- Studies suggested that cannabidiol (CBD) may help manage acute arthritic conditions by reducing inflammatory immune responses and lessening pain responses(1).
- Researchers have not fully confirmed CBD’s anti-inflammatory and pain-relieving properties in humans.
The Arthritis Foundation recommends that individuals consult a doctor before taking CBD with any medication for arthritis as CBD may interact with these drugs(2).
Medical Research on CBD Oil for Arthritis
Researchers have not thoroughly evaluated the effects and benefits of CBD oil for arthritis through human clinical trials.
However, animal studies suggested that cannabidiol (CBD) may help manage joint diseases, such as acute arthritic conditions, by attenuating pro-inflammatory immune responses and decreasing endogenous pain responses(3).
One study entitled “Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis,” accessible through the PubMed Central (PMC) database, showed that topical CBD application may have a therapeutic potential in relieving inflammation and pain of arthritis(4).
Results of the study, published in the European Journal of Pain, showed that transdermal cannabidiol (CBD) gels may help decrease joint swelling significantly.
Although these studies were performed on animals, researchers have not validated CBD’s pain-relieving and anti-inflammatory properties in humans. Thus, scientists cannot fully confirm whether CBD is good for arthritis.
However, the findings may help researchers conduct extensive and high-quality human clinical studies to determine how effective and safe CBD helps with arthritis.
Usage and Dosage of CBD for Arthritis
The United States Food and Drug Administration (USFDA) has not endorsed a CBD dosage guide specific to arthritis.
Individuals using CBD for the first time may consider starting with a low dose and gradually increasing the dosage(5).
For example, one dosing suggestion in administering CBD is to start with a 10 milligram (mg) dose per day(6).
Individual dosage may vary depending on the consumer’s diet, stress levels, exercise, genetics, and overall health conditions(7).
Safety and Effectiveness of CBD for Arthritis
The World Health Organization (WHO) indicates that CBD has low toxicity levels(8).
The agency also states that the compound does not appear to exhibit similar effects as tetrahydrocannabinol (THC), also called delta-9-tetrahydrocannabinol (Δ9-THC).
THC is a cannabis plant-derived compound typically associated with marijuana use due to the substance’s psychoactive effects that create a feeling of “high”(9).
Based on several open-label and controlled trials evaluating CBD’s therapeutic effects, the WHO finds CBD well tolerated among humans and has a good safety profile(10).
One study mentioned that humans may be capable of tolerating a high dose of up to 1,500 mg of CBD daily(11).
However, despite CBD being considered generally safe, scientists need to conduct further studies to determine the long-term effects of the compound(12).
What Is CBD?
Cannabidiol, popularly known as CBD, is a naturally occurring substance found in cannabis plants, such as marijuana and hemp, and may have pain-relieving and anti-inflammatory properties(13).
CBD typically comes from hemp, a Cannabis sativa variety containing about 0.3% THC(14).
CBD is a phytocannabinoid (plant-based cannabinoid) that interacts with the body’s endocannabinoid system (ECS)(15).
The ECS contains various cannabinoid receptors, primarily CB1 and CB2 receptors.
The CB1 receptors are mainly in the spinal cord and brain, specifically in the amygdala, hypothalamus, and nerve endings(16).
Meanwhile, CB2 receptors are primarily present in the peripheral nervous system, including immune cells, liver, and spleen(17).
Research suggests that when CBD interacts with these receptors, it produces pain-relieving and anti-inflammatory effects that may help with pain management(18).
Different Consumption Methods for CBD
There are various delivery methods to take CBD to help manage arthritis and promote overall wellness. These methods include:
- Topical application: Topicals are typically applied to the skin and do not get absorbed into the bloodstream. CBD topicals may help provide pain relief to the applied area(19).
Topical CBD products include CBD creams, lotions, ointments, and salves.
- Transdermal application: Transdermals are applied similarly to topicals, except the transdermal route allows a drug to penetrate the skin and enter the bloodstream.
Gels and patches are examples of transdermal CBD products.
- Sublingual administration: CBD oil products administered sublingually or under the tongue allows CBD to enter the bloodstream directly, bypassing the digestive tract.
Using CBD oil tinctures involves using calibrated droppers to deliver the drug sublingually with accurate dosing.
Other sublingually administered products include tablets, high-potency oils, and oromucosal sprays.
- Ingestion: Oral administration lets CBD pass through the individual’s digestive tract before the drug spreads into the bloodstream.
