If you have chronic arthritis pain, you may have been tempted to try cannabidiol as a treatment, or you may have tried it already. But is there any evidence that it works? Studies are finally addressing this question, and the results are just starting to come in. You may be wondering if marijuana may ease the pain and discomfort from rheumatoid arthritis. Here’s what to know.
Does CBD help with arthritis pain?
If you have chronic arthritis pain, you may be wondering about cannabidiol (CBD) as a treatment. CBD, along with delta-9-tetrahydrocannabinol (THC) and other chemicals, is found in marijuana. But unlike THC, CBD is not “psychoactive” — that is, it does not cause the intoxication or high associated with marijuana use.
There’s a good chance you’ve tried it already: according to a Gallup poll in August of 2019, about 14% of Americans report using CBD products, and the number one reason is pain. The Arthritis Foundation conducted its own poll and found that 29% reported current use of CBD (mostly in liquid or topical form), and nearly 80% of respondents were either using it, had used it in the past, or were considering it. Of those using it, most reported improvement in physical function, sleep, and well-being; of note, a minority reported improvement in pain or stiffness.
Perhaps you’ve been tempted to try it. After all, most types of arthritis are not cured by other treatments, and CBD is considered a less addictive option than opiates. Or maybe it’s the marketing that recommends CBD products for everything from arthritis to anxiety to seizures. The ads are pretty hard to miss. (Now here’s a coincidence: as I was writing this, my email preview pane displayed a message that seemed to jump off the screen: CBD Has Helped Millions!! Try It Free Today!)
What’s the evidence it works? And what do experts recommend? Until recently, there’s been little research and even less guidance for people (or their doctors) interested in CBD products that are now increasingly legal and widely promoted.
But now, there is.
A word about arthritis pain
It’s worth emphasizing that there are more than 100 types of arthritis, and while pain is a cardinal feature of all of them, these conditions do not all act alike. And what works for one may not work for another. Treatment is aimed at reducing pain and stiffness and maintaining function for all types of arthritis. But for certain conditions, such as rheumatoid arthritis, conventional prescription medications are highly recommended, because these drugs help prevent permanent joint damage and worsening disability.
In addition, individuals experience pain and respond to treatment in different ways. As a result, it’s highly unlikely that there is a single CBD-containing product that works for all people with all types of arthritis.
What’s the evidence that CBD is effective for chronic arthritis pain?
While there are laboratory studies suggesting CBD might be a promising approach, and animal studies showing anti-inflammatory and pain-relieving effects, well-designed studies demonstrating compelling evidence that CBD is safe and effective for chronic arthritis pain in humans do not exist. A randomized trial of topical CBD for osteoarthritis of the knee has been published, but in abstract form only (meaning it’s a preliminary report that summarizes the trial and has not been thoroughly vetted yet); the trial lasted only 12 weeks, and results were mixed at best. One of the largest reviews examined the health effects of cannabis and CBD, and concluded that there is “substantial evidence that cannabis is an effective treatment for chronic pain in adults.” But there was no specific conclusion regarding CBD, presumably because definitive studies were not available.
Of course, there is anecdotal evidence and testimonials galore, including reports of dramatic improvement by people who tried CBD in its various forms (including capsule, liquid, topical, and spray) for their pain. But we are still waiting for well-designed, scientifically valid, and rigorous clinical trials (such as this one in progress) that are so badly needed to answer the question of just how helpful CBD may be to people with chronic arthritis pain.
Are there downsides to CBD treatment?
As with any treatment, there can be downsides. CBD is generally considered safe; however, it can still cause lightheadedness, sleepiness, dry mouth, and rarely, liver problems. There may be uncertainty about the potency or purity of CBD products (since they are not regulated as prescription medications are), and CBD can interact with other medications. For pregnant women, concern has been raised about a possible link between inhaled cannabis and lower-birthweight babies; it’s not clear if this applies to CBD. Some pain specialists have concerns that CBD may upset the body’s natural system of pain regulation, leading to tolerance (so that higher doses are needed for the same effect), though the potential for addiction is generally considered to be low.
There is one definite downside: cost. Prices range widely but CBD products aren’t inexpensive, and depending on dose, frequency, and formulation, the cost can be considerable — I found one brand that was $120/month, and health insurance does not usually cover it.
Are there guidelines about the use of CBD for chronic arthritis pain?
Until recently, little guidance has been available for people with arthritis pain who were interested in CBD treatment. Depending on availability and interest, patients and their doctors had to decide on their own whether CBD was a reasonable option in each specific case. To a large degree that’s still true, but some guidelines have been published. Here’s one set of guidelines for people pursuing treatment with CBD that I find quite reasonable (based on recommendations from the Arthritis Foundation and a recent commentary published in the medical journal Arthritis Care & Research):
- If considering a CBD product, choose one that has been independently tested for purity, potency, and safety — for example, look for one that has received a “Good Manufacturing Practices” (GMP) certification.
- CBD should be one part of an overall pain management plan that includes nonmedication options (such as exercise) and psychological support.
- Choose an oral treatment (rather than inhaled products) and start with a low dose taken in the evening.
- Establish initial goals of treatment within a realistic period of time — for example, a reduction in knee pain that allows you to walk around the block within two weeks of starting treatment; later, if improved, the goals can be adjusted.
- Tell your doctor(s) about your planned and current CBD treatment; monitor your pain and adjust medications with your medical providers, rather than with nonmedical practitioners (such as those selling CBD products).
