CBD oil to relieve joint pain
Most people use CBD oil to relieve chronic diseases - especially joint conditions such as rheumatoid arthritis and osteoarthritis. CBD may reduce joint inflammation and slow the progression of chronic joint disease.
The science behind the use of CBD oil for arthritis
The primary medical use is to relieve chronic pain. Of the various painful conditions for which CBD oil is used, rheumatoid arthritis and osteoarthritis top the list. In a survey of 1500 medical CBD users, almost half of the respondents reported suffering from arthritis (1).
Many people also smoke medicinal cannabis to relieve arthritis pain. In 2 surveys of a total of 5000 people, 20% smoked cannabis for this reason. They often reported good results, but most of them used cannabis with higher THC than CBD levels (2, 3).
This raises the question of whether CBD relieves arthritis pain, or whether THC is the main component of cannabis responsible for the benefits. Let's take a look at the science behind CBD to find out.
How does CBD work?
Types of arthritis
The term arthritis covers a group of joint conditions that include inflammation, pain and damage to joint cartilage. Arthritis can be caused by repetitive mechanical damage (e.g. osteoarthritis), autoimmune disorders (e.g. rheumatoid arthritis) or disease (e.g. psoiatric arthritis) (4, 5).
Although there is no cure for arthritis, therapies can relieve pain, reduce inflammation and slow the progression of the disease. Let's take a look at how CBD can help.
Activating the endocannabinoid system
The endocannabinoid system consists of two receptors: CB1 and CB2. The cannabinoids that the body naturally produces - such as anandamide and 2-AG - bind to these receptors and activate them. Even though CBD blocks the CB receptors, it increased anandamide levels by preventing the breakdown of anandamide (6, 7, 8, 9, 10).
Two studies conducted on humans and dogs found that animals with rheumatoid arthritis or osteoarthritis had higher levels of CB receptors and certain cannabinoids in their joints. This suggests that the body activates the endocannabinoid system to fight arthritis. In line with this, increasing cannabinoids could be a good therapeutic strategy (11, 12).
Indeed, two synthetic CB2 activators reduced joint inflammation and damage in mice with rheumatoid arthritis and osteoarthritis (13, 14, 15)
Alternatively, a blocker of the enzyme that breaks down anandamide (FAAH) reduced pain in rats and guinea pigs with osteoarthritis. Anandamide appears to act via activation of the CB1 receptor, as blockade of this receptor prevented the analgesic effect of anandamide (16).
Summary: CBD oil may alleviate joint inflammation in arthritis by increasing the activity and levels of natural cannabinoids such as anandamide.
Blockade of the pain pathways
CBD activates a receptor (TRPV1) that is involved in inflammatory pain. Although this receptor causes pain in the joints of rats with osteoarthritis, its activation by CBD or capsaicin contained in chili pepper reduces the perception of pain (10, 17, 18, 19).
CBD also binds to another receptor with a similar function in inflammatory pain (TRPA1). Activation of this receptor (as well as TRPV1 and CB2) by a synthetic cannabinoid reduced inflammation in cells harvested from patients with arthritis (20, 21).
Another target of CBD - GPR55 - has been studied mainly for its role in intestinal inflammation. However, its activation by a synthetic CBD compound also reduced pain in arthritic rats (22, 23).
Summary: CBD may protect joints by blocking inflammatory pain pathways.
Reduction of inflammation
CBD is a potent anti-inflammatory. It blocks the primary inflammatory hub NF-kB, activates the anti-inflammatory PPAR-gamma and prevents the degradation of the anti-inflammatory compound adenosine (24, 25, 26).
In animals with arthritis, CBD reduced the production of two pro-inflammatory cytokines (IFN-gamma and TNF-alpha). In animals with other inflammatory diseases, it also reduced the levels of inflammatory neurotransmitters (IL-1beta, LL-6, nitric oxide and prostaglandins), while increasing the levels of two anti-inflammatory cytokines (IL-4 and IL-10) (27, 28, 29, 30,31, 32).
Summary: CBD oil may protect joints by increasing levels of anti-inflammatory compounds and blocking primary inflammatory pathways.
Suppression of the autoimmune response
In addition to this, CBD prevents T cells from dividing, migrating to sites of inflammation and producing pro-inflammatory cytokines. This is particularly relevant in autoimmune arthritis types such as rheumatoid arthritis or when the condition is caused by autoimmune diseases such as psoriasis, celiac disease and lupus (27, 33, 34, 35, 36, 37, 38, 4).
When does CBD work?
Evidence from studies conducted with animals
Osteoarthritis
Osteoarthritis is a chronic degenerative disease in which repeated damage to the joints from wear and tear, overuse or injury leads to inflammation and joint breakdown. Treatments for this disease usually focus on reducing inflammation and relieving pain (4, 5).
In rats with this type of arthritis, CBD applied to the skin reduced inflammation and slowed the progression of osteoarthritis at an early stage. In animals with advanced osteoarthritis, CBD injected into the site of inflammation reduced pain sensitivity and increased joint strength (39).
In dogs, orally administered CBD relieved pain but had no effect on limb mobility or joint strength (40).
Even though osteoarthritis is a chronic disease, these studies tested CBD for a maximum of 19 days. Longer treatments may also be effective, as CBD had delayed effects in mice with other inflammatory diseases that were given the compound for up to 8 months (41, 42).
Rheumatoid arthritis & autoimmunity
Rheumatoid arthritis is an autoimmune disease in which the body's immune system attacks the joints, leading to inflammation and damage. In this case, blocking the autoimmune response could produce better results (4, 5).
In mice with this condition, oral or injected CBD relieved inflammation and slowed the progression of joint damage. CBD also prevented T-cells and joint cells (synovial cells) from proliferating and releasing pro-inflammatory cytokines (TNF-alpha and IFN-gamma) (27).
