CBD Oil for Joint Pain - April 2024

Research Overview on Using CBD Oil for Joint Pain

Inflammation of the joints is a common cause of pain, and it can manifest in different body areas, such as the feet, hips, knees, hands, and spine⁽⁷⁾. 

Inflammation can be painful for a long time, and it can worsen as the body tries to heal itself. Joint pain can affect a person’s ability to perform simple tasks, leading to a decline in quality of life. Treating joint pain may involve addressing the underlying causes of the pain⁽⁸⁾.

There are no direct studies linking CBD oil to joint pain. However, studies show that CBD has anti-inflammatory and antioxidant potentials⁽⁹⁾.

Meanwhile, various molecular targets have been studied to develop CBD compounds’ pharmacological properties. Through clinical trials on the different biological properties of CBD, researchers have been able to gain a deeper understanding of its potential therapeutic applications⁽¹⁰⁾. 

Despite the lack of conclusive evidence supporting the use of CBD oil for managing joint pain, scientists noted that CBD may have the ability to reduce chronic pain⁽¹¹⁾. 

Arthritis can cause joint pain and stiffness, which usually worsen with age⁽¹²⁾. 

More studies have shown that CBD may reduce endogenous pain response in mice with acute arthritic diseases⁽¹³⁾. The nonpsychoactive compound also appears to help in fracture healing. 

In addition, CBD may help with epilepsy, potentially offering analgesia and increasing the quality of life⁽¹⁴⁾. 

In this study, researchers noted that CBD may positively affect chronic pain and negatively affect prenatal development.

Many investigations on CBD’s behavioral impact determined that the compound lacks the psychotomimetic effects of tetrahydrocannabinol or THC⁽¹⁵⁾. However, CBD may impact anxiety, inflammation, neuropathic pain, and epilepsy.

The psychotomimetic effect is the ability to mimic psychotic symptoms.  

In addition, the European Journal of Pain released a 2016 study examining the efficacy of topical CBD in rats with arthritis pain⁽¹⁶⁾. The researchers observed significantly lower joint swelling and limb posture scores following CBD application on rat models, suggesting topical CBD’s therapeutic potential for inflammation and pain-related arthritic behavior.

Despite the growing acceptance of the use of CBD in managing various conditions, a longitudinal study is necessary to elucidate CBD’s efficacy in managing joint diseases. 

How CBD May Help Reduce Pain

A narrative review is based on the International Association for the Study of Pain or IASP’s global task force on the use of cannabinoids, cannabis, and cannabis-based medicines for pain management⁽¹⁷⁾. Efficacy and other pain relief effects in preclinical laboratory animal studies were assessed.

Cannabis, cannabis plant extracts or oils, cannabinoid substances, and endocannabinoid modulators have been proposed as pain relievers⁽¹⁸⁾. 

Significant scientific advances in understanding the endocannabinoid system (ECS) and cannabinoids have fueled interest in these agents.

The approval of various forms of cannabis-based therapy, such as Epidiolex, Sativex, and Nabiximol, and changes in the regulatory framework allows the use of these drugs for pain management.

The ECS is involved in various aspects of the pain processing pathway⁽¹⁹⁾. The ECS comprises cannabinoid receptors, such as CB1 and CB2. 

CB1 receptors are also present in the central nervous system and peripheral nervous systems, while CB2 receptors are primarily found in immune cells.

CB1 and CB2 regulate neurotransmission in the nervous system. Both of these actions also affect the activity of the immune cells. The endocannabinoids that act on CB1 inhibit neurotransmission across the nervous system, while those that act on CB2 regulate the activity of CNS immune cells.

Meanwhile, the effects of cannabinoids, which are the major components of the ancient medical plant Cannabis sativa, are regulated by cannabinoid receptors CB1 and CB2⁽²⁰⁾. The CB1R is a subtype that has been identified as a potential therapeutic target for managing various neuropsychiatric disorders.