- Don’t make CBD your first choice for pain relief; it is more appropriate to consider it if other treatments have not been effective enough.
- Don’t have nonmedical practitioners (such as those selling CBD products) managing your chronic pain; pain management should be between you and your healthcare team, even if it includes CBD.
- For people with rheumatoid arthritis or related conditions, do not stop prescribed medications that may be protecting your joints from future damage; discuss any changes to your medication regimen with your doctor.
The bottom line
If you’re interested in CBD treatment for chronic arthritis pain or if you’re already taking it, review the pros, cons, and latest news with your healthcare providers, and together you can decide on a reasonable treatment plan. Depending on the type of arthritis you have, it may be quite important to continue your conventional, prescribed medications even if you pursue additional relief with CBD products.
We may not have all the evidence we’d like, but if CBD can safely improve your symptoms, it may be worth considering.
Follow me on Twitter @RobShmerling
About the Author
Robert H. Shmerling, MD , Senior Faculty Editor, Harvard Health Publishing
Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio
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Medical Marijuana: Facts about cannabis, THC, and CBD
Exploring medical cannabis means becoming a highly educated consumer. You need to learn as much as you can from a variety of sources. This guide is intended to help you make a more-informed decision. This guide can’t tell you whether medical cannabis will alleviate your health conditions or symptoms. But it will provide basic information to help you consider whether medical cannabis is right for you, ideally working openly with your physician and other health care providers.
Medical Marijuana, CBD Oil, and Rheumatoid Arthritis
Researchers still don’t know a lot about how marijuana affects your body. But there is substantial evidence that it can help relieve long-term pain. And pain is a major symptom of rheumatoid arthritis (RA).
Here’s what’s known so far about how medical marijuana and a marijuana extract called CBD (cannabidiol) might affect RA.
Benefits for RA
The Cannabis sativa plant has more than 100 chemicals that can affect your body and mind. The two that scientists know the most about are THC and CBD.
THC, or delta-9-tetrahydrocannabinol, is what gets you high when you smoke, vape, or eat marijuana. CBD doesn’t affect your brain that way. For that reason, some people prefer CBD for medical uses.
Rheumatoid arthritis is an autoimmune disease that can make your joints stiff, tender, and painful. RA also can affect your lungs, eyes, skin, and other body parts.
The federal ban on marijuana and CBD means studies on humans have been few. So researchers don’t know for sure that cannabis eases RA symptoms. But the results from several very small studies suggest that in people with rheumatic diseases, including RA and osteoarthritis, it may help:
- Curb morning pain (but not the overall level of pain)
- Improve sleep
- Lower inflammation in joints (but not joint stiffness)
Some lab testing suggests that cannabinoids may help tamp down the body’s immune response. But the studies have been limited to animals, not humans.
Doctors will need more proof before they can recommend cannabis products to treat rheumatic diseases. For example, we know very little about the effects on RA from smoking marijuana or other uses of herbal marijuana.
Is Cannabis Right for You?
The best way to answer this is to ask your doctor. They can tell you about possible side effects and drug interactions, legal considerations, and which form and at which dose may help you the most.
More than half of the states have legalized marijuana for medical use. More than a dozen other states allow limited medical uses of CBD.
The FDA doesn’t regulate marijuana or CBD, so you might not know exactly what’s in the products you buy. One batch of pot or edible marijuana may have a much higher or lower amount of THC than another, or affect you differently. CBD also can be unpredictable.
Cannabis can affect you mentally and physically. THC can impair driving, so you shouldn’t get behind the wheel for at least 8 hours after you take it. Smoking or vaping (inhaling) marijuana will hit you more quickly than if you eat it. It’s also not good for your lungs or respiratory system.
If you use marijuana regularly, it could make you more likely to get anxiety, depression, and other mental illnesses.
CBD side effects are usually mild or moderate. They can include:
Medical marijuana has similar side effects, that may include:
Where to Get It
Depending on your state, you may need to buy medical marijuana and CBD at specific dispensaries or pharmacies from approved vendors. Your doctor may need to certify that you have a condition that may benefit from marijuana.
Marijuana is available in many forms, like pills, prepared foods, teas, nasal sprays, and as something you smoke or vape.
In some states, CBD is sold at many all-natural food stores and online. It can be taken by mouth as oil or extracts, or applied to your skin.
Chemistry & Biochemistry: “History of Cannabis and Its Preparations in Saga, Science, and Sobriquet.”
Mayo Clinic: “Mayo Clinic Q and A: Treatment with medical cannabis,” “Marijuana,” “What are the benefits of CBD — and is it safe to use?” “Rheumatoid arthritis.”
News release, The National Academies of Sciences, Engineering, and Medicine: “The Health Effects of Cannabis and Cannabinoids.”
Dialogues in Clinical Neuroscience: “Cannabis, Cannabinoids, and Health.”
Arthritis Care & Research: “Efficacy, Tolerability, and Safety of Cannabinoid Treatments in the Rheumatic Diseases: A Systematic Review of Randomized Controlled Trials.”
Nature Reviews Rheumatology: “Cannabinoids for the treatment of rheumatic diseases — where do we stand?”
U.S. Drug Enforcement Administration: “Drug Scheduling.”
Cannabis and Cannabinoid Research: “Cannabis and Pain: A Clinical Review.”
Journal of Medical Toxicology: “Medical Marijuana and Driving: A Review.”
National Center for Complementary and Integrative Health: “Marijuana and Cannabinoids.”