CBD Oil Dosage For Osteoarthritis Pain

Learn more about how to figure out the right CBD dosage for your pain and other symptoms when there’s not definitive dosing information or research. If you have chronic arthritis pain, you may have been tempted to try cannabidiol as a treatment, or you may have tried it already. But is there any evidence that it works? Studies are finally addressing this question, and the results are just starting to come in. Many people with arthritis turn to CBD oil to relieve joint inflammation and pain. Does it work and how should you take it? Find out here.

CBD Dosage: What’s the Right Dose of CBD for Pain Relief?

Take a look at the label on any over-the-counter pain reliever and you can easily figure out how much you’re supposed to take for your symptoms. Finding the right dose of cannabidiol (CBD) for pain relief, however, isn’t that simple.

Enthusiasts rave about CBD’s potential to ease pain, reduce inflammation, relieve anxiety and promote sleep. However, there’s no conclusive research about just how much CBD a person needs to take in order to experience benefits.

There are very few human studies on CBD, and those that have been done include doses that are all over the map: In some studies, patients used 5 mg of CBD; in others, they took as much as 600 mg. To further add to the confusion, CBD comes in a number of forms — oils and tinctures, creams and lotions, pills, vaping, and edibles — and each one has differences in terms of bioavailability (the percent of active ingredient that gets into your bloodstream).

“There are no standard doses for patients,” says Rachna Patel, DO, a physician who does consultations about medical marijuana and CBD and sells her own line of CBD products. “Ultimately, it’s trial and error, but you have to go about it in a methodical way.”

Here are some tips to guide you on how to find the right CBD dosage for your pain relief and other symptoms.

1. Work with an expert

Many factors, such as your body mass index (BMI), specific health condition(s) you have, medications you take, your health history, and the form of CBD you plan to use can influence how much CBD you may need to treat your symptoms. Although CBD is different than medical marijuana — which contains CBD as well as THC, an intoxicating ingredient — a doctor who’s well-versed in cannabis (marijuana) is probably the best person to help you help you sort it out.

“I wouldn’t recommend starting CBD without the supervision of a physician,” says Dr. Patel, author of The CBD Solution. “Many times people purchase a CBD product, try a dose that that doesn’t work for them, switch products and spin their wheels. Or, worse, they develop side effects.”

Ask your rheumatologist or primary care provider to recommend an expert, or find an expert near you by searching the directory of members of the Society of Cannabis Clinicians or the database maintained by your state’s medical marijuana program (if it has one).

2. Do some math

Let’s say you and your doctor settle on a dose of 30 mg of CBD per day. Now what? The answer depends on which form of CBD you take.

Figuring out how much CBD is in capsules or gummies is simple — just read the supplement facts section on the label. (If it says 10 mg of CBD per capsule, you’d take three capsules to get your 30 mg of CBD a day.)

Oils and tinctures can be trickier because the packaging often states the amount of CBD in the entire bottle, not in a dropper. This calculator can help you figure out how many drops you need based on the strength of the product.

When it comes to CBD in topical form (creams, lotions, and salves), you’ll probably see the total amount of CBD in the container listed on the label. You’ll then have to divide that total by the number of millimeters in the package to determine how much is in each milliliter. For example, if you have a 50 ml jar of salve that contains 200 mg of CBD, there’s 4 mg per ml. You should then use a metric measuring spoon to scoop out 7.5 ml to get a 30 mg dose of CBD.

3. Expect some trial and error

No two patients respond to CBD in the same way. You and your doctor will probably need to adjust the dose either up or down until you hit the right balance of benefits without side effects. “A lot of it depends on your biochemistry and the way your liver breaks down these chemicals. There’s a wide variety of factors that come into play,” says Dr. Patel.

It can take a little while to get it right, so be patient. Many people do not see a difference in symptoms after one or two doses of CBD. It can take up to eight weeks of regular use to feel an impact, says Bridget Seritt, co-founder of the Canna-Patient Resource Connection, a Colorado-based organization that is working to protect patient rights and end stigma against those who choose cannabis as medicine.

4. If you have side effects, stop or lower the dose

CBD won’t get you high the way that cannabis with THC can, but it may still cause side effects. “The most common side effects are fatigue and lethargy, and in rare cases diarrhea,” says Dr. Patel, who notes that CBD that’s taken topically less commonly causes side effects. Topical CBD is best used to address pain in a single joint, rather than widespread pain, she adds.

No matter which form of CBD you use, pay attention to how you feel. If you notice any negative side effects, stop or lower the dose and consult your doctor.

Does CBD help with arthritis pain?

