People with arthritis may consider CBD products for pain relief. Learn what science and experts say about CBD’s benefits, risks, different ways the product can be used and how to be a smart shopper. Every form of CBD has its pros and cons, and some tend to be more effective than others. Here are a few things to know about each. Millions use CBD products to ease pain and treat symptoms of a wide range of diseases. What are the pros and cons of CBD? Learn more…
Pros And Cons Of CBD Oil For Pain
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CBD for Arthritis Pain: What You Should Know
Learn what the science says about the risks and benefits of CBD use for arthritis and what to shop for.
What is CBD? CBD, short for cannabidiol, is an active compound found in the cannabis plant. CBD is not intoxicating but may cause some drowsiness. The CBD in most products is extracted from hemp, a variety of cannabis that has only traces (up to 0.3%) of THC, the active compound that gets people high.
Does CBD work for arthritis? Animal studies have suggested that CBD has pain-relieving and anti-inflammatory properties, but these effects have not been validated in quality studies in humans. Anecdotally, some people with arthritis who have tried CBD, but not all, report noticeable pain relief, sleep improvement and/or anxiety reduction.
Is CBD safe to use? Research evaluating the safety of CBD is underway. At this point very little is known. So far, no serious safety concerns have been associated with moderate doses. CBD is thought to have the potential to interact with some drugs commonly taken by people with arthritis. Talk to your doctor before trying CBD if you take any of the following: corticosteroids (such as prednisone), tofacitinib (Xeljanz), naproxen (Aleve), celecoxib (Celebrex), tramadol (Ultram), certain antidepressants, including amitriptyline (Elavil), citalopram (Celexa), fluoxetine (Prozac), mirtazapine (Remeron), paroxetine (Paxil), sertraline (Zoloft), and certain medications for fibromyalgia, including gabapentin (Neurontin) and pregabalin (Lyrica).
Are CBD products legal? CBD products derived from hemp are no longer considered Schedule I drugs under the federal Controlled Substances Act, but they still remain in a legal gray zone. There are changes underway on federal and state levels that will ultimately clarify the laws and regulations related to CBD-based products and sales. Despite that, they’re widely available in nearly every state and online. People who want to use CBD should check their state laws.
Taking the First Step
Should I give CBD a try? Without quality clinical studies on CBD and arthritis, doctors have not been able to say who might benefit from CBD, at what dose and in which form, who likely won’t benefit and who should avoid it. Still, there is agreement on several points:
- CBD is not a substitute for disease-modifying treatment for inflammatory arthritis.
- Patients who are interested in trying CBD should first talk to the health care provider who treats their arthritis before trying CBD. Together, they can review what has worked or not worked in the past, whether there are other options to try first, how to do a trial run, what to watch for and when to return for a follow-up visit to evaluate the results. Keep a symptom and dose diary to track effects.
- Quality CBD products can be expensive, especially when used for prolonged periods. To avoid wasting money, be completely sure that the product is truly having a positive effect on symptoms.
What type of product should I consider? CBD-based products can be taken orally, applied to the skin or inhaled. There are pros and cons for each.
By mouth. CBD that is swallowed, whether in capsules, food or liquid, is absorbed through the digestive tract. Absorption is slow and dosing is tricky due to the delayed onset of effect (one to two hours), unknown effects of stomach acids, recent meals and other factors.
Capsules can work for daily use after a safe, effective capsule dose has been established. Experts discourage taking CBD via edibles, like gummies and cookies, because dosing is unreliable, and they are appealing to children but do not come in childproof containers. Like any medicine, edibles should be secured out of sight and reach of children.
CBD can also be absorbed directly into the bloodstream by holding liquid from a spray or tincture (a liquid dosed by a dropper) under the tongue (sublingual) for 60 to 120 seconds. The taste may not be pleasant. Effects may be felt within 15 to 45 minutes.
On the skin. Topical products, like lotions and balms, are applied to the skin over a painful joint. Whether these products deliver CBD below the skin is unknown. Topical products may also include common over-the-counter ingredients such as menthol, capsaicin or camphor, making it difficult to determine if a positive effect is due to the CBD or another ingredient.
