CBD FOR ARTHRITIS PAIN
Does CBD help with arthritis pain? It’s a question I hear all the time. The short answer is yes. The longer answer is yes, but not for everyone. But then again, nothing is.
There’s a reason I get this question so often and it’s not just because so many people have arthritis. It’s also because current treatments leave something to be desired for many people. Existing medications may not work as well as expected, may have significant side effects or may be one of too many prescriptions. I’m not against medicine or pharmaceuticals; no sane person is. But I am against the current state of affairs where so many conditions seem to be nothing more than vehicles to sell medications; no sane person isn’t.
What am I talking about? I googled “what is arthritis” expecting a reasonably clear answer, hopefully an impartial one from a scientific source. First listing: A Tylenol ad. The ad wasn’t deceptive in any way but it didn’t answer the question and it was obviously advocating a product.
Arthritis is swelling of one or more joints, characterized by pain and stiffness. It affects tens of millions of people. The two most common types are osteoarthritis and rheumatoid arthritis. Other common types are psoriatic arthritis, gout and fibromyalgia. There are 100 other types of arthritis. Like nearly every inflammatory condition, arthritis can be painful (nothing that ends in “itis” is good just as nothing that happens after 2 a.m. is good). And the pain ranges from mild to debilitating.
MOST COMMON TYPES OF ARTHRITIS
Every source that lists the most common types of arthritis leads with osteoarthritis and rheumatoid arthritis. Osteoarthritis is a degenerative disease that affects the entire joint as protective cartilage and fluid break down over time. Ultimately, the bones may rub directly against one another resulting in severe pain, joint damage and reduced joint function.
Rheumatoid arthritis is an autoimmune disorder where an overactive immune system attacks healthy tissue such as the lining of the joints, called synovium. The resulting persistent inflammation can lead to permanent joint damage, worsening pain and reduced joint function. I’ve known people with severe RA and it is an awful disease that grinds and grinds along a very painful path.
There is no cure for arthritis. The goals of treatment are to alleviate pain and inflammation and preserve joint function.
As with most diseases, arthritis exists on a spectrum. For some people, arthritis pain is moderate and infrequent. For others it’s debilitating and constant. For the former group it’s not uncommon to take an over the counter pain killer like aspirin, acetaminophen or ibuprofen as needed. For most of these people there won’t be dangerous side effects because they’re not taking the medications often enough or in high enough dosages.
The next step up is a range of drugs called NSAIDs. That stands for Non-Steroidal Anti-Inflammatory Drug. Since arthritis is characterized by inflammation, it makes sense that an anti-inflammatory drug would be a primary treatment. NSAIDs range from over the counter the counter pills like ibuprofen, which would be included with everyday pain relievers referred to above, to the drug diclofenac thought to be the strongest NSAID.
I’ve got to mention an ad I’ve seen for one of them. It’s for a cream called Voltaren (who chose the not-so-vaguely-evil-sounding name?) and features Paula Abdul dancing in high gear. Presumably, since it’s an ad for Voltar the grim Voltaren, she’s able to dance like that because of the drug and if you’ll just buy it, you’ll be dancing like Paula Abdul in no time. I wonder what would happen if a CBD company put out an ad like that?
NSAIDs work by blocking or inhibiting the production of the enzyme cyclooxygenase which is necessary to convert arachidonic acid into, among other things, prostaglandins. (What, you didn’t know that?) Excess prostaglandins cause inflammation, as mentioned pretty much always a bad thing, and increased pain sensitivity. Prostaglandins also help our bodies deal with injuries and control processes such as inflammation and blood clotting, so wiping them out entirely isn’t an option.
There is a need here, as in all things, to create balance. It can’t be an easy task to design a medication that takes the level of something in the body down to just the right level without going too far. The creation of balance, or homeostasis, is one of the primary characteristics of CBD. You’ll see this as a theme in the posts on this site.
Finally, there are DMARDs which are used primarily for RA. That stands for Disease Modifying Antirheumatic Drug. These have come in two types: conventional and biologic, with a third now available: Janus kinase Inhibitors (JAK). It doesn’t take much research to realize that these are complex drugs. In order to provide a general understanding, the following is a general description.
Conventional DMARDs are synthetic (that’s not as scary as it may sound, in the context of pharmaceuticals it means that a drug was synthesized and not naturally occurring) and block the entire immune system. Because they are synthetic they can be taken in conventional forms such as pills or injections. Because they block the entire immune system they can be an ax when what you need is a scalpel.
Biologics are made using recombinant DNA technology and are much more complex and comprised of larger molecules. Because of this they are much more expensive and can be administered in fewer methods. They are seen as an advance in DMARDs because they can be targeted to block only part of the immune system.
You probably saw this coming: JAKs are synthetic DMARDs that target specific parts of the immune system. This is the newest class of DMARDs.
So that’s an extremely general statement of the current state of play for pharmaceutical treatments for arthritis. If you want to take a deeper dive, here’s an article from Johns Hopkins that can start you down that path.
There’s always a bill to be paid. Even common over the counter medications like ibuprofen can cause problems. A friend whose job required a lot of hard manual labor felt as though he could never stop working. His body had other thoughts on the matter. After months of taking ibuprofen like candy, he had a bleeding ulcer. I’ve since found that GI issues aren’t as uncommon as you might think.
