What Causes Joint Pain and How does CBD Oil Work ?
There are over 100 different types of arthritis, which is a condition where the joints are inflamed, red, swollen, and painful. Joint pain is a common feature in all of those types of arthritis, even though the cause is not the same. The main treatment modality in these conditions is to control the pain, reduce the stiffness, and maintain the function of the joint. Although there are many conventional medications that are used to manage different types of arthritis, most of these drugs are not curative, not much effective, and with serious side effects, including addiction, which is mainly due to the use of opiates to reduce the joint pain. That is why cannabidiol (CBD) is being investigated as an alternative option to manage joint pain in people with arthritis.
Cannabis contains both CBD and delta-9-tetrahydrocannabinol (THC) along with other compounds. However, unlike THC, cannabidiol oil does not have any of the ‘psychoactive’ properties of THC, and that is why CBD oil, and not THC, is proposed as an alternative medication for joint pain, that is because it does not impact the psychological state of its users. Surprisingly, in 2019, a population-based survey was carried out in the United States, and it was found that 14% of Americans use CBD products, and the main reason for usage was to manage pain.
What do Animal Studies Say?
Cannabinoid compounds, like CBD, exerts their actions mainly through cannabinoid receptors in the body, namely cannabinoid receptor 1 (CB1) and cannabinoid receptor 2 (CB2). The modulation of nociception, which is known as pain perception, is hypothesized to take place via CB1 and CB2 receptors as well as other non-cannabinoid receptors such as the GPR55 receptor.
Recently, an animal study was conducted to determine the effectiveness of a cannabidiol analogue in controlling joint pain in a rat model with acute joint inflammation. It was noted that the use of peripherally-administered cannabidiol analogue (O-1602) successfully reduced the sensation of nociception and joint pain. These results highlight the fact that cannabidiol can act on non-cannabinoid receptors and reduce the feeling of joint nociception or pain. Cannabidiol is reported as a promising option for controlling inflammatory joint pain.
Can CBD Control Joint Pain in Humans?
In the mentioned preclinical studies, CBD has been shown to be effective in the management of pain and the resolution of inflammation of inflamed joints. That being said, the number of human studies assessing the effectiveness of CBD in this regard remains scarce.
In 2018, the abstract of a randomized, placebo-controlled clinical trial of human subjects with osteoarthritis was conducted to determine the effectiveness of local CBD gel on reducing joint pain in affected individuals. The CBD gel was administered twice daily for a period of 12 weeks in 320 adults with knee osteoarthritis. Recruited subjects were allocated to receive CBD gel (250 mg) twice daily, CBD gel (500 mg) twice daily, or placebo. It was observed that after 12 weeks of treatment, CBD (250 mg) resulted in a better reduction in pain level from baseline compared to the other treatment groups. CBD was also significantly better than placebo in reducing the pain in osteoarthritic knees of affected individuals. That being said, patients who were given topical CBD gel reported only two side effects in 3% of individuals: dryness of skin and headache.
Noteworthy, this is the only clinical trial that has been conducted in this regard so far, and to be able to draw solid conclusions about the effectiveness of CBD in reducing joint pain, more clinical trials should be conducted to confirm these findings.
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Is CBD Useful for Osteoarthritis?
Osteoarthritis is a multifactorial joint disease, which includes joint degeneration, intermittent inflammation, and peripheral neuropathy. Currently, the therapeutic options for osteoarthritis are limited as no drugs are available to control the disease progression, and the analgesic treatment has limited effectiveness. An increasing body of evidence from preclinical studies supports the interest of the endocannabinoid system as an emerging therapeutic target for osteoarthritis pain.
The aim of the current research is to determine whether CBD is an effective option for controlling joint pain in people with osteoarthritis and whether the control of inflammation by CBD could prevent the development of OA pain and joint neuropathy.
A recent animal study was conducted to investigate the therapeutic effects of peripheral CBD (100-300 μg) in male rats with osteoarthritis. Signs of joint inflammation, such as blood flow and white blood cell trafficking, as well as pain perception, were assessed after 14 days. It was observed that joint pain was reduced significantly, and the signs of joint inflammation were resolved by the local administration of CBD. Furthermore, it was reported that the prophylactic administration of CBD prevented the occurrence of joint pain, as well as being neuroprotective during later stages.
The results of available evidence suggest that the local administration of CBD blocks osteoarthritic pain, while prophylactic CBD treatment prevents the later development of pain and nerve damage in people with osteoarthritic joints.
Is CBD Effective in Rheumatoid Arthritis?
Rheumatoid Arthritis is characterized by the infiltration of immune cells into the joint, augmented cytokine and chemokine production by resident macrophages. This process is accompanied by cartilage destruction by matrix-degrading enzymes. In the same context, current therapies for rheumatoid arthritis, such as glucocorticoids, often interfere with cytokine production or signaling but are often associated with side effects related to infection or disturbances in the function of the immune system.
CBD might be added to RA therapy, as it elicits anti-depressive and anti-inflammatory effects independent of cannabinoid receptors and without psychotropic side effects. It is proposed that inactivation of CB1 receptors in the brain, through the use of a CB1 receptor antagonist such as cannabidiol, can lead to the augmentation of the anti-inflammatory effects of this compound. It is also reported that the use of a Fatty Acid Amid Hydrolase (FAAH) inhibitor along with CBD can elevate the levels of endocannabinoids in the brain to degrees that counteract depression and pain, while the use of a CB1 receptor inhibitor, such as CBD, can suppress the inflammatory effects of CB1 in the periphery, and thus, boosting anti-inflammatory effects by increasing the sympathetic nervous activity.
That being said, the available body of evidence is still not confirmed by large clinical trials on human subjects. Therefore, it is advised not to take CBD for the treatment of rheumatoid arthritis pain without consulting a physician first.
The Take-Home Message
Many preclinical and some clinical research studies have been conducted to determine whether CBD is an effective option for the management of joint pain of different causes or not. Surprisingly, in January 2019, the Arthritis Foundation published a commentary containing a set of recommendations regarding the use of CBD in treating joint pain. Here are some of their recommendations:
- Make sure that the CBD product that you are using is pure, potent, and safe. For example, use a CBD product that has received a ‘good manufacturing practices’ certification.
- CBD should be used as a part of a pain management plan that also includes non-medical options, including exercise and psychological support.
- It is advised to use the oral forms of CBD and not the inhaled forms, starting with a low dose that is taken in the evening.
- The treatment plan should have a set of initial and late goals. For example, if CBD is prescribed for joint pain, then the affected individual, along with the treating physician, should put a clarified goal that includes reduction of joint pain with regaining the ability to move the affected joint within two weeks from starting CBD treatment. Later on, if the pain is further improved, the goals can be modified.
- Notify your physician of your planned and your current CBD treatment plan. Monitor your pain and let your physician adjust your medications based on your response to them.
- Do not stop your previous medications once you start your CBD treatment unless your treating physician deems them ineffective.
- Do not make CBD your first option to control joint pain. It is advisable to try other conventional treatment options first. If they become ineffective, then CBD can be an alternative.
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