However, despite the growing evidence supporting the safety and efficacy of medical marijuana, many healthcare professionals and scientists remain divided on the issue of regulating its use⁽²¹⁾. 

Benefits of Using CBD for Pain

CBD may possess analgesic (pain-relieving) and anti-inflammatory properties to help with chronic pain⁽²²⁾. CBD may be beneficial in managing the pain associated with the following health conditions⁽²³⁾:

• Inflammation⁽²⁴⁾: In animal models of rheumatoid arthritis, CBD has shown promise in reducing inflammation and relieving pain. 

Researchers show that CBD preferentially affects the tumor necrosis factor-activated protein (TNF-activated) cell viability in the rheumatoid arthritis joint. ​​Rheumatoid arthritis is a type of autoimmune disease in which the immune system mistakenly attacks a person’s joints, resulting in inflammation.

• Arthritis symptoms⁽²⁵⁾: Sativex, an oral spray containing a 1:1 THC:CBD extract ratio, was influential in managing pain at rest, morning stiffness, and sleep quality in patients with rheumatoid arthritis in a small clinical study.
• Cancer⁽²⁶⁾: CBD may inhibit the growth and migration of certain tumors, neovascularization, and cell death. CBD may also affect the microenvironment by regulating the activities of specific immune cells. Neovascularization is referred to the growth of new blood vessels.

The effects of CBD on different cellular targets vary depending on the type of tumor. For instance, the nonpsychoactive compound may affect the cellular targets of other cancer cells, leading to cell death.

• Diabetes⁽²⁷⁾: Chronic cerebral hypoperfusion (CCH) is a risk factor for cognitive decline. It has been shown that diabetes and age can increase the risk of cognitive impairment. Cannabidiol appears to have beneficial effects on both diabetes and cognitive function.

The animal models subjected to either a sham or a chronic combined headache condition (CCH) surgery received CBD. The repeated CBD administration resulted in weight loss in both sham-operated and CCH-operated animals. Cannabidiol also seem to enhance memory performance and decreased hippocampal inflammatory marker levels.

CBD may enhance memory performance and reduce the levels of inflammation markers in the brain. It also seems to attenuate the decrease in neurotrophic factor levels observed in diabetic animals.

• Fibromyalgia⁽²⁸⁾: Researchers surveyed to gather information about the safety and effectiveness of CBD among individuals with fibromyalgia. 

Almost half of all respondents (58%) never use CBD, while 29.4% have used CBD in the past, and 32.4% currently use CBD. The respondents who used CBD generally did so due to insufficient symptom relief, while those not using CBD cited safety concerns as their main reason for not utilizing the compound.

Although many participants admitted to using CBD, only a third of them asked for advice from their doctor. Nevertheless, some respondents reported mild to moderate reduction in various fibromyalgia symptoms following CBD application, while half of them experienced minor side effects.

Still, the studies were limited due to the design and selection biases. 

Although some individuals use CBD for fibromyalgia, the effects of CBD on the symptoms are not known. Hence, the study highlights the need for more research to understand the potential benefits of CBD on fibromyalgia and how CBD works.

Fibromyalgia is another chronic disorder that causes widespread pain, exhaustion, sleep disturbances, and mental and emotional discomfort⁽²⁹⁾. 

• Migraines⁽³⁰⁾: Medical cannabis or medical marijuana has shown promise in lessening the severity of migraines and reducing prescription medication use. Although there is not enough supporting data to recommend specific cannabis doses, the effects of CBD and THC may have the potential to relieve migraine.
• Multiple sclerosis⁽³¹⁾: Individuals with multiple sclerosis (MS) use marijuana to manage their symptoms. In a survey conducted by the National MS Society, over 60% of the organization’s members use the drug for symptom management. 

A study conducted in Canada also noted that about half of the organization’s members would consider using marijuana if the substance’s legal status was evident.