Inhaled. CBD can be inhaled via a vaporizing, or vape, pen. However, inhalation of vapor oils and chemical byproducts carry unknown risks, particularly for people with inflammatory arthritis. For this reason and because the Centers for Disease Control and Prevention is investigating vaping in association with widespread hospitalizations and deaths from severe pulmonary disease, vaping is not recommended.
How much CBD should I use? While there are no established clinical guidelines, the medical experts consulted by the Arthritis Foundation recommend the following for adults:
- When preparing to take a liquid form, be aware that the CBD extract is mixed with a carrier oil, so there are two measures to know: the amount of the liquid product to take (the dose) and the amount of CBD in each dose.
- Go low and slow. Start with just a few milligrams of CBD in sublingual form twice a day. If relief is inadequate after one week, increase the dose by that same amount. If needed, go up in small increments over several weeks. If you find relief, continue taking that dose twice daily to maintain a stable level of CBD in the blood.
- If CBD alone doesn’t work and you are in a state where medical or recreational marijuana is legal, talk to your doctor about taking CBD with a very low-dose THC product. Be aware that THC, even at low levels, may get you high, creating cognitive, motor and balance issues. Try THC-containing products at home or at night first, so you can sleep off any unwanted effects.
- After several weeks, if you don’t find relief with CBD alone or with a combination of CBD and very low THC, CBD may not be right for you.
- If you experience any unwanted side effects when using a CBD product, immediately discontinue use and inform your doctor.
What to Look for When Shopping
There is good reason to be a cautious shopper. CBD products are largely unregulated in the U.S. market. Independent testing has shown mislabeling and lack of quality control. The biggest issues are strength of CBD (significantly more or less than the label says), the presence of undeclared THC, and contamination with pesticides, metals and solvents. Here’s what to look for:
- Find products manufactured in the U.S. with ingredients grown domestically.
- Choose products made by companies that follow good manufacturing practices established by the FDA for pharmaceuticals or dietary supplements (a voluntary quality standard because CBD products are not federally regulated under either category) or required by the state where they are manufactured.
- Buy from companies that test each batch and provide a certificate of analysis from an independent lab that uses validated standardized testing methods approved by the American Herbal Pharmacopoeia (AHP), the U.S. Pharmacopeia (USP), or the Association of Official Agricultural Chemists (AOAC).
- Avoid companies that claim their products have disease benefits.
- Be aware that marketers and people behind retail counters are not health professionals; they are salespeople. That’s why your doctor is your best source for guidance and monitoring when using an unregulated product.
Our gratitude to the following experts for their guidance and review:
Kevin Boehnke, PhD, a researcher at the Chronic Pain and Fatigue Research Center at the University of Michigan, focuses on medical cannabis as an analgesic and opioid substitute in chronic pain.
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.
Mary-Ann Fitzcharles, MD, an associate professor of medicine in the Division of Rheumatology at McGill University in Montreal, Quebec, conducts research on pain and rheumatic diseases. She is the lead author of the 2019 Canadian Rheumatology Association (CRA) position statement for medical cannabis.
During Pain Awareness Month in September and all year long, we’ve got you covered with unique pain management tools and resources you won’t find anywhere else.
6 Popular Ways To Consume CBD + The Pros & Cons Of Each
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The wellness world moves quickly: It’s two years after regulations on hemp-derived CBD loosened, and we already have CBD-infused activewear, pet water (pet water!), and tampons in our hands.
With so many versions of the compound now available, it can be fun to play around with new ones from time to time. But it’s important to remember that even though this plant medicine is non-intoxicating, it’s still a medicine and should be consumed slowly, cautiously, and with the blessing of your doctor. It’s also worth noting that every form of CBD has its pros and cons, and some tend to be more effective than others. So for the sake of your stress relief—and your wallet—here are a few things to know about each.
When consuming a CBD capsule product, you’ll have a better idea of how much of the compound you’re actually taking.
Compared to oils or vapes, capsules are less of a guessing game. This is why doctors will oftentimes recommend starting with capsules to find your ideal dose. “If I’m going to use a product, I want my patient to get exactly the same amount every single day,” functional medicine doctor Robert Rountree, M.D., explained on the mbg podcast. “I like the stability of the capsules. And I like the consistency of the capsules.”