It should come as no surprise that a class of drugs that is designed to block or inhibit one of the most important systems in our body can have some side effects. So for all of these drugs an increased risk of infection is a possible side effect; one that varies in degree based on the scope and effectiveness of the immunosuppression the cause.
NSAIDs have the benefit that they can provide fairly immediate pain relief. They can also increase your risk of heart attacks or strokes, can damage the kidney, liver and heart and can cause stomach ulcers. Handle with care. Methotrexate, one of the most common NSAIDs, was originally (and is still) used in cancer treatment.
DMARDs and JAKs take weeks or months to be effective and they aren’t all effective for all people. They can also cause feeling or being sick (or being? I guess that’s worse than just feeling sick), hair loss, head aches muscle pain, bleeding gums, swelling of the eyes. They also carry a greater risk of allergic reaction. OK, I think that’s enough. There can be serious side effects.
A TRUE STORY
To humanize the complexity of all this, here’s a true story about a person taking biologics for severe rheumatoid arthritis. He found that if he took a particular biologic long enough it could slowly become less effective requiring him to move on to another one. At the time, this was more than 5 years ago, there were about 4 biologics that would work for him so he wanted to take the one he was on as long as possible. I got the feeling from him of doors closing.
CBD FOR ARTHRITIS PAIN
CBD and other cannabinoids interact with the body’s Endocannabinoid System (ECS). Here’s a painfully long quote that is warranted because it’s exactly on point and is from a research article published by the NIH:
The Endocannabinoid System (ECS) is primarily responsible for maintaining homeostasis, a balance in internal environment (temperature, mood, and immune system) and energy input and output in living, biological systems. In addition to regulating physiological processes, the ECS directly influences anxiety, feeding behaviour/appetite, emotional behaviour, depression, nervous functions, neurogenesis, neuroprotection, reward, cognition, learning, memory, pain sensation, fertility, pregnancy, and pre-and post-natal development. The ECS is also involved in several pathophysiological diseases such as cancer, cardiovascular diseases, and neurodegenerative diseases.
The bodily system that is responsible for maintaining balance in the immune system is going to be of interest to people with arthritis as well as people researching treatments for arthritis.
NSAIDs and DMARDs are designed to block or suppress the immune system. That’s what they do. While an improperly functioning immune system is clearly the problem in the case of arthritis, the possibility that it could be brought back into balance, not selectively or completely shut down, has an understandably strong appeal.
A study published in 2022 designed to explore the effectiveness of CBD for arthritis and joint pain reported some positive outcomes:
- Improvements in pain exhibited by 83%
- Improvement in physical function exhibited by 66%
- Improvement in quality of sleep exhibited by 66%
- 60% reported a reduction or cessation of other medications
These improvements were present in all groups but more so in those with osteoarthritis than rheumatoid arthritis. One study, one group but the number of similar studies is growing.
In 2019 the Arthritis Foundation, faced with large and growing number of its members taking CBD, said CBD appears to be safe and helpful for certain types of pain.
Meanwhile, the Arthritis Society of Canada said many of its members reported that CBD helps to alleviate the arthritis symptoms of many of their members. They pointed out that it doesn’t cure arthritis. They didn’t point out that nothing else does either. Oh well.
If you take a look at the status of CBD research in other countries, most notably Israel where the “father” of cannabis research lived, you’d probably be surprised. An article titled “Research Without Prejudice” cover the topic well.
An essential point of that article is that the U.S. comes to cannabis research with an enormous amount of baggage. For decades even hemp was considered a Schedule I drug, along with heroin and PCP. Think about that. A plant that was praised by Jefferson, Washington, Lincoln and others and is acknowledged as a source material to replace thousands of plastic products was put in the same class of drugs as Angel Dust! I have a hard time imagining Honest Abe tweaking out with a shot of hemp in the basement of the White House.
Yes, CBD can help with arthritis pain. It can do so by alleviating pain and by reducing the inflammation that causes the pain. The mechanism through which it does this is the ECS which is involved in establishing homeostasis in bodily systems, one of which is the immune system. It is an out of balance immune system which causes RA and many other types of arthritis.
Like every known treatment for arthritis, CBD won’t cure the disease, won’t work for all people, all the time and to the same extent. I know many people and have talked to many more for whom CBD did provide some relief from the pain and other symptoms (i.e. inflammation) of arthritis.
I know enough people with arthritis to be genuinely grateful that I don’t have it. I cannot know their pain and I would never tell them or anyone else to quit whatever medications they’re on and replace them with CBD on a whim or without first consulting their rheumatologist.
At the same time, I would (and almost certainly have) suggested that they try CBD. I don’t make that suggestion because I sell CBD or with the cavalier idea that “hey, it can’t hurt.” I make the suggestion because there is anecdotal proof from millions of people that CBD helps with arthritis and because there is an existing and growing body of scientific research that supports the idea that CBD can help with arthritis pain.
If you suffer from arthritis pain and are considering CBD, do what you would do before starting any new treatment. Research the product, look for reputable providers, talk to your doctor, talk to people you know with the same condition. That way, you will be able to make an informed decision.