If you have chronic arthritis pain, you may be wondering about cannabidiol (CBD) as a treatment. CBD, along with delta-9-tetrahydrocannabinol (THC) and other chemicals, is found in marijuana. But unlike THC, CBD is not “psychoactive” — that is, it does not cause the intoxication or high associated with marijuana use.

There’s a good chance you’ve tried it already: according to a Gallup poll in August of 2019, about 14% of Americans report using CBD products, and the number one reason is pain. The Arthritis Foundation conducted its own poll and found that 29% reported current use of CBD (mostly in liquid or topical form), and nearly 80% of respondents were either using it, had used it in the past, or were considering it. Of those using it, most reported improvement in physical function, sleep, and well-being; of note, a minority reported improvement in pain or stiffness.

Perhaps you’ve been tempted to try it. After all, most types of arthritis are not cured by other treatments, and CBD is considered a less addictive option than opiates. Or maybe it’s the marketing that recommends CBD products for everything from arthritis to anxiety to seizures. The ads are pretty hard to miss. (Now here’s a coincidence: as I was writing this, my email preview pane displayed a message that seemed to jump off the screen: CBD Has Helped Millions!! Try It Free Today!)

What’s the evidence it works? And what do experts recommend? Until recently, there’s been little research and even less guidance for people (or their doctors) interested in CBD products that are now increasingly legal and widely promoted.

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But now, there is.

A word about arthritis pain

It’s worth emphasizing that there are more than 100 types of arthritis, and while pain is a cardinal feature of all of them, these conditions do not all act alike. And what works for one may not work for another. Treatment is aimed at reducing pain and stiffness and maintaining function for all types of arthritis. But for certain conditions, such as rheumatoid arthritis, conventional prescription medications are highly recommended, because these drugs help prevent permanent joint damage and worsening disability.

In addition, individuals experience pain and respond to treatment in different ways. As a result, it’s highly unlikely that there is a single CBD-containing product that works for all people with all types of arthritis.

What’s the evidence that CBD is effective for chronic arthritis pain?

While there are laboratory studies suggesting CBD might be a promising approach, and animal studies showing anti-inflammatory and pain-relieving effects, well-designed studies demonstrating compelling evidence that CBD is safe and effective for chronic arthritis pain in humans do not exist. A randomized trial of topical CBD for osteoarthritis of the knee has been published, but in abstract form only (meaning it’s a preliminary report that summarizes the trial and has not been thoroughly vetted yet); the trial lasted only 12 weeks, and results were mixed at best. One of the largest reviews examined the health effects of cannabis and CBD, and concluded that there is “substantial evidence that cannabis is an effective treatment for chronic pain in adults.” But there was no specific conclusion regarding CBD, presumably because definitive studies were not available.

Of course, there is anecdotal evidence and testimonials galore, including reports of dramatic improvement by people who tried CBD in its various forms (including capsule, liquid, topical, and spray) for their pain. But we are still waiting for well-designed, scientifically valid, and rigorous clinical trials (such as this one in progress) that are so badly needed to answer the question of just how helpful CBD may be to people with chronic arthritis pain.

Are there downsides to CBD treatment?

As with any treatment, there can be downsides. CBD is generally considered safe; however, it can still cause lightheadedness, sleepiness, dry mouth, and rarely, liver problems. There may be uncertainty about the potency or purity of CBD products (since they are not regulated as prescription medications are), and CBD can interact with other medications. For pregnant women, concern has been raised about a possible link between inhaled cannabis and lower-birthweight babies; it’s not clear if this applies to CBD. Some pain specialists have concerns that CBD may upset the body’s natural system of pain regulation, leading to tolerance (so that higher doses are needed for the same effect), though the potential for addiction is generally considered to be low.

There is one definite downside: cost. Prices range widely but CBD products aren’t inexpensive, and depending on dose, frequency, and formulation, the cost can be considerable — I found one brand that was $120/month, and health insurance does not usually cover it.

Are there guidelines about the use of CBD for chronic arthritis pain?

Until recently, little guidance has been available for people with arthritis pain who were interested in CBD treatment. Depending on availability and interest, patients and their doctors had to decide on their own whether CBD was a reasonable option in each specific case. To a large degree that’s still true, but some guidelines have been published. Here’s one set of guidelines for people pursuing treatment with CBD that I find quite reasonable (based on recommendations from the Arthritis Foundation and a recent commentary published in the medical journal Arthritis Care & Research):

Dos:

  • If considering a CBD product, choose one that has been independently tested for purity, potency, and safety — for example, look for one that has received a “Good Manufacturing Practices” (GMP) certification.
  • CBD should be one part of an overall pain management plan that includes nonmedication options (such as exercise) and psychological support.
  • Choose an oral treatment (rather than inhaled products) and start with a low dose taken in the evening.
  • Establish initial goals of treatment within a realistic period of time — for example, a reduction in knee pain that allows you to walk around the block within two weeks of starting treatment; later, if improved, the goals can be adjusted.
  • Tell your doctor(s) about your planned and current CBD treatment; monitor your pain and adjust medications with your medical providers, rather than with nonmedical practitioners (such as those selling CBD products).