• Parkinson’s disease (PD)⁽³²⁾: Researchers compared CBD to a placebo in a double-blind trial. PD patients without dementia were divided into three groups of seven and given either placebo, 75mg of CBD per day, or 300mg of CBD daily. The participants’ well-being and quality of life were examined using the Parkinson’s Disease Questionnaire.

However, the placebo and CBD 300 mg/day groups exhibited substantially different mean total scores on the PDQ-39. It means that the total scores of the groups given with CBD 300 mg/day differed considerably. 

The authors suggested that CBD may help enhance the quality of life of those PD patients without psychiatric disorders.

Types of CBD Products for Joint Pain

There are no specific types of CBD products for joint pain. However, after CBD extraction, CBD oil is classified as CBD full-spectrum, broad-spectrum, or CBD isolates.

Full-spectrum CBD oil contains all cannabinoids present in the cannabis plant, including flavonoids and terpenes. 

Terpenes are naturally occurring chemical molecules in plants responsible for their aroma⁽³³⁾. On the other hand, flavonoids have purported antioxidant components⁽³⁴⁾.

Full-spectrum CBD oil also has less than 0.3% THC.

Meanwhile, broad-spectrum CBD oil is also made up of the same ingredients as full-spectrum CBD oil, except THC.

Lastly, CBD isolates are made of pure cannabidiol.

Hemp oil is derived from Cannabis sativa or hemp plants. CBD is extracted from the plant using various methods, including carbon dioxide (CO2), hydrocarbon, or ethanol extraction.

A carrier oil, such as coconut oil or hempseed oil, is often used to dilute CBD oil. CBD oils do not have psychoactive effects.

CBD products are mostly available in CBD oil or tinctures in various concentrations. Other formulations include CBD capsules, gummies, and sprays.

Effectiveness of CBD Oil

Cannabidiol and hemp oils have grown in popularity due to their low tetrahydrocannabinol (THC) content, resulting in potential therapeutic advantages without the “high” associated with marijuana”⁽³⁵⁾. In 2018, Epidiolex, the first drug containing CBD, was approved by the United States Food and Drug Administration or FDA to manage severe epilepsy.

There is growing evidence supporting cannabidiol (CBD) oils for managing various conditions, such as chronic pain and opioid addiction⁽³⁶⁾. However, caution should be used when guiding patients toward CBD products due to a lack of regulation and reports of misleading labeling of CBD and THC concentrations.

How to Use CBD

While there are several CBD products available, CBD oils can be used in various ways, such as the following:

1. Aside from being used in food, CBD oil can also be added as an ingredient in various drinks. There are also multiple ways to utilize the compound, such as adding it to salad dressings.
2. Consumers can take CBD oil sublingually (under the tongue). CBD oil taken sublingually may retain its efficacy for two to four hours, with a bioavailability between 6% to 20%⁽³⁷⁾.
3. Topical CBD products, such as CBD creams, lotions, salves, and balms,  are available in the market. CBD users can also apply CBD oils topically.
4. CBD can be inhaled using a vaporizing pen or vape pen. However, there are no regulations regarding vaping CBD in particular. The FDA, which oversees tobacco products, has not yet decided how it will regulate CBD⁽³⁸⁾.

CBD Usage and Dosage

There is no standard CBD usage and an available dosing chart for CBD for joint pain. 

In one study, CBD doses up to 300mg a day were used safely for up to 6 months, while doses of 1,200 to 1,500mg per day were used safely for up to 4 weeks⁽³⁹⁾.

In pain management, one study reported the safety of oral CBD administration (400 to 800mg) in combination with fentanyl, owing to their distinct modes of action⁽⁴⁰⁾.

Fentanyl is an 80-100 times stronger narcotic than morphine. The pharmaceutical fentanyl was designed to relieve cancer patients’ pain⁽⁴¹⁾.

However, additional scientific research on humans is required at this moment to define appropriate dosing and overall safety standards.

No single CBD dosage is appropriate for everyone because each individual is unique and reacts differently to CBD. For this reason, some may benefit from a low dose, while others may require a higher dose. 