A CBD gel applied to the skin reduced joint swelling, pain and the levels of inflammatory markers such as TNF-alpha in the nerves of rats with rheumatoid arthritis (28).
In addition, synthetic CBD-like compounds reduced inflammation, pain perception and joint pain in mice and rats with this type of arthritis (23, 43, 44).
Summary: Animal studies suggest that CBD oil can relieve symptoms and prevent disease exacerbation in both rheumatoid arthritis and osteoarthritis.
Clinical studies
To date, there have been no clinical studies of the effects of CBD on arthritis in humans. An initial study of CBD - both on its own and in combination with THC - in people with rheumatoid arthritis and ankylosing spondylitis is underway (45).
An oral spray containing equal amounts of CBD and THC (Nabximols) reduced pain and morning stiffness while improving sleep quality in a small study of 58 patients with rheumatoid arthritis (46)
CBD has been shown to prevent excessive skin cell division, as is the case with psoriasis, and a gel containing CBD relieved psoriasis in a small study of 5 people. This suggests that CBD oil applied to the skin could help to prevent exacerbation of psoriasis and thus also prevent it from developing into psoriatic arthritis (47, 48).
CBD oil for arthritis
Dosage
As CBD has not yet been tested in clinical trials for this area of application, there is no dose with a proven effect. We can only estimate the optimal dose based on experience and recommendations from manufacturers and health blogs.
In general, it is recommended to start with a low dosage (5 to 10 mg, twice daily) and gradually increase this dosage until the desired effects occur. Most people experience relief at a dosage in the range of 20 mg twice daily, although the dosage can be increased up to 80 to 100 mg for severe pain. If CBD alone does not work, using medication with CBD and THC may be worth a try.
Another option is to estimate the dosage based on data from studies conducted with animals. However, it should be noted that the amounts of active ingredient per kilogram of body weight cannot simply be transferred to humans. Due to numerous physiological differences, there are conversion formulas in which the amount of active ingredient per kilogram of body weight is significantly lower than in animals. It is also important to remember that the correct dose will also depend on weight, pain intensity and tolerance to CBD.
Type of application
The preferred form of CBD should be chosen based on the type and distribution of pain (49).
Skin-applied dosage forms are a good option for arthritis as they can be applied directly to the target areas. These dosage forms are most helpful for localized joint pain and inflammation.
Oral dosage forms distribute the CBD throughout the body. Capsules and teas release the CBD more slowly and their effects therefore last longer. They are therefore a better choice for constant pain.
Vaporizers, oral sprays and oil tinctures provide faster-acting, temporary relief. These dosage forms are the better choice for sudden onset, acute pain.
Testimonials
People who use CBD oil for joint pain usually suffer from osteoarthritis, rheumatoid arthritis and psoriatic arthritis. These users are generally quite satisfied with CBD and often report that CBD has reduced their pain and improved their quality of life. However, there are also users who feel no effect at all.
Conclusion
CBD oil is a safe anti-inflammatory compound that can be used by many people for joint pain and arthritis. Clinical studies are being planned to investigate the effectiveness of CBD oil for rheumatoid arthritis and osteoarthritis.
Based on data from animal studies, CBD oil could alleviate arthritis symptoms by increasing levels of natural cannabinoids such as anandamide, blocking pain pathways, suppressing autoimmune responses and reducing inflammation. For this reason, it could also help people suffering from forms of arthritis caused by other autoimmune diseases such as psoriasis or lupus.
Dosage forms such as creams, gels and lotions that are applied to the skin are a good option for localized joint pain and inflammation. For severe pain and inflammation, skin-applied dosage forms can also be combined with CBD oil capsules, tinctures or other oral dosage forms for a stronger and longer-lasting effect.
References:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6043845/
- https://www.ncbi.nlm.nih.gov/pubmed/16621924
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968020/
- https://www.ncbi.nlm.nih.gov/books/NBK518992/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4524637/
- https://www.ncbi.nlm.nih.gov/pubmed/9336020
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2189767/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2219532/
- https://www.ncbi.nlm.nih.gov/pubmed/8874830
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1573017/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2453762/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5674828/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4243420/
- https://www.ncbi.nlm.nih.gov/pubmed/25601571
- https://www.ncbi.nlm.nih.gov/pubmed/25937028
- https://www.ncbi.nlm.nih.gov/pubmed/21185649
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283626/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1575333/
- https://www.ncbi.nlm.nih.gov/pubmed/10754399
- https://www.ncbi.nlm.nih.gov/pubmed/18354058/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4858820/
- https://www.ncbi.nlm.nih.gov/pubmed/21726355
- https://www.ncbi.nlm.nih.gov/pubmed/21683763
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804319/
- https://www.ncbi.nlm.nih.gov/pubmed/19833407/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472541/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC16904/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851925/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2189818/
- https://www.ncbi.nlm.nih.gov/pubmed/14963641
- https://www.ncbi.nlm.nih.gov/pubmed/19690824
- https://www.ncbi.nlm.nih.gov/pubmed/16698671
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6447028/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4618347/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5004721/
- https://www.ncbi.nlm.nih.gov/pubmed/23851307
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6085417/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3069975/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5690292/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6065210/
- https://www.ncbi.nlm.nih.gov/pubmed/27767974
- https://www.ncbi.nlm.nih.gov/pubmed/25024347
- https://www.ncbi.nlm.nih.gov/pubmed/15022343
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4576666/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561449/
- https://www.ncbi.nlm.nih.gov/pubmed/16282192
- https://www.ncbi.nlm.nih.gov/pubmed/17157480
- https://www.ncbi.nlm.nih.gov/pubmed/30993303
- https://www.ncbi.nlm.nih.gov/pubmed/29307505
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5053383/