Efficacy of CBD for chronic pain & joint disease | Arthritis NSW (2022)

This particular Research Review will use a variety of studies and study reviews to summarise answers for the following questions about Cannabidiol (CBD).

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  • What is CBD?Efficacy of CBD for chronic pain & joint disease | Arthritis NSW (1)
  • How does it work for chronic pain and arthritis?
  • Is CBD better than common mainstream pain medications (e.g., NSAIDs, Opioids)?
  • Are there any side effects of CBD?
  • Are there any guidelines/recommendations?
  • Can I get CBD over the counter (OTC)?

Please be aware that Arthritis NSW is not providing clinical advice on the individual use of CBD products. The purpose of presenting this information istoprovide an objective and non-biased review of the literature. The information presented is for education purposes only.

What is Cannabidiol (CBD)?
  1. The Cannabis sativa plant contains 144 components known as cannabinoids, which are drugs that act on the endocannabinoid system in the brain. The endocannabinoid system in the brain is not a structure per se, but a molecular system responsible for regulating and balancing many processes in the body, including immune response, communication between cells, appetite and metabolism, memory and anxiety/mood. Endocannabinoids are essentially neurotransmitters that bind to cannabinoid receptors that are active in the central nervous system (CNS; brain and spine) and peripheral nervous system.
  2. Of the 144 cannabinoids, two are of medical interest – the psychoactive delta-9-tetrahydrocannabinol (THC) and the non-psychoactive component Cannabidiol (CBD). When in the body, CBD and THC interact with cannabinoid receptors to help treat or limit the effects of various conditions.
  3. Medical marijuana* contains cannabis or cannabinoids that have a THC concentration greater than 0.3%. THC is the euphoria-producing, hallucinogenic component of marijuana.
  4. On the other hand, CBD products that are extracted from hemp** contain less than 0.3% THC and can come in many forms, including oils, sprays and food, among many other options. Since these CBD products do not contain greater than 0.3% THC, they do not require a prescription like typical medical marijuana, and the products in them are not regulated and sometimes do not contain the same ingredients as marketed. CBD is not addictive and carries with it very little risk in its use.
How does it work?
  1. The mechanism behind how CBD works is complex and still under investigation.
  2. The most well-known proposed mechanism for CBD is its effect on type 1 cannabinoid receptors (CB1) and type 2 cannabinoid receptors (CB2). CB1 receptors are mainly located in the CNS, particularly in regions of the midbrain and spinal cord that are responsible for pain perception, therefore can help to reduce pain severity and chronic pain.
  3. CB2 receptors are more often associated with the immune system. In a rather complex way, they can inhibit the inflammatory response. Because of this, CBD helps reduce pain and inflammation, and in turn may help to reduce disease progression, such as those with inflammatory arthritis and OA.
  4. Essentially, the mechanism/s by which CBD works is still unclear, nonetheless, research indicates CBD has been attributed to analgesic, anti-oxidative, anti-inflammatory, anti-convulsant, and anxiolytic properties.
  5. There have been many studies using animal models. The first thing you must know is, while there are promising results on the efficacy of CBD use in chronic pain and arthritis in animal models, they cannot be generalised to the human population. However, if there are promising results in animal models, then trials are progressed to using humans. Since animal studies have shown such promising results for the efficacy of CBD, clinical trials have been conducted on humans for a few years now. For example, one of the earliest studies by Blake et al. (2006) studied the efficacy, tolerability and safety of the cannabis-based medicine (CBM) called, Sativex. Sativex (aka Nabiximols) is used to treat RA, neuropathic pain and multiple sclerosis. In this first ever controlled trial of a CBM in rheumatoid arthritis, the study saw a significant analgesic effect and even indications that disease activity was significantly suppressed following the use of Sativex. Other published scientific inquiries have found similar connections between overall cannabis use and the reduction of chronic pain.
Is CBD better than common mainstream pain/arthritismedications (e.g., NSAIDs, Opioids)?
  1. While further studies are to be conducted, many studies comparing CBD with other typical pain medications tend to CBD superior. For example, Capano et al. (2019) found over half of the chronic pain patients (53%) in the study reduced or eliminated their opioid use within eight weeks after adding CBD-rich hemp extract to their regimens. Therefore, it is suggested that CBD could significantly reduce opioid use and improve chronic pain and sleep quality among patients who are currently using opioids for pain management.
  2. When comparing side effects, CBD appears to have fewer or less severe side effects than mainstream pain medications.
  3. The medications used to treat arthritis include disease-modifying anti-rheumatic drugs (DMARDs), biologic response modifiers, corticosteroids and more. By far, though, most arthritis suffers typically rely on painkillers—either acetaminophen/paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs) or prescribed opioids.
  4. While effective (for the short term anyway), NSAIDS, corticosteroids and opioids only mask pain and their side effects carry substantial health risks and side effects, especially for the older populations.
  5. CBD is presenting as a safe and potentially effective medical alternative to more risky medications commonly prescribed for arthritis pain. Cannabidiol use has little to no health risk or adverse side effects like those presented by NSAIDs and opioid medications. Though, research into CBD use and efficacy have only begun and more longitudinal studies need to be conducted in order to assess the side effects and efficacy of CBD use.
Are there any side effects of CBD?
  1. Yes there are. In a systematic review by Darkovska-Serafimovka et al. (2018), 15 of 18 trials demonstrated a significant analgesic effect on CBD as compared to placebo. Patients reported over 30% reduction in pain intensity. The main side effects reported were drowsiness, nausea, vomiting, and dry mouth, however they were generally well tolerated, mild to moderate.
  2. Side effects may be dose dependent, and dependent on other ingredients included in CBD products.

