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CBD for Arthritis—2023 Research Review

Updated: Jan 10

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According to the U.S. Centers for Disease Control and Prevention (CDC), arthritis is a disease that affects nearly 55 million Americans, or about one in four adults (including 300,000 children). More than sixty varieties of arthritis exist, including lupus, bursitis, gout, fibromyalgia, and Inflammatory Bowel Disease.


The CDC predicts that by the year 2040, "an estimated 78.4 million (26 percent of the projected total adult population) adults aged 18 years and older will have doctor-diagnosed arthritis."

Most forms of arthritis are characterized by swelling and inflammation of the joints, resulting in pain and decreased range of motion. Common symptoms of the disease include "joint pain, swelling, fever, stiffness, rash, fatigue, loss of appetite, and ocular inflammation."


There is no single origin of arthritis, although genetic influences and infectious disease may play a small role. However, the largest contributing factor is the Standard American Diet (SAD), which is largely filled with animal proteins, fats, oils, and sugars—all of which are pro-inflammatory and low in fiber, phytonutrients, and antioxidants. A sedentary lifestyle also contributes to this unhealthy state. Extreme cases of arthritis can result in deformation of the hands and feet, a crippling limitation of movement, and chronic pain.


Two Types of Arthritis

Although dozens of types of arthritis exist, the two most common are rheumatoid arthritis (RA) and osteoarthritis (OA). RA is an autoimmune disease in which one's immune system basically attacks their joints, resulting in inflammation that produces swelling, pain, and sometimes limited mobility. This form of the disease most commonly targets the hands and feet and is sometimes called "inflammatory arthritis."


"Extreme cases of arthritis can result in deformation of the hands and feet, a crippling limitation of movement, and chronic pain."

OA, on the contrary, is a degenerative disease that affects joint cartilage and bones and often manifests in the hips, knees, and joints of the thumb. Technically, it involves a condition called "articular cartilage degradation." For this reason, it is sometimes called "degenerative arthritis."


Mechanisms of CBD Efficacy

The biochemical mechanisms by which phytocannabinoids such as cannabidiol (CBD) are able to deliver beneficial efficacy to consumers is important for wellness practitioners to understand. Research indicates that CBD delivers a variety of benefits. Chief among them is its anti-inflammatory properties.


Reductions in inflammation are achieved when CBD inhibits production of inflammatory mediators, including IL-6, MMP-3, and CCL2 (in tumor necrosis factor factor-α). Reported a 2008 study, "CBD is able to inhibit tumor necrosis factor-alpha (TNF-α) in its own right in a rodent model of rheumatoid arthritis."


"Research indicates that CBD delivers a variety of benefits. Chief among them is its anti-inflammatory properties."

Synovial fluid from patients with OA or RA contained the endocannabinoids anandamide and 2-arachidonyl glycerol, confirming that endocannabinoid synthesis occurs following tissue injury.


CBD has been shown to provide symptomatic relief of joint pain and swelling, as well as suppressing joint destruction and disease progression. A 2018 research study, "Cannabinoids and Pain: New Insights From Old Molecules" that was published in the journal Frontiers in Pharmacology, provides additional information regarding the underlying mechanisms involved in the interaction of CBD with the human endocannabinoid system.


Importance of CBD Dosing

Proper dosing (titration) is critical to gain the maximum efficacy from CBD products. While tinctures are in some use cases more straightforward, capsules can result in doses that are unintentionally too strong or too weak. Correct dosing is an exercise in trial-and-error experimentation. Combined with careful journaling and healthcare practitioner oversight, dosing can result in maximum relief and efficacy (in addition to cost savings resulting from reduced waste of product).


Dosing, however, extends beyond the volume, or amount, of an herbal extraction consumed during a single session. Also of importance is the number of times per day that an extraction is consumed and the duration over which this routine occurs. Some studies have revealed that maximum efficacy results after a week or more of regular, sustained consumption of a supplement such as CBD.

Image courtesy Sunil Pai, MD


Sunil Pai, MD, an Integrative Medicine expert and author of the 2016 book An Inflammation Nation, echoes other medical professionals when he advocates a "start low and go slow" approach to dosing CBD. Pai recommends the following steps to his patients and readers to determine proper individual dosing of wellness products such as CBD tinctures:

  1. Begin a journal to record all daily consumption data, including exact dose and experienced efficacy (or lack thereof).

