Patients now ask me about CBD for their arthritis pain. Osteoarthritis is one of the most common ailments affecting the hands. Wear and tear arthritis within the joints can lead to weakness, deformity, limited range of motion, inflammation, and pain. These symptoms can impair the function of the hand and reduce a person’s quality of life. Conventional medical treatments for hand osteoarthritis in the United States include oral anti-inflammatory medications (NSAIDs), oral acetaminophen, topical medications, splints, hand therapy, and corticosteroid injections. Opioid medications are prescribed less frequently for this condition due to the concern for adverse effects, addiction, and overdose. Surgery can also reduce the symptoms, but this is considered a last-resort option for many people.
Side effects and adverse reactions from conventional osteoarthritis medications are well-known. Due to the limitations of these treatments, many people have turned toward alternative options. These include dietary changes, oral supplements such as glucosamine, chondroitin, and turmeric, and topical cannabidiol (CBD) products.
Cannabidiol (CBD) products became widely available in the United States after the passage of the Agriculture Improvement Act in 2018, known as the Farm Bill. This bill legally differentiated hemp from marijuana. Marijuana and hemp are closely related plants in the cannabis family. Industrial hemp is now defined as cannabis with less than 0.3% THC, the psychoactive component of marijuana. Marijuana is defined as cannabis with greater than 0.3% THC. Although several US states have legalized the recreational use of marijuana, the federal Drug Enforcement Agency considers marijuana a controlled substance with a high potential for abuse.
CBD is one of the many cannabinoid compounds found within the cannabis plant. CBD is thought to have antioxidant, anti-inflammatory, and analgesic (pain-relieving) effects in the body. CBD does not have the psychoactive effects of THC. CBD products derived from licensed hemp growers can be legally purchased over-the-counter in most US states, including North Carolina. CBD is available in many product forms including oral and topical (absorbed through the skin) application.
A recent article in the Journal of Hand Surgery evaluated the safety and efficacy of topical CBD for treatment of thumb basal joint arthritis. In this study, half of the patients were treated with 2 weeks of topical CBD cream and the other half were treated with a topical placebo. This was a randomized, controlled trial in which the patients did not know whether they were using the CBD cream or the placebo cream. The patients using the CBD cream reported significantly less pain than the control group, noting a 60% reduction in pain on average. There were no adverse events reported. The study concluded that “twice-daily topical CBD application resulted in improvements in thumb basal joint arthritis-related pain and disability without adverse events.” Additional studies are needed to confirm these results and to determine the safety and efficacy of topical CBD in longer term use.
Many CBD products on the market today do not meet the US Food and Drug Administration (FDA) quality standards. It is unknown which brand or concentration of CBD is preferred. Third-party, independent company testing is available to confirm the purity and quality of CBD products. The FDA is also concerned about potential health effects of CBD treatment including liver toxicity, drug interactions, and fertility issues. The FDA has not approved the marketing of CBD for treatment of osteoarthritis.
All current osteoarthritis remedies are aimed at treating the symptoms of arthritis. They do not change the underlying degenerative joint disease process. In 2022, there is still no known “cure” for osteoarthritis. Manufacturers may promise miraculous results, but many medical claims are unproven. Consumers should be skeptical of unrealistic expectations.
Based on recent research, the results appear to be encouraging for short term use of topical CBD products in patients with hand osteoarthritis symptoms. However, the FDA has not approved the marketing of CBD for treatment of osteoarthritis. More studies are required to determine the safety and efficacy of these products.
This editorial does not constitute medical advice. Please talk to your doctor before starting any new medication.
Dr. Erickson writes editorials for the American Society for Surgery of the Hand.
Posted on January 2, 2023.