CBD for Osteoarthritis: Does CBD work as an effective analgesic?

CBD for Osteoarthritis: Does CBD work as an effective analgesic?

Content

Overview of Osteoarthritis

CBD - A Promising agent to treat Osteoarthritis

  1.   Therapeutic values of CBD for Osteoarthritis management
  2.   Choose the right dose
  3.   How to use
  4.   Notice about using CBD to treat Osteoarthritis
  5.     Drug - CBD interaction
  6.   Customer feedback 

Conclusion

Overview of Osteoarthritis (OA)

What is osteoarthritis?

Osteoarthritis is the most common type of arthritis, affecting millions of people all over the world. It is a chronic and progressive condition where the joint cartilage is inflamed, broken down, and eventually lost. This type of arthritis is categorized into primary and secondary forms. 

Primary OA is more common and not linked to causes.

Secondary OA is due to trauma, rheumatoid arthritis, congenital factors, or other causes.

What are the signs and symptoms of OA

Osteoarthritis symptoms develop slowly and exacerbate over time. These include:

  • Pain affected joints, occurs with activity and resolves at rest.
  • Joint stiffness lasts under 30 minutes and happens upon awakening or after being inactive
  • Creaking and clicking sensation might be felt when you use the joints, and you may hear these sounds.
  • Swelling is caused by inflammation surrounding the cartilage joints
  • Loss of flexibility
  • The mentioned symptoms can result in limited daily activities, disability, sleep deprivation, and depression when the disease becomes severe.

What causes OA?

Osteoarthritis is referred to as a wear and tear disease. It causes biomedical and inflammatory changes in joint cartilage, resulting in an imbalance between breakdown and repair. As a consequence, the cartilage is lost. Besides the breakdown of cartilage, there is deterioration of the bone and connective tissue that hold the joint together and attach muscle to bone. 

Various factors which can increase the risk of osteoarthritis are known, including:

Older age is associated with aging cartilage

Obesity: Increased weight adds extra stress to the weight-bearing joints. The more you weigh, the greater the risk.

Congenital abnormalities: Some people are born with defective cartilage.

Gender: Females are more likely to develop osteoarthritis, especially after the age of 50.

Joint injuries: Injuries can occur when playing sports or from an accident which can increase the risk of osteoarthritis

How can I manage osteoarthritis and improve quality of life?

There is no cure for OA, so doctors usually treat OA symptoms with a combination of methods, which may include the following: 

Taking exercise: Weight-bearing exercise (walking, dancing, swimming), strength training.

Weight loss

Supportive devices

Medications: Pain killers, antidepressants.

Surgery indicated for patients with functional disability and/or unresponsive to therapy.

In treating OA, patient education plays an important role, helping reduce pain and gain confidence for patients. They should follow five self-management strategies for managing OA and its symptoms.

Learn self-management skills: It helps patients understand how OA affects their lives, management approach, prognosis, and so on.

Getting physically active can help reduce pain and disability related to arthritis and improve mood and flexibility.

Talking to your doctor and following your recommended treatment plan.

Losing weight reduces pressure exerting on joints.

Protecting your joints helps prevent injuries and worsening the disease.

When non-drug measures fail to manage the symptoms of osteoarthritis, pain relievers can be combined. First line treatments are acetaminophen and NSAIDs. For severe pain or patients with no response to 1st therapy, opioids can be used with NSAIDs or acetaminophen to relieve pain for short-term. In spite of efficacy, there are a wide range of considerations associated with the use of analgesics. They include:

  • Acetaminophen: Hepatotoxicity with high dose and alcohol consumption.
  • NSAIDs: Risk of gastrointestinal bleeding, cardiovascular disease.
  • Opioid: Drug addiction, constipation, respiratory failure with overdose.

CBD - A Promising agent to treat Osteoarthritis

Currently, the therapeutic approaches for osteoarthritis are very limited since no drugs are available to control the disease progression and the analgesic medications have restricted efficacy. Increasing evidence from preclinical studies supports the interest of the endocannabinoid system as a therapeutic target on osteoarthritis pain. Indeed, CBD has shown analgesic and antiinflammatory effects as well as the active participation of the endocannabinoid system in the pathophysiology of osteoarthritis became more and more clear. The aim of this paper is to review some promising results supporting the role of CBD for osteoarthritis management.

