The Effect of Cannabidiol on Arthralgia and Arthritis

by | Jul 6, 2023 | 2022, Alternative Therapies, Arthritis, CBD, Joint Health

Written by Dr. Clara Sartor. CBD use was associated with improvements in pain (83%), physical function (66%), and sleep quality (66%). Additional controlled, randomized clinical trials will help further assess the risk-to-benefit profile and efficacy of this botanical modality for arthritis and arthralgia.

CBD oilArthritis, defined as inflammation of the joints, affects about 1 in 4 adults in the United States; of these individuals, nearly 50% experience limitations to their daily activities from symptoms such as arthralgia (joint pain)1. Not only can arthritis diminish quality of life, but this illness stands as the most common cause of work disability2. The most common form of arthritis is osteoarthritis (OA), a “wear and tear” joint disease that typically progresses with age3. Arthralgia and arthritis account for 99% of knee and joint replacements and $81 billion in healthcare expenses in the United States, annually1. Given our increasing life expectancy worldwide, treatment and prevention options of arthritis remain a public health concern.

Research into botanicals as therapeutic options for arthritis and general pain has led to the investigation of cannabidiol (CBD) as a potential treatment. CBD is a phytocannabinoid found in Cannabis sativa; while CBD lacks the main psychoactive component in marijuana, delta-9-tetrahydrocannabinol (THC), and thus does not produce psychoactive properties, it demonstrates anti-inflammatory and analgesic properties4,5. Studies have found CBD to be specifically anti-arthritic via targeting cytokine pathways6. Current pharmaceutical options for pain include non-steroidal anti-inflammatory drugs (NSAIDs), which are often first-line recommended drugs for arthritis7. However, other, stronger options for pain, such as opioids, are sometimes sought out when those fail. Given the adverse long-term effects of NSAID use and the continuing opioid epidemic, safe alternatives for arthralgia and pain in general are warranted7,8. CBD presents a potential option for this as demonstrated in a study on patients taking opioids for chronic pain in which over half were able to reduce or cease opioid use with the introduction of CBD-rich extract8.

Frane et al. conducted a cross-sectional study to assess CBD’s effect on subjective arthritis symptom improvement. An anonymous questionnaire was created, and variables including qualitative scales for improved pain intensity, sleep quality, and physical function were utilized to evaluate CBD efficacy. Quantitative scales, ranging from 0-10, were incorporated as well including having the participants rank their arthritis severity both prior and post-CBD consumption. The study also included questions regarding CBD-associated medication reduction or termination.

The survey was displayed online, and participants included all who used the online survey during the accessible period. Inclusion criteria included those 18 or older with a previous clinical diagnosis of arthritis and associated arthralgia and who had utilized CBD for arthritis. Adults who carried an arthritis diagnosis who had not tried CBD were included for comparison to those meeting the inclusion criteria. Arthritis type was distinguished and utilized for grouping participants for comparison of outcomes. A total of 428 participants met the inclusion criteria, and significant findings were as follows:

  • Prior treatments included the following: anti-inflammatory modalities (91.4%), a acetaminophen (a non-NSAID analgesic) (66.0%), physical therapy (60.7%), intra-articular steroid injections (45.9%), and opioids (42.19%).
  • Average daily pain, sleep quality, and physical function were each considered “much better” by 37.9%, 37.6%, and 28.7% of participants and “a little better” by 45.1%, 28.5%, and 37.4% of participants, in each category, respectively.
  • Less than 3% of the sample reported aggravations in the aforementioned categories.
  • Post-CBD pain reduction demonstrated a 44% decrease in pain scores (p < 0.001).
  • Both higher frequency of CBD ingestion and longer duration of CBD use were individually associated with improvements in all three categories (p < 0.001).
  • 60.5% of participants decreased or terminated intake of opioids, acetaminophen, or anti-inflammatory medications for arthralgia including 18.9% ceasing opioid use; medication termination or reduction was notably higher among those in the OA group (66.2%).
  • Both higher frequency of CBD ingestion (p < 0.001) and longer duration of CBD use (p = 0.004) were correlated with higher rates of medication termination or reduction.
  • 41% of participants reported a CBD side effect with 84% being mild, 14% moderate, and 2% severe. These included the following (from most to least commonly reported): dry mouth, somnolence, appetite changes, dry eyes, concentration difficulty, dizziness, headache, and gastrointestinal concerns.

The study poses several limitations. By using an online platform, this survey may have been inaccessible to those without access to internet or technology which may disproportionately exclude and underrepresent certain demographics. Given the self-selected, convenience type of the sampling conducted, this group may inaccurately represent the general population. Most of the patients failed to know what kind of CBD product they were consuming, which limits the study in specifying what form of CBD was more or less effective. Moreover, as there was no blinding in the study, bias for or against CBD may have influenced survey input. Survey input was also vulnerable to recall bias given the subjective style of the study and the lack of control for when patients were required to report outcome variables in relation to CBD ingestion times. The authors suggest that a prospective study may help address this. Additionally, controlled, randomized clinical trials will help further assess the risk-to-benefit profile and efficacy of this botanical modality for arthritis and arthralgia.

Source: Frane, Nicholas, Erik Stapleton, Cesar Iturriaga, Maximillian Ganz, Vijay Rasquinha, and Robert Duarte. “Cannabidiol as a treatment for arthritis and joint pain: an exploratory cross-sectional study.” Journal of Cannabis Research 4, no. 1 (2022): 47.

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Posted July 6, 2023.

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