Oral CBD products include CBD capsules, gummies, chews, or cookies.
- Inhalation: This method includes vaping or smoking to deliver CBD into the system. The compound passes through the lungs, heart, and brain through inhalation before spreading throughout the body(20).
Vapes are linked to health risks associated with lung disease(21). Individuals must exercise caution and be wary of these adverse effects before vaping CBD.
Individuals with preexisting medical conditions must consult a doctor or healthcare provider for a diagnosis and effective treatment before taking CBD.
Researchers have not conclusively determined CBD’s onset times or the time before the drug starts working in the body, specifically for joint pain relief in humans.
However, CBD’s onset times, in general, may vary based on the chosen delivery route, such as the following(22):
- Topical application: 15 to 30 minutes
- Transdermal application: 15 to 30 minutes
- Sublingual administration: 15 to 30 minutes
- Oral ingestion: 30 to 90 minutes
- Inhalation: 2 to 15 minutes
In addition, the different delivery routes also determine how long CBD’s effects may last, as shown below(23):
- Topical application: two to four hours
- Transdermal application: four hours for gels and eight hours for patches
- Sublingual administration: two to four hours
- Oral ingestion: six to eight hours
- Inhalation: two to four hours
Difference Between CBD and THC
CBD and THC have purported therapeutic properties that CBD brands claim may benefit an individual’s health and wellness.
However, THC produces a feeling of “high” typically associated with marijuana use(24). On the other hand, CBD does not produce psychoactive effects like THC(25).
Additionally, CBD does not have intoxicating effects as THC, and CBD may reduce THC’s psychoactive effects(26).
CBD Extraction
Individuals may look into the extraction method CBD companies use when choosing the best CBD products.
Manufacturers extract CBD and other compounds from the Cannabis sativa plant using various extraction processes, such as carbon dioxide (CO2), hydrocarbon, or ethanol techniques.
- CO2 extraction: This method uses highly pressurized carbon dioxide for deriving the CBD extract. Many manufacturers consider this method the safest way to extract CBD(27).
- Hydrocarbon extraction: This method uses hydrocarbon solvents such as butane or propane to obtain CBD from the hemp plant.
Hydrocarbons are neurotoxic and flammable. Solvents not adequately purged from the CBD extract may be accidentally ingested and become a health hazard.
This extraction method may effectively derive CBD, provided that manufacturers follow proper procedures(28).
- Ethanol extraction: This method uses ethanol for extracting CBD from cannabis. Different cultures have used ethanol extraction for centuries to derive medicinal compounds from cannabis plants(29).
After extracting the hemp extract and processing it into CBD oil, manufacturers categorize it as full-spectrum, broad-spectrum, or isolate.
- Full-spectrum CBD oil: The product category typically contains all beneficial compounds from the cannabis plant. Compounds and cannabinoids in full-spectrum CBD oil include flavonoids, terpenes, and THC.
Flavonoids are substances in plants that act as antioxidants and antimicrobials(30). Meanwhile, terpenes are essential oil constituents that produce a distinct aroma(31).
Combining these compounds in full-spectrum CBD oil may create an “entourage effect.” This phenomenon is characterized by the active cannabis compounds working together synergistically to provide better therapeutic results(32).
- Broad-spectrum CBD oil: Products under this category contain most of the cannabinoids and compounds in full-spectrum products. However, broad-spectrum CBD products do not contain THC.
- CBD isolates: These products are made of pure CBD only. These products are THC-free and do not include any other cannabinoids or compounds.
Individuals who prefer to experience the full benefits of the entourage effect may consider purchasing full-spectrum products, such as full-spectrum CBD oil tinctures.
On the other hand, consumers averse to THC or its psychoactive effects may choose broad-spectrum CBD oil or CBD isolates instead.
Risk and Considerations
Common side effects of CBD include diarrhea, changes in appetite or body weight, and tiredness(33).
In general, CBD may cause fatigue, drowsiness, dry mouth, appetite loss, and diarrhea, which may be considered tolerable side effects among humans(34).
Reputable CBD companies typically provide certificates of analysis (COAs) for their CBD products for transparency.
Third-party labs provide these COAs, containing details of a CBD product’s actual content. Third-party testing and analysis are industry-standard procedures to minimize the concerns surrounding falsely labeled products(35).
COAs may also include information on whether the product has contaminants, such as pesticides, heavy metals, or solvents that can trigger a health risk to consumers.