For a fine-tuned CBD dosage, individuals should consult a doctor versed in cannabis use. 

Risks and Side Effects of Using CBD

There are specific risks associated with CBD consumption⁽⁴²⁾. CBD may induce side effects, including dry mouth, diarrhea, reduced appetite, drowsiness, and fatigue. As with any medicine, CBD can also interfere with other medications, including blood thinners.

Recent studies on the use of cannabidiol for managing epilepsy noted that CBD may cause various side effects, such as decreased appetite and somnolence, in up to 36% of patients⁽⁴³⁾. 

These side effects were less frequent and less severe than those experienced with other drugs, such as clobazam⁽⁴⁴⁾. The FDA also suggested that patients with known decreased liver function should be monitored for these conditions before starting Epidiolex therapy.

However, other drug interactions have been reported, mainly due to the metabolism of CBD⁽⁴⁵⁾. These interactions are not expected to cause severe effects. However, CBD products should be taken into account when assessing the safety of a product.

Safeness

Because CBD full-spectrum phytocannabinoid oils are relatively new, there have been no rigorous safety studies conducted on these products⁽⁴⁶⁾. However, the various active ingredients of CBD have been examined, and no significant adverse effects were noted.

A study indicated that CBD does not seem to induce catalepsy and does not alter physiological parameters like body temperature, blood pressure, and heart rate⁽⁴⁷⁾. Catalepsy is a significant lack of voluntary mobility in which the limbs stay in any posture⁽⁴⁸⁾. 

While the other components in CBD and hemp oils are typically in such low quantities that serious interactions are rare, caution should still be exercised when identifying the compounds in a product.

Legality

In recent years, there has been wide interest in creating products derived from cannabis, such as cannabidiol (CBD)⁽⁴⁹⁾. The FDA recognizes the potential of these high-quality CBD products and encourages the development of new therapy based on CBD compounds.

Still, the FDA is aware of the marketing practices of some CBD companies that violate the federal law regulating the sale and use of drugs and cosmetic products containing marijuana and other plant-derived compounds.

Restrictions

The FDA sends warning letters to CBD companies that illegally sell products that claim to contain cannabidiol⁽⁵⁰⁾, which can be used to manage various medical conditions. These CBD products were also impermissibly marketed as dietary supplements.

These CBD products, which the FDA does not approve, are considered unauthorized new drugs since they do not have the necessary approval to be marketed. 

Under the FD&C Act, a drug is defined as any substance designed to diagnose, cure, mitigate, treat, or prevent illness, as well as any substance (other than food) intended to change the structure or function of the human or animal body. 

Before new human and animal pharmaceuticals may be lawfully sold as drugs, they must be authorized by the FDA or adhere to a “monograph” for a specific drug category developed by the FDA’s Over-the-Counter (OTC) Drug Review⁽⁵¹⁾. 

Still, CBD was not considered as an ingredient in the OTC Drug Review.The FDA has only approved one CBD medication for managing seizures related to TSC(tuberous sclerosis complex), LGS (Lennox-Gastaut syndrome), and Dravet syndrome in humans⁽⁵²⁾. Thus, CBD is neither a food additive nor a dietary supplement.

What Is CBD?

CBD or cannabidiol is a component in marijuana. CBD is devoid of tetrahydrocannabinol (THC), the psychoactive compound of marijuana that induces euphoria⁽⁵³⁾. 

Although CBD oil is the most common CBD product, cannabidiol is also available as an extract, a vaporized liquid, and an oil-based pill. Other CBD-infused products accessible online are incorporated in food, beverages, and cosmetics.

How to Choose CBD Oil Products 

For first–time users, choosing CBD oil can be challenging since the CBD market is unregulated. There is a risk of buying a mislabeled product that will be ineffective and even dangerous for the health and wellness of the consumers.

Research is paramount when it comes to choosing CBD products. Hence, users should always check the source of hemp, extraction methods, reports from a third-party lab, and the company’s reputation.