  2. Take note of any environmental factors that might skew results (such as a flu or unusually high anxiety due to environmental stressors).

  3. Take 0.25-1.0 dropper sublingually (hold under tongue for one minute) three times daily (after breakfast, lunch and dinner) and at bedtime.

  4. The final bedtime dose can be increased when extra support is needed for those with pain and trouble sleeping.

  5. If consuming capsules, begin with approximately 7.5 mg.

  6. Sustain this routine for seven to 10 days.

  7. Slowly increase the weekly dose until the desired effects are experienced.

  8. Continue increasing the dose until either:

  9. Negative side effects are experienced

  10. Positive efficacy begins to wane

  11. Leveraging the journal, decrease the dose to the previous most-efficacious dose.

  12. Sustain this level until efficacy wanes or undesired negative side effects are experienced.

Unfortunately, metabolic changes resulting from aging, injury, seasonal shifts, and environmental stressors may require a "recalibration" of dose at several points in the future.


Research Studies

Several studies have investigated the role of cannabidiol (CBD) and other hemp-derived phytocannabinoids in the treatment of arthritis, most notably for their anti-inflammatory and analgesic benefits.

An August 2022 research study entitled "Cannabidiol as a Treatment for Arthritis and Joint Pain: An Exploratory Cross-sectional Study" that was published in the Journal of Cannabis Research explored the efficacy of the hemp-derived cannabinoid cannabidiol (CBD) for arthritis.


CBD "is a non-psychoactive cannabinoid that has shown promise in preclinical studies to reduce inflammation and pain associated with arthritis."

"The purpose of this study was to explore patient perceived effects of cannabidiol on symptoms of arthritis," reported the research. It noted that patients who have "exhausted conservative measures" and conventional treatments suffer chronic pain and may "resort to symptomatic management with anti-inflammatories, acetaminophen, opioids," and CBD.


Psychoactivity vs. Intoxication

The scientists explained that CBD "is a non-psychoactive cannabinoid that has shown promise in preclinical studies to reduce inflammation and pain associated with arthritis." However, many researchers and scientists (including Project CBD) consider CBD and other cannabinoids to be "psychoactive" based on their ability to change the mental state of a consumer. In the case of CBD, some patients and practitioners report significant reductions in anxiety. Technically, this is a psychoactive (psychotropic) response.


Researchers and patients who embrace this approach differentiate CBD from its infamous and more overtly psychoactive sibling tetrahydrocannabinol (THC) by labelling the latter "intoxicating." This term does not mean that those who consume THC necessarily experience intoxication (although this is a contentious subject that has generated a great deal of controversy).

The researcher's analysis of the data collected from the questionnaire revealed that the study participants reported improvement in pain resulting from their use of CBD. 83 percent of study subjects reported a decrease in pain, 66 percent an improvement of physical function, and 66 percent improvements in sleep quality.


Improvements in physical function occurred most commonly in subjects suffering osteoarthritis. Overall, the participants reported a 44 percent "reduction in pain after CBD use." Also significant, 61 percent of subjects (259) reported a "reduction or cessation of other medications after CBD use."


The study's authors concluded that the results of their research mean that both medical professionals and their patients "should be aware of the various alternative therapeutic options available to treat their symptoms of arthritis" and that this awareness is especially important "in light of the increased accessibility to cannabidiol products."


The study stated that its data reveal "associations between CBD use and improvements in patient's arthritis symptoms and reductions in other medications."

The study stated that its data reveal "associations between CBD use and improvements in patient's arthritis symptoms and reductions in other medications." Like thousands of other studies that have investigated the efficacy of hemp, cannabis, and its constituent cannabinoids such as CBD and THC, it recommended ongoing research that focuses on "the benefits of CBD use in this patient population with clinical trials."


CBD Reduced Opioid Consumption

Of these, 31 percent reported reductions in anti-inflammatories (non-steroidal anti-inflammatories, or NSAIDs), 18 percent reduced acetaminophen, and nine percent reduced their opioid consumption. Eighteen percent of participants were able to fully discontinue their use of anti-inflammatories, 18 percent quit acetaminophen, and nearly 19 percent of subjects stopped consuming opioids.


