolized by the liver. These include:
- Ondansetron (Zofran)
- Clozapine (Clozaril, FazaClo)
- Progesterone (Endometrin, Prometrium)
- Disulfiram (Antabuse)
- Ketamine (Ketalar)
- Phenobarbital (Luminal)
- Omeprazole (Prilosec)
- Lansoprazole (Prevacid)
- Diazepam (Valium)
- Carisoprodol (Soma)
- Ibuprofen (Motrin)
- Celecoxib (Celebrex)
- Amitriptyline (Elavil)
- Warfarin (Coumadin)
- Paroxetine (Paxil)
- Tramadol (Ultram)
- Venlafaxine (Effexor)
- Alprazolam (Xanax)
- Fexofenadine (Allegra)
CBD also interacts with some substances that we put in our body.
In 2015, a study published in the journal Pharmacology Biochemistry and Behavior found that caffeine can protect against memory loss induced by high doses of CBD.
Another study in 2013 published in the Addictive Behaviors journal revealed that CBD significantly reduced cigarette consumption by as much as 40 percent in tobacco smokers who wanted to quit.
CBD may trigger an allergic reaction in some people. It is best to apply CBD on a small area of the skin first.
Is CBD legal?
CBD can be extracted from either marijuana plants or industrial hemp plants. Industrial hemp that is grown overseas can be imported into the United States to create CBD extracts that can be legally sold and bought – thanks to the passing of the 2018 Farm Bill.
Although individual states have the authority to regulate hemp CBD as they choose, the Farm Bill enables consumers to freely try CBD oil products without fear of breaking the law.
Choosing a CBD product for arthritis
As earlier mentioned, CBD comes in many forms. There are CBD oil drops, CBD capsules, CBD vaping liquids, topical CBD ointments, CBD edibles, and even CBD suppositories.
There are three things to consider when choosing a CBD product:
- CBD volume
- Hemp oil volume
- CBD concentration
The amount of CBD in each product may vary widely – from 2mg to 22mg per dose. The disclosed strength is not always accurate as well as the amount of THC if any.
Choosing a CBD product for arthritis ultimately depends on the location and severity of your pain. If you want to target a specific area such as an elbow or knee, the best solution is topical CBD. If the pain is all over your body, then a sublingual tincture may provide the most relief.
If you are new to CBD, start with 10mg per day. Most patients who are suffering from rheumatoid arthritis experience relief when they take 20mg of full-spectrum lab-grade sublingual CBD tincture twice per day. Those with more severe pain often have to go as high as 80mg twice per day to achieve maximum relief.
Talk to a doctor who is familiar with CBD supplementation. Contact the manufacturer and ask for a complete ingredients list and proof of a third-party laboratory analysis for purity and potency.
If you live in a state where marijuana is legal, try to look for dispensaries that specialize in medical marijuana rather than recreational pot.
How to take CBD for arthritis
Depending on the type of CBD product you end up purchasing, administration instructions that are written on the packaging may vary.
Applying topical CBD
- Wash the skin well and rinse all traces of soap. Cleanser residue can dilute the topical you are applying.
- Pat the skin dry.
- Apply a thin layer of cream or ointment evenly to the affected area(s).
- Massage the cream or ointment gently into the skin until it is absorbed completely.
- Wash your hands after applying CBD cream or ointment to avoid spreading the product to other areas.
- Fill the pipette by pressing the dropper top.
- Dispense the desired amount of CBD oil under your tongue.
- Wait 60 to 90 seconds before swallowing the oil.
- If the taste is too strong for you, try drinking juice along with it.
CBD oil is intended for symptom relief and not as a cure for arthritis. Although CBD can be highly effective at reducing discomfort and managing pain, it will never make your arthritis go away. Do not expect CBD to permanently heal any medical condition that you may have.
CBD has shown great potential as a therapeutic remedy for arthritis pain. When it interacts with receptors in the brain and the immune system, it could help reduce inflammation and pain.
Dr. Faye Rim, a pain management specialist at the Hospital for Special Surgery (HSS) in New York, recommends CBD as a supplement to arthritis medication and not as first-line treatment. Some of her patients have found relief from CBD while it has had no effects on others. Still, she encourages people to try it as there seems to be no problematic drug interactions or major side effects.
Despite numerous anecdotal reports, there is a lack of scientific evidence to conclusively say that CBD is an effective treatment for arthritis pain. More studies and trials on bigger groups of human participants need to be conducted to better understand how CBD affects pain signals and inflammation.
If you decide to try CBD for arthritis, the best products are CBD lotions, creams, balms, and ointments. CBD in topical form allows you to target specific areas that are swollen and stiff such as knees, elbows and ankles – without the CBD getting diluted in your gut. CBD is easily absorbed by the skin for direct relief of aches and pain.
The downside to CBD topical solutions is that they tend to work slower than CBD products that are absorbed directly by the bloodstream. Lotions and creams also contain a variety of other ingredients such as eucalyptus, lavender and mint which makes them a little more expensive than tinctures, capsules or edibles.
Important reminder: purchase topical CBD oils only from a reputable online CBD pharmacy to get the best value for your money.