CBD for Arthritis Pain: What You Should Know
Learn what the science says about the risks and benefits of CBD use for arthritis and what to shop for.
Taking the First Step
Should I give CBD a try? Without quality clinical studies on CBD and arthritis, doctors have not been able to say who might benefit from CBD, at what dose, and in which form, who likely won’t benefit and who should avoid it. Still, there is an agreement on several points:
CBD is not a substitute for disease-modifying treatment for inflammatory arthritis. Patients who are interested in trying CBD should first talk to the health care provider who treats their arthritis before trying CBD. Together, they can review what has worked or not worked in the past, whether there are other options to try first, how to do a trial run, what to watch for and when to return for a follow-up visit to evaluate the results. Keep a symptom and dose diary to track effects. Quality CBD products can be expensive, especially when used for prolonged periods. To avoid wasting money, be completely sure that the product is truly having a positive effect on symptoms.
What type of product should I consider? CBD-based products can be taken orally, applied to the skin, or inhaled. There are pros and cons to each.
By mouth. #CBD that is swallowed, whether in capsules, food or liquid, is absorbed through the digestive tract. Absorption is slow and dosing is tricky due to the delayed onset of effect (one to two hours), unknown effects of stomach acids, recent meals, and other factors.
Capsules can work for daily use after a safe, effective capsule dose has been established. Experts discourage taking CBD via edibles, like gummies and cookies, because dosing is unreliable, and they are appealing to children but do not come in childproof containers. Like any medicine, edibles should be secured out of sight and reach of children.
CBD can also be absorbed directly into the bloodstream by holding liquid from a spray or tincture (a liquid dosed by a dropper) under the tongue (sublingual) for 60 to 120 seconds. The taste may not be pleasant. The effects may be felt within 15 to 45 minutes.
On the skin. Topical products, like lotions and balms, are applied to the skin over a painful joint. Whether these products deliver CBD below the skin is unknown. Topical products may also include common over-the-counter ingredients such as menthol, capsaicin, or camphor, making it difficult to determine if a positive effect is due to the CBD or another ingredient.
Inhaled. CBD can be inhaled via a vaporizing, or vape, pen. However, inhalation of vapor oils and chemical byproducts carry unknown risks, particularly for people with #inflammatory arthritis. For this reason and because the Centers for Disease Control and Prevention is investigating vaping in association with widespread hospitalizations and deaths from severe pulmonary disease, vaping is not recommended.
How much CBD should I use? While there are no established clinical guidelines, the medical experts consulted by the Arthritis Foundation recommend the following for adults:
When preparing to take a liquid form, be aware that the CBD extract is mixed with a carrier oil, so there are two measures to know: the amount of the liquid product to take (the dose) and the amount of CBD in each dose.
Go low and slow. Start with just a few milligrams of CBD in sublingual form twice a day. If relief is inadequate after one week, increase the dose by that same amount. If needed, go up in small increments over several weeks. If you find relief, continue taking that dose twice daily to maintain a stable level of CBD in the blood.
If CBD alone doesn’t work and you are in a state where medical or recreational marijuana is legal, talk to your doctor about taking CBD with a very low-dose THC product. Be aware that THC, even at low levels, may get you high, creating #cognitive, motor, and #balance issues. Try THC-containing products at home or at night first, so you can sleep off any unwanted effects.
After several weeks, if you don’t find relief with CBD alone or with a combination of CBD and very low #THC, CBD may not be right for you. If you experience any unwanted side effects when using a CBD product, immediately discontinue use and inform your doctor.
What to Look for When Shopping
There is good reason to be a cautious shopper. CBD products are largely unregulated in the U.S. market. Independent testing has shown mislabeling and lack of #quality control. The biggest issues are the strength of CBD (significantly more or less than the label says), the presence of undeclared THC, and contamination with pesticides, metals, and solvents.
Look for products manufactured in the U.S. with ingredients grown domestically. Choose products made by companies that follow good manufacturing practices established by the FDA for pharmaceuticals or #dietary #supplements (a voluntary quality standard because CBD products are not federally regulated under either category) or required by the state where they are manufactured.
Buy from companies that test each batch and provide a certificate of analysis from an independent lab that uses validated standardized testing methods approved by the American Herbal Pharmacopoeia (AHP), the U.S. Pharmacopeia (USP), or the Association of Official Agricultural Chemists (AOAC). Avoid companies that claim their products have disease benefits.
Be aware that marketers and people behind retail counters are not #health professionals; they are salespeople. That's why your doctor is your best source for guidance and monitoring when using an unregulated #product. Our gratitude to the following experts for their guidance and review:
Daniel Clauw, MD, a professor of #anesthesiology, rheumatology, and #psychiatry at the University of Michigan and director of the Chronic Pain and Fatigue Research Center, leads research on #arthritis pain and #fibromyalgia, and the effects of cannabis, as particularly CBD, in pain.
Mary-Ann Fitzcharles, MD, an associate professor of medicine in the Division of Rheumatology at McGill University in Montreal, Quebec, conducts research on #pain and #rheumatic #diseases. She is the lead author of the 2019 Canadian #Rheumatology Association (CRA) position statement for #medical #cannabis.
*Read the Arthritis Foundation's official position statement on CBD use for adults with arthritis here.