The consumer’s choice will also depend on the type of CBD, consumption method, and potency; these factors should suit their lifestyle preferences and desired effects.

Note that reputable CBD companies actively seek out and make their third-party testing data available to the public. A trusted brand displays a certificate of analysis (COA) on its product’s page. 

Individuals must examine the COA to ensure that the product has passed all testing for heavy metals and other contaminants, such as mold and pesticides.

Consumers must always check the cannabinoid profile on the COA. This certificate will tell them whether or not the product’s CBD potency is accurate.

Causes of Joint Pain

According to the Arthritis Foundation, inflammatory arthritis causes joint pain, swelling, soreness, warmth, and morning stiffness lasting over an hour⁽⁵⁴⁾. 

The most common forms are psoriatic arthritis (PSA), gout and ankylosing spondylitis (AS), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE, lupus).

Inflammatory compounds are produced by the immune system when it does not work correctly. A weak immune system can cause inflammation in the joints and damage the cartilage and bone, leading to pain. 

Inflammatory joint pain may be caused by⁽⁵⁵⁾: 

• Bone erosion: Joints with damaged or pitted bones can hurt.
• Centralized pain: Inflammatory arthritis’ long-lasting pain can make individuals more sensitive to pain.
• Muscle weakness: Muscle weakness puts extra strain on joints.
• Ligament damage: Inflammation can harm these flexible tissue bands that support the joint.
• Joint fusion: The backbone’s tiny bones (vertebrae) may fuse together, making movement difficult and painful.
• Swollen joint capsule: Inflamed synovium causes pressure, stiffness, and pain in the joint.
• Synovitis: Inflamed thin membrane (synovium) releases chemicals that irritate nerves and increase joint fluid.

Alternative Products for Joint Pain

Various studies have shown that certain natural products (pycnogenol, curcumin, Boswellia extract) may promote joint health and manage osteoarthritis⁽⁵⁶⁾. These natural products may also stimulate the release of specific inflammatory markers.

Products with numerous plant extracts have shown efficacy similar to those observed with analgesics. These products include pycnogenol, pycnogenol, and curcumin.

A few clinical trials suggest that natural products may help manage osteoarthritis. However, more extensive clinical research is necessary.