Therapeutic values of CBD for Osteoarthritis management

Transdermal CBD reduces inflammation and pain - related behaviors in rats with arthritis

Current arthritis treatment often has side effects and low availability due to route of administration. Recent studies showed that CBD is proven to suppress inflammation and relieve pain without side effects but CBD is fat-soluble and has poor availability. Therefore, researchers from University of Kentucky designed a study to examine efficacy of  topical CBD for reduction in inflammatory and pain as well as evaluating any adverse events in rats with osteoarthritis. After arthritis induction, CBD gel was applied for 4 consecutive days to assess level of inflammation and pain - related behaviors. The results revealed dose-dependent reductions of pro-inflammatory biomarkers. The data presented suggest transdermal CBD is a good candidate for developing novel therapy for this disease [1].


CBD prevents pain and nerve damage in rats with osteoarthritis by inhibiting early phase inflammation

The symptoms of osteoarthritis are associated joint degradation, pain and inflammation. The objective of this study is to determine whether CBD can act as a pain reliever in OA and prevent OA progression by inhibiting inflammation in rats. The data suggested that CBD treatment decreased joint inflammation and prevented the development of osteoarthritis of rats after induction. At later time points, CBD was found to be neuroprotective to suppress nerve damage surrounding these joints [2].


Assessment of the efficacy and safety of cannabis-based medicine (Sativex) in the treatment of pain caused  by rheumatoid arthritis

The study compared patients using sativex with placebo in 58 patients over 5 weeks. The patients used sativex in the morning and assessments were made the next morning. The efficacy outcomes were pain on movement, pain at rest, joint stiffness and sleep quality. In comparison with placebo, patients using CBD showed significant improvements in pain on movement, or at rest as well as sleep quality. In particular, there were no serious side effects leading to discontinuation in the CBD-treatment group. Through this trial, CBD seems to produce analgesic effects and suppress disease activity. It paved the way for more detailed investigation for arthritis [3].


Zynerba pharmaceuticals announce results from phase 2 trial of using synthetic CBD gel in patients with osteoarthritis

320 patients aged 41 to 78 years of age with knee osteoarthritis received different doses of CBD gel or placebo during 12 week. Knee pain of enrolled patients was scored on a scale of 1 to 10. After 12 weeks, patients using CBD showed higher reduction in worst knee pain than placebo at week 12 although the results were not significant. Additionally, at week 8, the number of patients reporting over 30% reduction in worst pain severity were significantly higher in the group of CBD treatment. In terms of safety data, gel CBD was shown to be very well-tolerated with low rates of discontinuation and serious adverse events as compared to those who don’t use CBD. The authors said that the data from this study shaped the future for further investigation of CBD gel in treating osteoarthritis [4].

Choosing the right dose of CBD

There is no one size fits all dosage for CBD. What’s optimal mainly depends on a range of factors, such as body weight, tolerance, symptoms, metabolism, and so on. These factors can yield unique effects for each CBD consumer. Keep in mind that you should pay close attention to how you feel after each dose. It might not occur immediately, and you should be patient to remember that you’re unlikely to get immediate results. As soon as you experience positive effects, lock in that dose and stick with it.

With oral route, start at a dose of 20 milligrams per day (using twice or three times a day) and increase the dose gradually to achieve desirable effects. Do not increase or decrease your dose more often or longer than recommended. Your condition may not improve faster, your risks of side effects will increase.

With topical CBD products, take sufficient amounts of CBD to apply directly into the skin (2-3 times a day) and start at low dose and increase the dose gradually. You can combine using topical CBD products with oral route for maximizing effects.

The recommended dosage forms are CBD capsule, topical CBD products and CBD oil. As compared to capsule or cream, CBD oil is extremely versatile because it can be taken under the tongue, vaporized, infused in food, or cosmetics.

How to use

Taking capsules is the simplest and most convenient way to use CBD. You only need to swallow the capsule with at least 300 ml of water. The drawbacks of the oral route are low availability and delayed onset of effects.

There are some ways to take CBD oil, and we will provide two most common and effective methods to use CBD in this section.