CBD may have potential drug interactions with commonly taken medications for arthritis. The Arthritis Foundation advises individuals to consult their doctor before taking CBD together with any of the following drugs(36):
- Corticosteroids such as prednisone
- Naproxen (Aleve)
- Tramadol (Ultram)
- Antidepressants, including citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft)
- Fibromyalgia medications such as pregabalin (Lyrica) and gabapentin (Neurontin)
CBD oil is not FDA-approved as a treatment for any disease. CBD brands typically include a disclaimer telling consumers not to use these products to treat any medical condition.
Legality of CBD
The legality of CBD oil or medical marijuana varies among states. Before buying CBD products, consumers must review and understand their state’s laws regarding CBD use.
As of February 3, 2022, 37 U.S. states have implemented regulated cannabis programs. These states include Colorado, Texas, Nevada, California, and Florida(37).
Under federal law, CBD products with a THC content that exceeds 0.3% are considered illegal(38).
The FDA warns that labeling CBD products as food additives or dietary supplements is illegal. The agency has limited information on CBD’s safety and advises consumers to consider the risks before using CBD(39).
CBD’s Long History
Cannabis is a plant-based compound that may be traced back to 5,000 years ago in what is now Romania(40). Evidence in ashes suggested that the substance was first used for medicinal purposes around 400 A.D.
Between the 19th and early 20th centuries in the United States, individuals utilized cannabis as a patent medicine(41). In 1937, cannabis sale and use became federally restricted with the enactment of the Marihuana Tax Act.
The 2018 Farm Bill excludes hemp-based CBD products with no more than 0.3% THC from the Controlled Substances Act’s definition of “marijuana”(42). The law also establishes a regulatory framework for producing U.S.-grown hemp(43).
United States federal law mentions that CBD products with a THC content that exceeds 0.3% are illegal(44).
In June 2020, the FDA approved Epidiolex, an oral medication containing purified CBD used for treating seizures associated with epilepsy(45).
The U.S. has regulated cannabis programs that vary from one state to another. As of February 2022, 37 states, including New York, California, Arizona, Oregon, and Colorado, permit the medical use of cannabis(46).
Before purchasing CBD products, individuals must review and understand their state’s laws to avoid legal trouble related to the use of CBD.
What Is Arthritis?
Arthritis occurs when one or more of an individual’s joints become swollen and tender, causing the individual to feel joint pain and stiffness. These symptoms typically worsen as individuals age.
When an individual has too much uric acid in their blood, uric acid crystals may form and cause gout, a painful form of inflammatory arthritis(47). Additionally, underlying diseases or infections, such as lupus or psoriasis, can cause other forms of arthritis.
Lupus is an autoimmune disease wherein the body’s immune system attacks the individual’s organs and tissues. Psoriasis is a skin disease characterized by scaly and itchy patches that typically appear on the knees, elbows, trunk, or scalp.
Symptoms may vary depending on the arthritis type. However, common arthritis symptoms include pain, swelling, stiffness, redness, warmth, and tenderness(48).
Several risk factors can cause an individual to be more susceptible to arthritis. These factors include(49):
- Age: Arthritis risk increases as one gets older.
- Weight: Obese individuals may experience joint strain due to their weight, leading to arthritis.
- Lifestyle: Lack of exercise or smoking may increase the individual’s risk of acquiring the disease.
- Previous joint injuries: Individuals with injured joints, such as injuries from sports, are more likely to have arthritis in the affected joint(50).
Arthritis, when left untreated, may lead to a severe case of the disease, which can make daily tasks difficult to perform(51).
Additionally, when arthritis affects weight-bearing joints, the disease can prevent individuals from walking properly or sitting straight. In some cases, arthritis may cause the joints to lose shape and alignment.
To diagnose arthritis, doctors will typically perform a physical examination on the individual. During the exam, the doctor may perform the following tests(52):
- Evaluate the range and mobility of motion in the joints.
- Inspect the areas around the joints for signs of tenderness.
- Assess the individual’s overall health to determine if a different condition other than arthritis is causing the symptoms.
Doctors can also recommend imaging exams, such as X-ray or magnetic resonance imaging (MRI) scans, on individuals with arthritis. These exams help doctors get a clear picture of the joints, bones, and surrounding tissues by revealing the following:
- Bone dislocations or fractures causing joint pain
- Muscle, tendon, or ligament injuries near the joints
- Soft tissue inflammation
- Cartilage breakdown around the joints
A blood test may not necessarily detect arthritis(53). However, individuals showing symptoms indicative of gout or rheumatoid arthritis may need a blood test. This test can detect uric acid or inflammatory proteins.