Are there any
guidelines/recommendations?
  1. Do your research. Health consumers should turn to products that have undergone some form of independent validation testing to ensure that the CBD they use is safe and is made from trusted and advertised ingredients. Not all CBD products provide the ingredients and effects of what the labels might promise.
  2. People taking CBD should do so for several weeks to better determine its effect on their health. Like many other medications or supplements, it is simply unrealistic for consumers to use CBD once or twice and expect consistent beneficial outcomes, which often don’t manifest until a week or more after CBD use begins.
  3. Also, CBD users should experiment with the different forms of CBD treatments to find the one with the greatest efficacy for their individual needs. For example, many arthritis sufferers might find that topical (transdermal) CBD products provide the best relief, while other individual arthritis suffers might get their best results from oral or sublingual forms of CBD instead. Regardless of the form used, CBD generally offers an attractive alternative to other medications, especially those with high health risks and substantial side effects like those exhibited in NSAID and opioid therapies.
6. Can I get CBD over the counter (OTC)?
  1. Yes you can, however, medicalised cannabis or CBD in Australia is a schedule 4 drug, which means you need a prescription for it.
  2. Just recently, the schedule of low dose CBD has been down-scheduled to a schedule 3. This means, you can now get certain low dose CBD products OTC without a script.
  3. But wait! Before you run off to your local pharmacy, while the class schedule been dropped, there are currently no TGA approved products on the Australian Register of Therapeutic Goods (ARTG) that meet the Schedule 3 criteria…Yet! Please check out this website for further information regarding this. https://www.tga.gov.au/media-release/over-counter-access-low-dose-cannabidiol

Schedule 3cannabidiol(CBD) cannot be supplied under the Special Access Scheme (SAS) and must be included (registered) on the Australian Register of Therapeutic Goods (ARTG).

There are also limitations for low-dose CBD products, namely:

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  • the maximum dose is limited to 150 mg per day
  • products must be contained child-resistant packaging
  • product forms are limited to oral, oral mucosal, and sublingual formulations only (i.e. no vaping, notopicals)

Please refer below for research references.

Author: Kat Keane, Health Educator ANSW
Published: 16/2/2021
Last updated: 16/2/2021


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References

Blake DR, Robson P,HoM,JubbRW, McCabe CS. Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheum

CapanoA, Weaver R,BurkmanE. Evaluation of the effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients: a prospective cohort study. Postgrad Med. 2020 Jan;132(1):56-61.doi: 10.1080/00325481.2019.1685298.

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Darkovska-SerafimovskaM,SerafimovskaT,Arsova-SarafinovskaZ,StefanoskiS,KeskovskiZ,BalkanovT.Pharmacotherapeuticconsiderations for use of cannabinoids to relieve pain in patients with malignant diseases. J Pain Res. 2018;11:837–42.