Don’ts:

  • Don’t make CBD your first choice for pain relief; it is more appropriate to consider it if other treatments have not been effective enough.
  • Don’t have nonmedical practitioners (such as those selling CBD products) managing your chronic pain; pain management should be between you and your healthcare team, even if it includes CBD.
  • For people with rheumatoid arthritis or related conditions, do not stop prescribed medications that may be protecting your joints from future damage; discuss any changes to your medication regimen with your doctor.

The bottom line

If you’re interested in CBD treatment for chronic arthritis pain or if you’re already taking it, review the pros, cons, and latest news with your healthcare providers, and together you can decide on a reasonable treatment plan. Depending on the type of arthritis you have, it may be quite important to continue your conventional, prescribed medications even if you pursue additional relief with CBD products.

We may not have all the evidence we’d like, but if CBD can safely improve your symptoms, it may be worth considering.

Follow me on Twitter @RobShmerling

About the Author

Robert H. Shmerling, MD , Senior Faculty Editor, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio

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CBD Oil for Arthritis: Does It Work & How Can You Use It?

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Note that each number in parentheses [1, 2, 3, etc.] is a clickable link to peer-reviewed scientific studies. A plus sign next to the number “[1+, 2+, etc. ]” means that the information is found within the full scientific study rather than the abstract.

Most people use CBD oil to relieve chronic pain, especially from joint diseases like rheumatoid arthritis and osteoarthritis. CBD may reduce joint inflammation and slow disease worsening. Read on to find out if it works and whether you should take it.

The Science Behind Using CBD Oil for Arthritis

The only FDA-approved use of CBD oil is for reducing epileptic seizures. However, many people take CBD oil for other investigational, non-proven uses [1].

The main medical use of CBD oil is, indeed, not to improve epilepsy but to relieve chronic pain. Among the various painful conditions people use CBD oil for, inflammatory joint disorders such as rheumatoid arthritis and osteoarthritis rank first. In a survey of 1500 medical CBD users, almost half reported suffering from arthritis [2].

Similarly, many people smoke medical cannabis to relieve arthritic pain. In 2 surveys on 5k people, 20% did so for this purpose. They often reported good results, but most of them used cannabis types with higher THC than CBD levels, such as indica strains [3+, 4].

This leaves us with the question: does CBD alone relieve arthritic pain or is THC the main cannabis-derived compound responsible for the benefits? Unfortunately, the question remains unresolved because no clinical trials have tested CBD in people with arthritis and the only studies carried out so far have been done in animals.

How Does It Work?

Arthritis Types

The term ‘arthritis’ includes a group of joint diseases with inflammation, pain, and cartilage damage. It can be caused by repeated mechanical damage (e.g., osteoarthritis), autoimmunity (e.g., rheumatoid arthritis), or by other diseases (e.g., psoriatic arthritis) [5, 6].

While there is no cure for arthritis, therapies can relieve pain, reduce inflammation, and slow the progression of the disease. Let’s take a look at how CBD can help.

Activating the Endocannabinoid System

The endocannabinoid system is made up of two receptors: CB1 and CB2. The cannabinoids naturally produced in the body – such as anandamide and 2-AG – bind to and activate them. Though CBD blocks CB receptors, it increases anandamide by preventing its breakdown [7+, 8, 9, 10, 11].

Two studies in humans and dogs found that animals with rheumatoid arthritis or osteoarthritis had higher levels of both CB receptors and several cannabinoids in the joints. This suggests that the body activates the endocannabinoid system to fight arthritis. In line with this, increasing cannabinoids may be a good therapeutic strategy [12, 13].

Indeed, two synthetic CB2 activators reduced joint inflammation and damage in mice with rheumatoid arthritis and osteoarthritis [14, 15, 16].

Alternatively, a blocker of the enzyme that breaks down anandamide (FAAH) reduced pain in rats and guinea pigs with osteoarthritis. Anandamide seems to work by activating CB1, since blocking this receptor prevented the pain-relieving effect [17].

CBD oil may relieve joint inflammation in arthritis by increasing the activity and levels of natural cannabinoids like anandamide.