Arthritis has no cure. However, various treatments, including surgical and nonsurgical options, may help manage the symptoms of this condition.
Nonsurgical treatments include the following(54):
- Medications: Pain relief or anti-inflammatory medications may help relieve arthritis symptoms.
Doctors can prescribe biologics, drugs that typically target the immune system’s inflammatory response, to help manage rheumatoid arthritis.
- Therapeutic injections: Arthritis in joints, such as in the knees, may improve through viscosupplementation, a treatment procedure that injects a lubricant to help joints move smoothly.
Cortisone shots may also help relieve joint pain and inflammation temporarily.
- Physical therapy: This method involves rehabilitation to improve mobility, range of motion, and strength. The therapist helps individuals by creating a program with adjusted daily activities that help lessen arthritis pain.
For cases of severe arthritis or conditions that have not improved through nonsurgical means, doctors can recommend the following surgery treatments:
- Joint replacement: This procedure involves replacing a damaged arthritic joint with an artificial joint to help preserve joint function and movement.
Examples of joint replacement procedures are hip replacement, knee replacement, ankle replacement, and shoulder replacement.
- Fusion: In this procedure, two or more bones are permanently fused into one. Fusion immobilizes the affected joint to help lower pain due to movement.
Two Common Types of Arthritis
The two most common forms of arthritis are rheumatoid arthritis and osteoarthritis.
Rheumatoid Arthritis
This arthritis type is an autoimmune disorder wherein the individual’s immune system mistakenly attacks the body’s own tissues.
Rheumatoid arthritis is a chronic inflammatory disease that affects the joints and other body systems, such as the skin, eyes, heart, lungs, and blood vessels.
Symptoms of rheumatoid arthritis include:
- Swollen and tender joints
- Joint stiffness
- Appetite loss and fatigue
While doctors have little information on what exactly causes rheumatoid arthritis, they point to genetics as one of the most likely causes of the disease(55).
In this case, the genes themselves do not cause the disorder. However, genetic information may cause an individual to react to environmental factors that may trigger the disease.
Individuals with rheumatoid arthritis are at risk of developing the following complications:
- Osteoporosis
- Dry mouth and eyes
- Rheumatoid nodules
- Heart problems
- Lymphoma
- Carpal tunnel syndrome
Osteoarthritis
Osteoarthritis occurs when the cartilage cushioning the bone ends breaks down. The cartilage is the hard and slippery tissue covering the ends of bones that form a joint.
This disorder commonly affects the joints in the hands, knees, hips, and spine(56). Symptoms include:
- Joint pain and stiffness
- A grating sensation
- Flexibility loss
- Swelling
- Bone spurs (extra bone bits that feel like hard lumps around the joint).
Osteoarthritis is a degenerative disorder that causes the wear and tear of the cartilage that worsens over time and often leads to chronic pain. If left untreated, joint pain and stiffness may cause individuals to have difficulty performing daily tasks(57).
Other Arthritis Types
Aside from osteoarthritis and rheumatoid arthritis, other forms of arthritis include the following:
- Ankylosing spondylitis: An inflammatory disease that causes the bones in the spine to fuse
- Juvenile idiopathic arthritis: A common type of arthritis affecting children under 16
- Psoriatic arthritis: A disease similar to rheumatoid arthritis that is linked to psoriasis
- Septic arthritis: A type of arthritis caused by a joint infection due to germs coming from another body part and traveling through the bloodstream
Individuals with arthritis or any of its symptoms should seek a doctor for diagnosis and treatment before considering taking CBD for these conditions.