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1. Joint Pain
   https://my.clevelandclinic.org/health/symptoms/17752-joint-pain
2. Ibid.
3. Antioxidative and Anti-Inflammatory Properties of Cannabidiol
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7023045/
4. Cannabidiol: A Brief Review of Its Therapeutic and Pharmacologic Efficacy in the Management of Joint Disease
   www.ncbi.nlm.nih.gov/pmc/articles/PMC7176325/
5. Arthritis
   https://www.mayoclinic.org/diseases-conditions/arthritis/symptoms-causes/syc-20350772
6. Cannabidiol: A Brief Review of Its Therapeutic and Pharmacologic Efficacy in the Management of Joint Disease
   www.ncbi.nlm.nih.gov/pmc/articles/PMC7176325/
7. Joint Pain
   https://my.clevelandclinic.org/health/symptoms/17752-joint-pain
8. Ibid.
9. Antioxidative and Anti-Inflammatory Properties of Cannabidiol
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7023045/
10. Ibid.
11. A Balanced Approach for Cannabidiol Use in Chronic Pain
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204604/
12. Arthritis
    https://www.mayoclinic.org/diseases-conditions/arthritis/symptoms-causes/syc-20350772
13. Cannabidiol: A Brief Review of Its Therapeutic and Pharmacologic Efficacy in the Management of Joint Disease
    www.ncbi.nlm.nih.gov/pmc/articles/PMC7176325/
14. A Balanced Approach for Cannabidiol Use in Chronic Pain https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204604/
15. Diversity of molecular targets and signaling pathways for CBD
    https://bpspubs.onlinelibrary.wiley.com/doi/10.1002/prp2.682
16. Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851925/
17. Cannabinoids, the endocannabinoid system, and pain: a review of preclinical studies
    https://journals.lww.com/pain/Fulltext/2021/07001/Cannabinoids,_the_endocannabinoid_system,_and.3.aspx
18. Ibid.
19. The role of the endocannabinoid system in pain
    https://pubmed.ncbi.nlm.nih.gov/25846617/
20. Cannabinoid Receptors and the Endocannabinoid System: Signaling and Function in the Central Nervous System
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5877694/
21. Cannabinoids, the endocannabinoid system, and pain: a review of preclinical studies
    https://journals.lww.com/pain/Fulltext/2021/07001/Cannabinoids,_the_endocannabinoid_system,_and.3.aspx
22. Cannabidiol for Pain Treatment: Focus on Pharmacology and Mechanism of Action
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700528/
23. What are CBD gummies? Are there any health benefits?
    https://www.drugs.com/medical-answers/cbd-gummies-health-benefits-3515165/
24. Cannabidiol (CBD): a killer for inflammatory rheumatoid arthritis synovial fibroblasts
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7463000/
25. Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis
    https://pubmed.ncbi.nlm.nih.gov/16282192/
26. ​​Cannabidiol (CBD) as a Promising Anti-Cancer Drug
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7693730/
27. Effects of Cannabidiol on Diabetes Outcomes and Chronic Cerebral Hypoperfusion Comorbidities in Middle-Aged Rats
    https://pubmed.ncbi.nlm.nih.gov/30430393/
28. Cannabidiol Use for Fibromyalgia: Prevalence of Use and Perceptions of Effectiveness in a Large Online Survey
    https://pubmed.ncbi.nlm.nih.gov/33400996/
29. Fibromyalgia
    https://www.cdc.gov/arthritis/basics/fibromyalgia.htm
30. Cannabis and Migraine: It’s Complicated
    https://pubmed.ncbi.nlm.nih.gov/33630181/
31. Cannabidiol to Improve Mobility in People with Multiple Sclerosis
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5874292/#B6
32. Effects of cannabidiol in the treatment of patients with Parkinson’s disease: an exploratory double-blind trial
    https://pubmed.ncbi.nlm.nih.gov/25237116/
33. Therapeutic and Medicinal Uses of Terpenes
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7120914/
34. Health Benefits of Flavonoids
    https://www.sciencedirect.com/science/article/pii/B9780128147740000104
35. Clinicians’ Guide to Cannabidiol and Hemp Oils
    https://www.sciencedirect.com/science/article/pii/S0025619619300072#bib88
36. Ibid.
37. Healing with CBD, page 192
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
38. Clinicians’ Guide to Cannabidiol and Hemp Oils
    https://www.sciencedirect.com/science/article/pii/S0025619619300072#bib88
39. Ibid.
40. 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
41. Fentanyl
    https://www.dea.gov/factsheets/fentanyl
42. 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
43. ​​Clinicians’ Guide to Cannabidiol and Hemp Oils
    https://www.sciencedirect.com/science/article/pii/S0025619619300072#bib88
44. Ibid.
45. Ibid.
46. Ibid.
47. Safety and side effects of cannabidiol, a Cannabis sativa constituent
    https://pubmed.ncbi.nlm.nih.gov/22129319/
48. Catalepsy
    https://www.sciencedirect.com/topics/neuroscience/catalepsy
49. FDA Regulation of Cannabis and Cannabis-Derived Products, Including Cannabidiol (CBD)
    https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd
50. FDA Warns Companies Illegally Selling CBD Products
    https://www.fda.gov/news-events/press-announcements/fda-warns-companies-illegally-selling-cbd-products
51. Ibid.
52. Ibid.
53. 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
54. Causes of Inflammatory Joint Pain
    https://www.arthritis.org/health-wellness/healthy-living/managing-pain/understanding-pain/causes-of-inflammatory-joint-pain
55. Ibid.
56. Natural Products for Promoting Joint Health and Managing Osteoarthritis
    https://pubmed.ncbi.nlm.nih.gov/30232562/

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