Arthritis seems to be one of the earliest conditions that cannabis was employed as a treatment for, and generally refers to two different forms of joint inflammation. Research on using cannabis for arthritis has demonstrated that tetrahydrocannabinol (THC) can reduce the pain of arthritis and, used singly or in combination, THC and CBD reduce cytokine release from inflammatory cells believed to be responsible for tissue deterioration in arthritis. In other words, both of these potent cannabinoids can pull out the compound that causes the joint destruction in the first place. Quite incredible.
The two most common forms of types of joint inflammation collectively named arthritis are generally caused by osteoarthritis or rheumatoid arthritis, but other underlying conditions can include fibromyalgia, Lyme disease, injuries to the joints, or lupus erythematosus. Osteoarthritis (OA), arthritis of the bones, is characterized by a loss of cartilage in the joints, typically in the hands, knees, hips, and spine. Rheumatoid arthritis (RA) is an autoimmune disease, characterized by serious inflammation of a joint’s interior lining. RA can cause chronic severe pain, disability, and permanent joint damage.
Cannabis was used for the treatment of arthritis and rheumatoid diseases since roughly 2500 BC, where it was found in Shen-Nung’s classic Chinese pharmacopeia. The Roman herbalist Dioscorides recommended cannabis for restoring “the softness of joints” in his De Materia Medica (50 and 70 CE), where it was later cited by early English herbalists. However, the cannabis type used for this 16th-century medicine was likely a fiber variety of hemp, rather than a drug variety, due to the fact that there is no mention of psychoactivity. Although hemp varieties have no THC, they often contain significant amounts of cannabidiol (CBD), which is an effective anti-inflammatory. Vivian Crawford writes that cannabis was featured in the famous Culpepper herbal of 1653 as a treatment for “the hard humors of knots in the joints.” 
Plant-based cannabinoids elicit a range of anti-inflammatory responses. Burstein’s review articles   cover the large amount of preclinical and animal study data that shows the antiinflammatory effect of CBD and its analogs in preclinical trials, as well as the exciting possibility that CBD and THC may possess synergistic anti-inflammatory actions. This has now been proven by Dr Ethan Russo and coined as the “entourage effect” where combinations of cannabinoids (naturally found in the whole cannabis plant), produce a kind of synergy that brings more potency and effectiveness.  THC alone, has also been cited as having double the antiinflammatory power as hydrocortisone.  For more information, read our article on The Entourage Effect.
Cannabis is effective for treating the chronic pain caused by arthritis for most people, but the drug varieties containing THC are not always well tolerated by older, cannabis-naive arthritis patients.
Cannabis can augment or replace opioid medications, even making it possible for a few patients to discontinue their opioid use with their doctor’s supervision.  Preclinical laboratory studies also indicate a dynamic interaction between cannabinoids and nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs and cannabinoids, when utilized in combination, can work together to relieve pain.  For more information on opioids and cannabis, read our article on Opioid Addiction and Withdrawal with Cannabis, and Can Cannabis Be Used to Treat Addiction.
There are several human studies to date of rheumatoid arthritis comparing placebo to a cannabinoid-rich spray (using the pharmaceutical by GW Pharmaceuticals called Sativex, which is also approved for use in over 30 countries). This pharmaceutical extract made from whole-plant cannabis contains a concentration of 1:1 CBD to THC.  In one study, 31 patients randomized to Sativex had statistically significant improvements in pain on movement, pain at rest, sleep, and active pain when evaluated, compared to the 27 patients who received a placebo.
A study from 2017 had researchers discover that cannabidiol may be a useful and safe option for the joint pain experienced by arthritis sufferers. Another study from 2016 showed that topical CBD products could relieve the pain and inflammation associated with arthritis.
The endocannabinoid system (ECS) is a molecular system of physiology inside the body that is responsible for bringing order and balance to every other major bodily system. If there is disorder present in the form of a health condition, whether that be arthritis, anxiety, autoimmunity, and so on. Dysfunction of the endocannabinoid system is behind it. Restore the ECS to full health and function, and it will go to work on restoring function to the bodily system under stress. Keep in mind, if the ECS has been in a state of dysfunction chronically, for many years, there is the possibility it may be impaired beyond repair, or could take longer to be restored. Research shows the ECS has two types of receptors that may provide avenues for the relief of arthritis symptoms in people. The two main cannabinoid receptors within the body are the CB1 and CB2 receptors. CB1 is primarily found in the nervous system and stimulation of this receptor by THC is responsible for the psychoactive effects of cannabis. THC’s ability to distract from arthritis pain is well established. The CB2 receptor is primarily found on immune cells.