The study's authors concluded that the results of their research mean that both medical professionals and their patients "should be aware of the various alternative therapeutic options available to treat their symptoms of arthritis" and that this awareness is especially important "in light of the increased accessibility to cannabidiol products."


The study stated that its data reveal "associations between CBD use and improvements in patient's arthritis symptoms and reductions in other medications."

The study stated that its data reveal "associations between CBD use and improvements in patient's arthritis symptoms and reductions in other medications." Like thousands of other studies that have investigated the efficacy of hemp, cannabis, and its constituent cannabinoids such as CBD and tetrahydrocannabinol (THC), it recommended ongoing research that focuses on "the benefits of CBD use in this patient population with clinical trials."

A 2017 research study entitled "Attenuation of Early Phase Inflammation by Cannabidiol Prevents Pain and Nerve Damage in Rat Osteoarthritis" that was published in the journal Pain investigated the ability of CBD to act as an analgesic and neuroprotective agent.


The study's authors found not only that CBD reduced joint inflammation and pain, but also that it was neuroprotective. Reported the study, "Acute, transient joint inflammation was reduced by local CBD treatment. Prophylactic administration of CBD prevented the development of...joint pain...and was also found to be neuroprotective."


The study found that CBD decreased inflammation, resulting in reduced swelling and lower pain levels.

A 2016 research study entitled "Transdermal Cannabidiol Reduces Inflammation and Pain-related Behaviours in a Rat Model of Arthritis" that was published in the European Journal of Pain explored the ability of CBD to treat arthritis. Observed the researchers, "CBD attenuates inflammation and pain without side-effects."


The study found that CBD decreased inflammation, resulting in reduced swelling and lower pain levels. "Transdermal CBD gel significantly reduced joint swelling [and] limb posture scores as a rating of spontaneous pain and immune cell infiltration."


Concluded the study's authors, "These data indicate that topical CBD application has therapeutic potential for relief of arthritis pain-related behaviours and inflammation without evident side-effects."

A 2014 study entitled "Involvement of the Endocannabinoid System in Osteoarthritis Pain" that was published in The European Journal of Neuroscience investigated the role of the endocannabinoid system (ECS) in the management of pain in OA subjects.


The study's researchers observed the "active participation" of the ECS in OA. "Indeed, pharmacological studies have shown the anti-nociceptive effects of cannabinoids in different rodent models of osteoarthritis and compelling evidence suggests an active participation of the endocannabinoid system in the pathophysiology of this disease," reported the study.


"Compelling evidence suggests an active participation of the endocannabinoid system in the pathophysiology of this disease."

The study's authors concluded, "The ubiquitous distribution of cannabinoid receptors, together with the physiological role of the endocannabinoid system in the regulation of pain, inflammation, and even joint function further support the therapeutic interest of cannabinoids for osteoarthritis."


A 2011 study entitled "The Abnormal Cannabidiol Analogue O-1602 Reduces Nociception in a Rat Model of Acute Arthritis via the Putative Cannabinoid Receptor GPR55" that was published in the journal Neuroscience Letters explored how some cannabinoids bind to receptors in the ECS other than CB1 and CB2.


The study's authors concluded, "This [research] clearly shows that atypical cannabinoid receptors are involved in joint nociception and these novel targets may be advantageous for the treatment of inflammatory pain."

A 2008 literature review study conducted by noted California-based endocannabinoid researcher Dr. Ethan Russo entitled "Cannabinoids in the Management of Difficult to Treat Pain" that was published in the journal Therapeutics and Clinical Risk Management investigated the ability of CBD and other phytocannabinoids to reduce pain.


Reported Russo, "The endocannabinoid system is tonically active in control of pain, as demonstrated by the ability of SR141716A (rimonabant), a CB1 antagonist, to produce hyperalgesia upon administration to mice." The study noted a mechanism in which the ECS is "active peripherally where CB1 stimulation reduces pain, inflammation, and hyperalgesia."


The study noted that CBD offers multiple layers of benefits beyond merely functioning as an analgesic. "Cannabinoids may offer significant 'side benefits' beyond analgesia. These include anti-emetic effects...demonstrated for CBD, the ability of CBD to produce apoptosis in malignant cells and inhibit cancer-induced angiogenesis, as well as the neuroprotective antioxidant properties of the substance and improvements in symptomatic insomnia," concluded Russo.