- Cannabidiol: A Brief Review of Its Therapeutic and Pharmacologic Efficacy in the Management of Joint Disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176325/
- CBD for Arthritis Pain: What You Should Know https://www.arthritis.org/health-wellness/healthy-living/managing-pain/pain-relief-solutions/cbd-for-arthritis-pain
- Cannabidiol: A Brief Review of Its Therapeutic and Pharmacologic Efficacy in the Management of Joint Disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176325/
- Transdermal Cannabidiol Reduces Inflammation and Pain-Related Behaviours in a Rat Model of Arthritis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851925/
- CBD Dosing https://www.projectcbd.org/guidance/cbd-dosing
- Page 218 of Healing With CBD https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
- CBD Dosing https://www.projectcbd.org/guidance/cbd-dosing
- WHO Expert Committee on Drug Dependence: Fortieth Report https://apps.who.int/iris/bitstream/handle/10665/279948/9789241210225-eng.pdf
- Tetrahydrocannabinol https://www.sciencedirect.com/topics/neuroscience/tetrahydrocannabinol
- WHO Expert Committee on Drug Dependence: Fortieth Report https://apps.who.int/iris/bitstream/handle/10665/279948/9789241210225-eng.pdf
- Safety and Side Effects of Cannabidiol, a Cannabis sativa Constituent https://doi.org/10.2174/157488611798280924
- Effectiveness of Cannabidiol Oil for Pediatric Anxiety and Insomnia as Part of Posttraumatic Stress Disorder: A Case Report https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5101100/
- CBD Oil: What Is It and How Does It Work? https://www.eehealth.org/blog/2019/09/cbd-oil/
- CBD for Arthritis Pain: What You Should Know https://www.arthritis.org/health-wellness/healthy-living/managing-pain/pain-relief-solutions/cbd-for-arthritis-pain
- Page 103 of Healing With CBD https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
- Cannabidiol Primer for Healthcare Professionals https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340472/
- Ibid
- CBD Oil: What Is It and How Does It Work? https://www.eehealth.org/blog/2019/09/cbd-oil/
- Page 210 of Healing With CBD https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
- Best Way to Take CBD https://www.projectcbd.org/guidance/best-way-take-cbd
- Can Vaping Damage Your Lungs? What We Do (and Don’t) Know https://www.health.harvard.edu/blog/can-vaping-damage-your-lungs-what-we-do-and-dont-know-2019090417734
- Page 190-194 of Healing With CBD https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
- Ibid
- hat You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis
- CBD & THC: Myths and Misconceptionshttps://www.projectcbd.org/guidance/cbd-thc-myths-and-misconceptions
- What Is CBD? https://www.projectcbd.org/about/what-cbd
- CBD Oil: An Introduction https://www.projectcbd.org/wellness/cbd-oil-introduction
- Ibid
- Ibid
- Flavonoids as Antioxidants https://pubmed.ncbi.nlm.nih.gov/10924197/
- The Cannabis Terpenes https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763918/
- Page 92 of Healing With CBD https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
- Dosage, Efficacy and Safety of Cannabidiol Administration in Adults: A Systematic Review of Human Trials https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7092763/
- What Are the Benefits of CBD — And Is It Safe to Use? https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/is-cbd-safe-and-effective/faq-20446700
- Page 260 of Healing With CBD https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
- CBD for Arthritis Pain: What You Should Know https://www.arthritis.org/health-wellness/healthy-living/managing-pain/pain-relief-solutions/cbd-for-arthritis-pain
- State Medical Cannabis Laws https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx
- CBD & THC: Myths and Misconceptions https://www.projectcbd.org/guidance/cbd-thc-myths-and-misconceptions
- What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis
- Medicinal Cannabis: History, Pharmacology, And Implications for the Acute Care Setting https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312634/
- Ibid
- Hemp Production and the 2018 Farm Bill https://www.fda.gov/news-events/congressional-testimony/hemp-production-and-2018-farm-bill-07252019
- Hemp Production https://www.ams.usda.gov/rules-regulations/hemp
- CBD & THC: Myths and Misconceptions https://www.projectcbd.org/cbd-101/cbd-misconceptions
- FDA Approves New Indication for Drug Containing an Active Ingredient Derived from Cannabis to Treat Seizures in Rare Genetic Disease https://www.fda.gov/news-events/press-announcements/fda-approves-new-indication-drug-containing-active-ingredient-derived-cannabis-treat-seizures-rare#
- State Medical Cannabis Laws https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx
- Arthritis: Symptoms & Causes https://www.mayoclinic.org/diseases-conditions/arthritis/symptoms-causes/syc-20350772
- Arthritis https://my.clevelandclinic.org/health/diseases/12061-arthritis
- Ibid.
- Arthritis: Symptoms & Causes https://www.mayoclinic.org/diseases-conditions/arthritis/symptoms-causes/syc-20350772
- Ibid.
- Arthritis https://my.clevelandclinic.org/health/diseases/12061-arthritis
- Ibid.
- Ibid.
- Rheumatoid Arthritis: Symptoms & Causes https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648
- Osteoarthritis: Symptoms & Causes https://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925
- Ibid.