Blocking Pain Pathways

CBD activates a receptor involved in inflammatory pain (TRPV1). Although this receptor causes pain in the joints of rats with osteoarthritis, its activation by CBD or the chili pepper compound capsaicin reduces pain perception [11, 18, 19, 20].

CBD also binds to another receptor with a similar function in inflammatory pain (TRPA1). Activating this receptor (as well as TRPV1 and CB2) by a synthetic cannabinoid reduced inflammation in joint cells taken from people with arthritis [21, 22].

Another target of CBD, GPR55, has been mainly investigated for its role in gut inflammation. However, its activation by a synthetic CBD compound reduced pain in arthritic rats [23, 24].

Reducing Inflammation

CBD is a strong anti-inflammatory. It blocks the major inflammatory hub NF-kB, activates the anti-inflammatory PPAR-gamma, and prevents the removal of the anti-inflammatory compound adenosine [25, 26, 27].

In animals with arthritis, CBD reduced the production of two pro-inflammatory cytokines (IFN-gamma and TNF-alpha). In animals with other inflammatory conditions, it also reduced inflammatory messengers (IL-1beta, IL-6, NO, and prostaglandins) while increasing two anti-inflammatory cytokines (IL-4 and IL-10) [28, 29, 30, 31, 32, 33].

CBD oil may protect the joints by increasing anti-inflammatory compounds and blocking major inflammatory pathways.

Suppressing the Autoimmune Response

Additionally, CBD prevents T cells from dividing, migrating to inflammation sites, and producing pro-inflammatory cytokines. This is particularly relevant in autoimmune arthritis types such as rheumatoid arthritis or when the condition is caused by autoimmune diseases such as psoriasis, celiac disease, and lupus [28, 34, 35, 36, 37, 38, 39, 5].

When Does It Work?

Evidence from Animal Studies
Osteoarthritis

Osteoarthritis is a chronic degenerative condition in which the repeated damage of the joints due to wear and tear, overload, or injuries leads to their inflammation and breakdown. Therapies for this condition normally focus on reducing inflammation and relieving pain [5, 6].

In rats with this type of arthritis, topical CBD reduced inflammation and slowed the progression of osteoarthritis in the early stages. In animals with advanced osteoarthritis, CBD injected at the inflammation site reduced sensitivity to pain and increased weight-bearing capacity [40].

In dogs, oral CBD relieved pain but had no effect on limb mobility and weight-bearing capacity [41].

Although osteoarthritis is a chronic condition, these studies only tested CBD for up to 19 days. Longer treatments may also be effective, since CBD had sustained effects in mice with other inflammatory conditions given this compound for up to 8 months [42, 43].

Nevertheless, it’s important to note that these studies were done only in animals. There is no evidence that CBD oil will have the same effects in people with osteoarthritis.

Rheumatoid Arthritis & Autoimmunity

Rheumatoid arthritis is an autoimmune disease in which the body’s immune system attacks the joints, causing inflammation and damage. In this case, blocking the autoimmune response may yield better results [5, 6].

In mice with this condition, oral and injected CBD relieved inflammation and slowed the joint damage progression. CBD also prevented T cells and joint cells (synoviocytes) from reproducing and releasing pro-inflammatory cytokines (TNF-alpha and IFN-gamma) [28].

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Similarly, a topical CBD gel reduced joint swelling, pain, and the levels of inflammatory markers (such as TNF-alpha) in the nerves of rats with rheumatoid arthritis [29].

Additionally, synthetic CBD-like compounds reduced inflammation, pain perception, and joint damage in mice and rats with this type of arthritis [24, 44, 45].

Again, these preliminary results cannot be considered any evidence that CBD oil improves rheumatoid arthritis.

Animal studies suggest CBD oil relieves symptoms and prevents the worsening of both rheumatoid and osteoarthritis.

Clinical Trials

No human studies tested CBD for arthritis yet. A trial testing CBD – both alone and followed by an add-on of THC – in people with rheumatoid arthritis and ankylosing spondylitis is underway [46].

In contrast, a mouth spray delivering the same amount of CBD and THC (nabiximols) reduced pain and morning stiffness while improving sleep quality in a small trial on 58 people with rheumatoid arthritis [47].

Extracts with similar amounts of CBD and THC reduce joint stiffness and pain in people with arthritis. Clinical studies on CBD oil alone are still lacking.

Alternatively, CBD prevented skin cells from over-dividing – as they do in case of psoriasis – and a gel with CBD but no THC improved psoriasis in a small trial on 5 people. This suggests that topical CBD oil may help prevent psoriasis from worsening and developing into arthritis [48, 49].