When creating our own hemp product, mbg landed on capsules for this reason. They deliver a controlled amount of cannabinoids (our hemp multi+ is full-spectrum, meaning it contains CBD and other beneficial hemp plant compounds) and deliver a relatively similar experience each time.* And for more product recommendations, check out our cbd capsule roundup.
When you consume a CBD capsule, it needs to pass through the digestive tract before making its way into the bloodstream. Along the way, it loses some of its potency. This means you might need to take a higher dose of it at the start in order to feel its full effects.
“When you take CBD by mouth, only about 6% gets into the bloodstream—so it’s low,” says Dani Gordon, M.D., a double board-certified medical doctor and author of The CBD Bible. “It still works for many people, but it is low, and because of that, you often need larger doses than something that’s absorbed more easily.”
Some research suggests that taking CBD oil sublingually (placing it under the tongue and allowing it to dissolve) allows it to enter the bloodstream faster, making it quicker to kick in than a capsule.
It can be difficult to gauge dose when consuming an oil out of a dropper. Bonni Goldstein, M.D., a California-based physician and author of the upcoming book Cannabis Is Medicine, has also found that taking CBD in oil form can lead to digestive side effects like gastric upset or diarrhea, depending on the person and the product.
Like oils, vape pens deliver CBD to the bloodstream faster so you can feel its effects almost immediately.
There’s a lot we don’t know about the long-term health effects of vaping, as shown by recent investigations into e-cigarettes and lung health. Those with preexisting lung conditions should definitely not vape, and the rest of us might want to hold off until we know more about it—especially in the age of COVID-19. Plus, integrative medicine doctor Amy Shah, M.D., previously told mbg, “The cartridges used in vape pens may contain chemicals such as polyethylene glycol and propylene glycol, which can be irritants and may cause allergic reactions when inhaled.”
Topical CBD cream has been shown to reduce joint swelling and pain in studies on arthritic mice, but more research still needs to be done to validate its effect on humans. Anecdotally, some people find success applying CBD products to stiff muscles or using it as a relaxing all-around massage oil.
Pros and Cons of CBD for Medical Conditions
Coping with a serious illness is hard. Of course, everyone wants to be as healthy as possible, with as few side effects from treatments as possible. In an effort to improve their health, many patients turn to complementary and alternative medicine (CAM). This post provides information on the pros and cons of CBD for medical conditions.
I strongly encourage you to read the first post in the series for important general information on CAM treatments. Additionally, read my other posts to learn about the pros and cons of additional common CAM treatments:
It’s important to realize that CBD and other CAM treatments come with some degree of risk (as do all other medical treatments and medications). So before you try CBD, do some research, talk to your doctor, and be realistic about potential outcomes. And don’t ignore traditional treatments while pursuing CAM therapies.
CBD – cannabis plant extracts
CBD, formally known as cannabidiol, naturally occurs in cannabis plants. The CBD extract does not get you high but may provide health benefits. On the other hand, THC is the component in marijuana that makes you high.
What’s the difference between hemp and marijuana?
Hemp is the common, legal term used for cannabis that has less than 0.3% of THC. Conversely, marijuana is the common, legal term for cannabis that contains more than 0.3% of THC.
What kinds of conditions can CBD help?
Nobody knows for sure. But a 2018 World Health Organization (WHO) report team determined that CBD has “been demonstrated as an effective treatment for epilepsy” for adults, children, and animals. Furthermore, the WHO report states that there is “preliminary evidence” that CBD could help Alzheimer’s disease, cancer, psychosis, Parkinson’s disease, and other serious conditions.
What about pain relief?
There is some evidence that CBD may help relieve pain – for some patients. But the evidence is inconclusive.
For instance, in 2021, an international group of researchers analyzed dozens of studies evaluating the pain relief provided by non-inhaled medical cannabis. (Note: the studied cannabis likely contained varying levels of THC and CBD.)
The researchers concluded there is not enough evidence to say that medical marijuana helps relieve chronic pain. They found the “use of medical cannabis or cannabinoids probably results in a small increase in the proportion of patients experiencing an important reduction of pain”.
Additionally, they found that medical cannabis or cannabinoids led to a “very small increase” in the number of patients experiencing an important improvement in physical functioning.