Gusho, C. A., & Court, T. (2020).Cannabidiol: A Brief Review of Its Therapeutic and Pharmacologic Efficacy in the Management of Joint Disease. Cureus, 12(3), e7375.https://doi.org/10.7759/cureus.7375

Khaleghi, M. (2020). New Arthritis Foundation Guidelines On CBD Use Could Be First of Many More to Come. Alternative therapies in health and medicine, 26, 8-11.

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Urits, I.,Gress, K.,Charipova, K., Habib, K., Lee, D., Lee, C., …&Viswanath, O. (2020). Use ofcannabidiol(CBD) for the treatment of chronic pain. Best Practice & Research Clinical Anaesthesiology.

CBD for Arthritis Pain: What You Should Know

About Arthritis What Is Arthritis?. Arthritis and Mental Health Learn about the connection between arthritis, depression and anxiety and how these conditions can make your arthritis worse.. Conquering Childhood Arthritis The Arthritis Foundation is mobilizing patients and their families to engage in studies comparing the effectiveness of treatments for juvenile arthritis and funding research for more options.. 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, particularly CBD, in pain.. CBD Guidance for Adults With Arthritis See the Arthritis Foundation's official position on CBD use for adults with arthritis.

CBD oil is a popular natural solution for many types of aches and pains. In this guide, we cover the top 5 CBD oil brands for pain and explain how this supplement can help with your condition.

We’ll get into the details of how CBD is suggested to help with pain later, along with some suggestions for the best CBD oils for pain and inflammation.. Before we get into the nitty-gritty of how CBD is suggested to work for pain and inflammation, here’s our top 5 list of CBD oils I’ve used myself for back pain .. Technical Details Total CBD Content 300 – 4000 mg Available Flavors Unflavored, Acai Berry, Orange Creamsicle, Peppermint, Watermelon Potency 10 – 133.3 mg/mL What I Like About HempBombs: I used HempBombs CBD isolate-based hemp oil for quite some time before switching to full-spectrum CBD oil and in my opinion, this is the best brand when it comes to CBD isolates .. ProsCons Available as full-spectrum CBD or pure CBD oil (THC-free) 5 strengths to choose from Carries up to 33.3 mg of CBD per mL (in the 1000 mg bottle) Excellent value CBD oil. Technical Details Total CBD Content 240 – 4850 mg Available Flavors None Potency 48.5 mg/mL What I Like About NuLeaf Naturals Nuleaf Naturals is one of the most popular CBD companies in the United States — most likely related to how long the company has been in the business of selling CBD.. 5mL — 240mg of CBD 15mL — 725mg of CBD 30mL — 1450mg of CBD 50mL — 2425mg of CBD 100mL — 4850mg of CBD. The brand offers premium CBD oils in different spectra: full-spectrum CBD, broad-spectrum CBD, and isolates.. Premium-grade CBD oils Up to 3000 mg of CBD per bottle Available as full-spectrum CBD, broad-spectrum CBD, and isolates Lab tested for potency and purity. The Joy Organics CBD oil features a broad-spectrum CBD formula in a modest potency range, from 450 to 900 mg of CBD per bottle.. The strongest version of the Joy Organics CBD oil contains 30 mg of broad-spectrum CBD in every milliliter, which is a standard dose for most people who take CBD oil for daily supplementation.. CBD oil is a combination of a CBD extract, with a carrier oil to help dissolve and store the CBD.. Most CBD oils use carrier oils like MCT oil, or hemp seed oil — which is then combined with CBD isolate, or full-spectrum hemp extract rich in CBD and other similar cannabinoids.. CBD may reduce inflammation, limiting the initial cause of pain in the body CBD acts as an antioxidant, helping the body resist and recover from damage CBD relaxes muscle fibers, reducing pain caused by muscle spasms and tightness. It’s important as a CBD user that you understand what makes a CBD oil good , and what makes it bad so you can avoid wasting your money, or worse — using CBD oils that contain harmful or damaging ingredients.. CBD inhibits inflammation at several different levels CBD offers antioxidant support CBD may relieve muscle tension and inflammation CBD interacts with the vanilloid receptors in the brain responsible for regulating inflammatory pain transmission