Firstly, applying CBD sublingually is incredibly easy. CBD oil needs to be put under the tongue and held from 60 to 120 seconds without swallowing to allow adequate time for CBD to diffuse completely across the epithelial cells. The method remains the same when you use CBD oils or tinctures. You must hold the CBD under the tongue since different areas of the mouth might not be permeable enough for diffusion into the bloodstream. Taking CBD sublingually provides fast onset of action and high bioavailability.

As for CBD cream, consumers should apply it directly to affected skin areas. Topical CBD products contain cream, ointments, and transdermal patches. To use, simply clean the skin areas, then gently message.

Vaping CBD seems to be slightly more difficult than taking CBD sublingually. The first step to vaping properly is to determine how much CBD you consume each time. If you feel unconfident at first,  you should start with the easiest option. Disposable cartridges and pods are the simplest tools for new users. Refillable vape pens are a little bit more advanced but more cost-effective in the long term. It is important to read the instructions carefully before using them.

Notice about using CBD for osteoarthritis

How you choose the best CBD products for osteoarthritis

Overall, it is vital that your doctor check your improvements, disease progression, side effects, and interaction with food or drugs at regular visits to make sure CBD is working properly.

  • Notice any side effects and tell your doctor right away.
  • Don’t take other medicine (including ETC, OTC medicines, herbal, or vitamin supplements) unless they have been discussed with your doctor.

As regards CBD products, they are made by a company that provides 

  • Third-party test
  • Business certification
  • Certificate of analysis (COA), no contain more than 0.3% THC and pass tests for heavy metals, pesticides, etc.
  • Source of their hemp
  • Product information (Brand, CBD content, ingredients, potency, route of administration, indication, instruction)
  • Customers’ review
  • No subject of FDA warning letter or make any unsupported health claim

If you use CBD by taking it under the tongue or vaping, there are a few things that you should take into account. We will provide details in the following section.

Applying CBD sublingually

Shake well before use

Determine the number of drops in accordance with the dose of CBD consuming each time

Start at a low dose as we recommend above and increase the dose to have the therapeutic effects.

Hold the CBD under the tongue for at least 60 seconds

Accidentally swallowing the CBD oil won’t pose any risks  to your body. However, once you swallow this substance, you no longer take it sublingually. Instead, you are eating it, which means that it has to pass the digestive system and metabolism before your body can utilize it. Although it’s not dangerous, it does mean decreased bioavailability and slower onset of action.

Taking CBD sublingual bypasses the digestive system, there’s no need to  worry about taking it with or without food.

After the necessary time is up, drinking water or eating food won’t interfere with the working of the CBD. At best, you might wait a few minutes prior to drinking water.

Putting a few drops of CBD under the tongue won’t turn your teeth yellow as well as make your breath smell.

Topical CBD

These topical products may contain other ingredients such as menthol, capsaicin or camphor, make sure you are not allergic to other ingredients before use.

Vaping CBD

Determine your suitable CBD dosage, the number of puffs each time, and types of CBD vape

Read carefully the user manual, especially if you are a new user

Wait 5 – 10 minutes between puffs and observe how CBD affects you

Always start at low dose, and work your way up to the optimal dose

After inhaling, you should check the battery life or clean the vape tank if needed

Drug interaction

People considering or taking CBD products should always mention their use to their doctor, especially if you are taking other medications or have underlying ailments, such as kidney disease, liver disease, heart failure, or immunocompromised condition. Pharmacists are also a reliable source to help you learn about potential drug interaction with supplements, over-the-counter drugs or prescribed drugs.

Conclusion

Through various studies, CBD oil shows promise as a treatment for osteoarthritis since it may act as a pain reliever and anti-inflammatory agent.

If you try using CBD to manage osteoarthritis, you should talk to your doctor, they can help you determine the most effective and safest way to take CBD.

Reference

     1.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851925/

  1. https://pubmed.ncbi.nlm.nih.gov/28885454/
  2. https://pubmed.ncbi.nlm.nih.gov/16282192/

      4.https://www.zynerba.com/zynerba-pharmaceuticals-announces-results-phase-2-stop-trial-support-continued-development-zyn002-osteoarthritis/

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