What about other studies?
Other studies provide some hopeful information. A 2018 report reveals that a combination of THC and CBD provided some pain relief for cancer patients. And one study with rats found topical CBD application relieved arthritis pain-related behaviors and reduced inflammation without any evident side-effects.
Other research found that CBD might reduce inflammation, which is often related to pain. Additionally, some small, preliminary human trials found there is a chance that CBD may help alleviate neuropathic pain (pain caused by nerve damage).
What do customers say?
In 2018, results of a survey of CBD users found that almost 62% of CBD users reported using CBD to treat a medical condition – the top three were pain, anxiety, and depression. About 36% of respondents stated that CBD treats their medical condition(s) “very well by itself”. In contrast, only 4.3% stated that it treated their conditions “not very well”. It’s worth noting that 1/3 of users reported a non-serious adverse effect.
Is CBD legal?
Not necessarily. Last year, the US government legalized hemp and the extract CBD as part of the 2018 Farm Bill. But it’s all a bit confusing.
Hemp is now legal, but the government has not created a system which allows people to freely grow hemp. Furthermore, the government still considers marijuana illegal, and since CBD comes from marijuana, it’s a very gray area.
To make the matter even more confusing, all 50 states and Washington, D.C., have different laws regarding hemp and marijuana. Wondering what the laws are in your state regarding CBD and marijuana? Look your state up here.
Is CBD safe?
Probably. But not certainly.
The 2018 WHO report on CBD found no adverse health outcomes, or any potential for addiction or abuse. However, because marijuana has historically been illegal in the US, it’s been hard for researchers to study the impact.
Therefore, there are still a lot of unknowns, including appropriate dosing, how it gets absorbed, and how CBD interacts with other medications.
Additionally, this is a widely unregulated industry right now, with new products and online stores regularly entering the market. And some manufacturers are more trustworthy than others.
For instance, some manufacturers use chemicals such as butane and hexane to extract the CBD, which can leave unwanted residue in the product. In contrast, others use “green” techniques which extract the CBD using CO2, which is considered safer.
Another major concern is that labels on CBD products can be inaccurate. Findings of a 2017 study should cause alarm – researchers tested 84 CBD products and determined that 70% were mislabeled.
Why does that matter? You cannot be certain what dosage you are getting. For example, if a label says the product contains 100 milligrams of CBD, in reality it might have 5 mg or even 200 mg.
What’s the FDA think about CBD?
The FDA is in the beginning stages of supporting CBD products. In 2018, the FDA approved the first CBD drug. The medication, made by a British pharmaceutical company, is for the treatment of severe epilepsy in children. I expect we’ll see more pharmaceutical companies making CBD products in the coming years.
It’s important to understand that the FDA is not regulating production of CBD products, so you don’t always know what you’re buying. However, even though the FDA isn’t regulating production, they are trying to make sure companies don’t make “unsubstantiated advertising claims”, such as claiming a cure for cancer or Alzheimer’s.
Where can you get CBD products?
Here, there and everywhere.
There is a huge industry around CBD. Note that some products only contain CBD, while others contain CBD and THC.
You can buy CBD products almost anywhere – at your local gas station or pharmacy (including some CVS and Walgreens stores) and at a wide range of other stores. Additionally, there are countless online stores selling CBD products.
What kinds of products contain CBD?
You name it, you can find it. Products with CBD include lotions, oils, creams, shampoos, candies, cookies, beers and makeup.
Buyer’s beware – you don’t always know exactly what you’re getting!
Since the FDA isn’t regulating CBD products, it’s a bit of the wild west out there. You might unknowingly buy a CBD product with THC, or who knows what else, in it. And, as discussed above, you might not get the dosage you expect.
If/when the pharmaceutical industry starts making more CBD products, we will likely see an increase in FDA-approved CBD products. This will likely give customers a sense of security regarding the purity of FDA-approved CBD products.
How popular is CBD?
Very! Results of a consumer survey indicate that around 7% of US adults use CBD products – that means there could be as many as 15 – 20 million people using CBD.
There’s been a lot of positive information flowing about the benefits of CBD, but there has not been a lot of scientific study. So, it’s a good idea to talk to your doctor before starting CBD and definitely do your research!