Endocannabinoids made by the endocannabinoid system are created through numerous cell types in the body that react with both CB1 and CB2. Cannabinoid-2 activation is linked to the adjustment of both immune and inflammatory response. The protective antiinflammatory effects of CB2 stimulation have been well documented in both human and animal models of arthritis. By acting on CB1 and CB2 receptors, the powerful anti-inflammatory effects of the cannabinoids THC and CBD may prove useful in controlling the secretions of pro-inflammatory factors secreted by cells (called cytokines) associated with the tissue damage that causes several forms of arthritis. Notably, the terpene found in the cannabis plant and others, beta-caryophyllene, has been found to activate CB2 with a potent anti-inflammatory response. For more information, read our article, The Endocannabinoid System Explained.
The information contained in this article is for informational purposes only and does not constitute medical advice. Prior to making changes to your lifestyle or treatment plan, always consult with your doctor.
Traditional Indian medical professionals have utilized turmeric for improved healing in the body for millenia. It turns out, modern science has discovered that curcumin, an active compound found in turmeric, may have beneficial properties for the management of rheumatoid arthritis symptoms due to its antiinflammatory nature.
The dosage of THC for arthritis pain should follow the “sweet spot” model for cannabis-induced distraction from pain. THC is a potent anti-inflammatory agent. Start with 2.5 to 5 mg of THC and slowly increase the size of subsequent doses until pain relief peaks. For anti-inflammatory effects with CBD and THC, products with a 1:1 ratio seem to provide further benefit while helping to neutralise much of the psychoactive effects of THC. The higher the ratio of CBD, typically produces less psychoactivity side effects from the THC, such as in a 5:1 or 20:1 ratio of CBD to THC. Caution is advised when utilizing large doses of THC (over 7.5 mg), because receptor downregulation (tolerance) to the effects of cannabis may develop and potentially interfere with its medicinal efficacy.
Oral cannabis products containing both CBD and THC can be of value in managing arthritis symptoms. Tinctures, edibles, and sprays can be of value, each taking approximately 30-60 minutes to take effect (on an empty stomach) and results can last anywhere from 4-6 hours or longer. The longer the effects, the more appropriate for arthritis use. These cannabis medicines can be utilized on their own as an antiinflammatory, or in combination with other medications. The terpene beta-caryophyllene which is also found in black pepper and sometimes in supplements, contains potent antiinflammatory properties and can be combined with CBD and/or THC. An initial dose of 25 to 50 mg of beta-caryophyllene in an enteric capsule to allow it to survive gastrointestinal passage intact, is ideal and recommended. For more information, read our Ultimate Guide to Terpenes.
Smoking and vaporizing cannabis products can be effective for bringing more immediate relief to arthritis symptoms of pain. For those new to cannabis products, especially those containing THC, an initial inhaled dose of no more than a matchstick head in size of high-potency cannabis flowers is a fair starting point. In the elderly, or those with balance issues, should exercise caution, sitting up or standing slowly to avoid hypotension (lightheadedness).
Topical cannabis products that come in the form of balms, salves, or lotions have been used as folk remedies for arthritis for millenia and are popular among those who grow their own cannabis. Fascinatingly, the traditional preparations are not heated, meaning their cannabinoid content is primarily in its raw acidic state as THCA or CBD before decarboxylation. Topical products have been found to bring great relief due to the abundance of cannabinoid receptors present in the skin. These can be purchased online or from many health food stores and dispensaries, pending your country of residence. An important note; THC cannot cross the blood-brain barrier when applied to the skin, thus rendering it non-psychoactive.
There are now many studies showing evidence for the benefits of topical cannabinoids, with their harmlessness and lack of psychoactivity making them increasingly popular in pharmacies. Although THC is commonly thought of as the main component to bringing pain relief in topicals, it is strongly hydrophobic, meaning that no measurable amounts can be absorbed through the skin into the bloodstream. This means that topical THC must be massaged into the skin over the painful joint to bring relief.
CBD has more water solubility, and though also a fat, like THC, it is more “polar”. This polarity allows CBD to pass into the dermis and some of it to be absorbed. By using facilitating vehicles such as transdermal gels or patches, the absorption can further be improved, and may produce more of an antiinflammatory effect, improving care and support.
Cannabis strains high in the terpenes myrcene, linalool, and/or limonene bring synergistic effects and increase the potency and effectiveness, which can help further with arthritis symptoms. These varieties may prove a little too relaxing for daytime use, but experimentation will help. Strains containing beta-caryophyllene and terpinolene are generally more energizing and invigorating, which can be more advantageous for daytime use. Lightly stimulating high-THC strains such as Cookies and Trainwreck are popular for providing daytime pain distraction and antiinflammatory effects. In combination with high-THC varieties, high CBD strains such as ACDC can be blended or used on its own to increase antiinflammatory effects.
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People with arthritis are calling for additional pain management options and CBD products containing CBD oil and/or varying combinations and ratios of THC:CBD may be a viable solution. As always, before making any changes to your lifestyle or treatment plan, consult with a licenced medical professional.
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