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.
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.
Arthritis sufferers have used marijuana for years to treat the associated pain, stiffness, and inflammation, whether they admitted it to their grandchildren or not. The fact is, most people will deal with some form of arthritis or joint stiffness as their body ages due to the normal “wear and tear” to our joints as we go through our lives. When enough cartilage and joint tissue has worn away, bones begin to grind together, which causes arthritis symptoms. As bad as this is for the elderly, it is unfortunately not limited to just senior citizens. In fact, arthritis can develop in the early 20s and remain throughout someone’s life.
On the upside, cannabis has been shown to be an effective treatment for arthritis, easing the symptoms and associated pain. There is also growing evidence that the CBD present in cannabis and hemp may be able to slow cartilage destruction and speed the healing of broken bones. Given the well-known anti-inflammatory and pain relieving effects of CBD, coupled with the pain relief and mood enhancement of THC, we have listed below our top high-CBD, medium-to-high THC strains that are best for treating arthritis.
A calm and happy strain descended from Cannatonic and Ruderalis, ACDC is known for helping marijuana enthusiasts focus on their work during the day and sharpen their social skills at night. ACDC’s 20:1 CBD:THC ratio has been traditionally used for chronic pain and anxiety, which are both common in arthritis sufferers.
A cultured, diverse descendant of Colombian Gold, Nepali Indica, Thai, and Swiss strains, Harlequin is highly regarded for its relaxing effects that don’t sedate or intoxicate. This strain’s other claim to fame is its consistent CBD:THC ratio of 5:2, exhibiting none of the minor fluctuations common to other high-CBD strains. This pain-relieving strain can help tremendously with joint pain and inflammation.
An indica-dominant strain through and through from its Sensi Star roots (despite the Sour Diesel in its parentage), DeathStar produces a heavy body effect for the user that comes on gradually before enveloping the user. With a pleasant aroma matched by its taste, it carries a potent soporific, “stoney” experience that’s perfect for arthritic symptoms. The high THC content, usually topping 20%, gives the user that stoney uplift that represses chronic pain and the related stresses.
A cross of Hash Plant and Swiss Big Bud, Ingrid’s strong indica ancestry makes it the Ambien of this list, but without the risk of night driving or tweets you may regret sending. Arthritis pain can lead to sleepless nights, making for a miserable one-two punch for those already having trouble getting through their day. Leading with a strong berry aroma, Ingrid’s potent pain relief comes on in about 20 to 30 minutes, relaxing the muscles and leading the user off to dreamland. Just be sure you’re not too far from your bed with this one.
As Ingrid is for the nighttime, Blue Diesel is for the day. A blend of indica-heavy Blueberry with sativa-dominant NYC Diesel, Blue Diesel produces a steady, non-intrusive high that lasts all day. Boasting a smooth lift without any dramatic peaks or valleys for the user, this strain is a perfect daytime treatment for joint pain. As an added bonus, the complimentary CBD ratio in Blue Diesel also helps to slow joint and bone deterioration.
Black and White
Combining the euphoric uplift of White Widow with the pain relief and inflammation reduction of Afghani, Black and White is another recommended strain for those dealing with arthritis. Two heavy-hitters of the medical marijuana community, Afghani’s heavy, full body relaxation is a perfect match for White Widow, which is revered for its anti-depressant effects. To put it mildly; suffering from chronic pain with no cure in sight can be a bit of a downer, which is why White Widow brings so much to the table for this hybrid.
Best Ways to Consume Cannabis for Effective Arthritis Relief
The classic way to consume cannabis strains for arthritis relief is to put the bud into a joint, pipe, or bong, apply fire, and inhale. If these work for you, read no further. However, many who are suffering from arthritis pain may have other associated health problems. Inhaling the carbonized particles in marijuana smoke can make these worse, since the joint pain, insomnia, and inflammation that arthritis may cause can weaken immune systems.
This is especially true for patients suffering from chronic arthritis, an autoimmune disorder. With their immune systems already primed to overreact, introducing foreign particles like smoke can only make things worse.
Despite this, inhalation remains the fastest method for pain relief. A good compromise is to invest in a vaporizer. There are plenty of dry herb vaporizers on the market, from handheld to tabletop varieties with options like temperature control. These use heating coils to vaporize the THC and other cannabinoids, allowing you to inhale the good stuff while limiting any foreign particles. If inhalation is off the table, then grab your grinder and head to the kitchen. THC and CBD are fat-soluble, meaning you can cook them into any oil and absorb most of the beneficial cannabinoids for arthritis into your gut. A little bit of internet research will provide you with the best methods for making your own cannabis oil to add to any recipe you choose. The effects will last longer, and the only caveat is that it will take about an hour to feel any relief. Also, it is more challenging to ensure a consistent dose, so expect some trial and error.