Osteoarthritis (OA) is the most common joint disease and a leading cause for impaired function and disability with significant treatment costs and socio-economic burden. Despite recent achievements in the knowledge on disease pathogenesis, the treatment is still a challenge and contrary to the infla …

Placebo-controlled trial evaluating the efficacy of HCT in inflammatory and erosive hand OA is under way (OA TREAT study).. Another field of recent research is the efficacy of TNF-alpha blockers based on the knowledge of their high efficacy in the inflammatory joint diseases and the significant role of TNF-alpha in the pathogenesis of OA.. New biologic agents that target the nerve growth factor-β are other currently investigated drugs as a potential symptomatic therapeutic option in OA.. Based on the current knowledge about the OA pathogenesis and the undergoing studies, new therapies for OA are awaited both as a safe symptomatic treatment - alternative to the conventional treatment options and as a disease-modifying therapy that would revolutionize the contemporary approach to OA.. PMID: 9476272 Clinical Trial.. Systems to assess the progression of finger joint osteoarthritis and the effects of disease modifying osteoarthritis drugs.

Wondering if CBD for rheumatoid arthritis actually works? Here, we explore the science behind CBD products for rheumatoid arthritis.

In fact, some of the research has suggested that rather than just treating the symptoms, CBD may actually be able to help prevent RA altogether.. In fact, some of the research has suggested that rather than just treating the symptoms, CBD may actually be able to help prevent RA altogether.. While most people are familiar with THC in the respect that it helps combat pain, Cannabidiol (CBD) has long since been known to work as a potentially effective treatment for pain related to swelling and inflammation.. If you’ve been waiting for a safe, all-natural, effective replacement for your prescription RA pain medications, CBD products just might be the treatment option you’ve been looking for.. RISK FACTORWHAT THE SCIENCE SUGGESTSSex Women are more than three times likelier to develop RA than men Genetics The presence of specific genes may cause increased susceptibility to environmental factors that trigger the onset of the disease Age People between the ages of 40 and 60 are most at risk for initial onset Obesity Overweight individuals are more at risk for developing RA due to weaker metabolisms (which promote joint area inflammation). And lastly, while surgery for rheumatoid arthritis is an option in some cases, it’s by no means a “guaranteed fix” as it often is with osteoarthritis (osteoarthritis is pain in the joints due to mechanical ‘wear and tear’ – not due to an autoimmune response).. One of the exciting things about CBD as an emerging RA treatment is the fact that it’s been suggested to have a physiological role as an immune modulator.. In a recent study , however, CBD was shown to suppress localized T-cell function and activity, suggesting that the cannabinoid may be the only scientifically-backed drug capable of treating the underlying cause of RA.. The double-blind study, whose objective was to “assess the efficacy of a cannabis-based medicine in the treatment of pain due to rheumatoid arthritis”, was carried out over the course of five weeks on 58 RA patients.. According to one study published in February 2014, cannabinoid receptors of the ECS were found to be “ubiquitously distributed” throughout body organ and tissue systems (including the synovial membrane tissue affected by RA), and to play a central role in the regulation of “pain, inflammation, and even joint function.”. In any regard, no matter how clear the objective evidence on CBD for rheumatoid arthritis is, the simple fact that thousands of people use it every day to effectively treat their condition has been enough to galvanize most chronic sufferers to take it into serious consideration.. While whole-plant marijuana (i.e. the flowers that are broken up and smoked as ‘weed’) contain copious amounts of both THC and CBD , CBD products have hardly any traces of the intoxicating ingredient – some of the only side effects it has shown to produce is mild fatigue, dizziness, and irritability.. As scientific research has more than capably suggested, CBD for rheumatoid arthritis may very well prove in the coming years to be a viable treatment option for the disease.. For those opting to utilize CBD for their arthritis, CBD topicals may be the best option because these products are applied directly onto the skin to targeted areas where pain or discomfort might be localized.. Utilizing CBD has the potential to be the safest approach to the prevention of worsening rheumatoid arthritis, without unwanted side effects from DMARDs or high concentration THC.

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