Taken together, the evidence to support the benefits of CBD in people with arthritis is extremely limited for psoriatic arthritis and non-existent for rheumatoid arthritis. Further clinical trials such as the ongoing one should shed some light on the potential use of CBD oil for arthritis.

Caveats

The only available clinical trial used a mouth spray with similar levels of CBD and THC. Animal research with CBD shows promising results for relieving and slowing the progression of both rheumatoid arthritis and osteoarthritis, but clinical trials have yet to determine if it’s helpful in humans.

CBD Oil Dosage for Arthritis

Dosage

Because CBD is not approved for any arthritis types, there is no official dose. The fact that CBD alone hasn’t been tested in clinical trials means that there is no proven dose either. We can only estimate the optimal one based on the guidelines from manufacturers and natural health blogs.

They generally recommend starting with a low dose (5-10 mg, 2x/day) and gradually increasing it until you achieve the desired effects. According to them, most people experience relief with 20 mg 2x/day but some with more severe pain may need to increase the dose to 80-100 mg. If CBD alone doesn’t work, you may want to try products with some THC for additional pain relief.

Another possibility is to estimate the dose based on data from animal studies. In animals with rheumatoid arthritis, researchers used oral doses of 10-50 mg/kg and topical doses of 20-240 mg/kg. For osteoarthritis, they reduced the dose to 0.5-2 mg/kg for oral, topical, and injected preparations [28, 29].

In any case, remember that the right dose will also depend on your weight, pain intensity, and tolerance to CBD. Consult your best starting dose with your doctor and never take CBD oil in place of the proven therapies for arthritis that he or she recommends or prescribes.

How to Use

You may choose your preferred form of CBD oil based on the type and distribution of your pain [50+].

Topical forms may be a good option for arthritis since you can apply them to a targeted area. They may be most beneficial for localized joint pain and inflammation.

Oral forms distribute CBD throughout the body. Capsules, edibles, and teas release CBD more slowly and their effects last longer – possibly a better choice if you are constantly in pain. Vapes, mouth sprays, and oil tinctures provide a faster, more temporary relief; they may be preferable for sudden, acute pain.

Importantly, loading a vaporizer can be troublesome for people with arthritis because they may have reduced hand dexterity. If you have acute, episodic pain but there’s nobody around to help you load it, go for other fast-acting forms such as tinctures and sprays [51].

Creams, gels, and other topical forms may be a good choice for localized joint pain and inflammation. You can combine them with capsules for a stronger, sustained effect.

Best CBD Oil for Arthritis

Product Quality

In addition to choosing a CBD oil adjusted to your budget (you may want to calculate the price per mL or mg to compare different brands), you should also evaluate the product quality. Read about how to choose the best CBD oil here.

Reviews

The opinions expressed in this section are solely those of CBD oil users who may or may not have medical or scientific training. Their reviews do not represent the opinions of SelfHacked. SelfHacked does not endorse any specific product, service, or treatment.

Do not consider user experiences as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare providers because of something you have read on SelfHacked. We understand that reading individual, real-life experiences can be a helpful resource, but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified healthcare provider.

People using CBD oil for joint pain most often had osteoarthritis, rheumatoid arthritis, or psoriatic arthritis. Users were generally satisfied and reported that CBD reduced their pain and improved their quality of life. However, some dissatisfied users didn’t notice any effects.

Takeaway

CBD oil is a safe anti-inflammatory many people with arthritis turn to. Clinical studies are currently underway to test its effectiveness for rheumatoid arthritis and osteoarthritis.

Based on data from animal studies, CBD oil may relieve the symptoms of arthritis by increasing natural cannabinoids like anandamide, blocking pain pathways, suppressing autoimmunity, and lowering inflammation. For this reason, it may also help people with arthritis from other autoimmune diseases such as psoriasis or lupus.

Topical forms – creams, gels, and lotions – may be a good option for localized joint pain and inflammation. If your pain and inflammation are severe, you may combine topicals with CBD oil capsules or tinctures to achieve a stronger and longer-lasting effect.

Some people have genes that make them more likely to experience inflammation. Check out SelfDecode’s Inflammation DNA Wellness Report for genetic-based diet, lifestyle, and supplement tips that can help reduce inflammation levels. The recommendations are personalized based on YOUR DNA.

About the Author

Carlos Tello

Carlos spent 9 years in the laboratory investigating mineral transport in plants. He then started working as a freelancer, mainly in science writing, editing, and consulting. Carlos is passionate about learning the mechanisms behind biological processes and communicating science to both academic and non-academic audiences. He strongly believes that scientific literacy is crucial to maintain a healthy lifestyle and avoid falling for scams.

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