In Australia, 1 in 6 people are living with arthritis, the leading cause of chronic pain. Chronic pain, and arthritis or joint pain are the top two medical conditions treated amongst cannabis users. Current evidence suggests medicinal cannabis is a safe, useful alternative or adjunct therapy for the treatment of joint pain and inflammation due to arthritis.
- Several studies suggest Medical Marijuana and CBD could help treat arthritis and relieve pain and inflammation.
- Repeated long-term use of many conventional medicines for arthritis conditions can damage your heart, liver, stomach, and kidneys, especially when doses are too high or taken for a prolonged period.
- Given the long-term course of progressive conditions like osteoarthritis, alternative treatment options like medicinal cannabis may have a place in therapy.
- There are no established clinical guidelines for CBD dose in arthritis. Experts recommend starting with a low dose, and if relief is inadequate, increase in small increments weekly.
- In Australia, medical marijuana (including CBD) is a scheduled medication and patients should discuss treatment with their doctor. If your doctor is not open to the conversation you may wish to speak with one of our medical marijuana doctors by booking in an initial consultation.
What is Arthritis?
Arthritis is not just one disease. It is an umbrella term for over a hundred conditions that affect joints where two or more bones meet. It can occur in almost any area of your body. The most commonly affected joints are the knees, hips, hands, and back.1
The most common forms of arthritis are:2
- rheumatoid arthritis
1 in 6 Australians have arthritis. That’s a staggering 4 million people living with arthritis. It is the leading cause of chronic pain and the second most common cause of early retirement due to ill health in Australia.3
While arthritis is very common, it is not well understood.
Signs and symptoms
Arthritis can affect people in different ways. Most people will have symptoms relating to their joints.2
Table 1: Common symptoms of arthritis2
|Joint symptoms||Other symptoms|
|Stiffness or reduced movement||Weight loss|
|Redness or warmth|
There can be many reasons why your joints may be sore. The pain in your muscles and joints may be cause by arthritis if it:2
- starts for no clear reason
- lasts for more than a few days
- comes with swelling, redness and warmth.
See your doctor if you notice these signs. It is important to start treatment as soon as possible to prevent the condition from worsening and causing long-term damage. Medicinal cannabis may be a suitable option if conventional medicines haven’t been working for you.
Medical Marijuana for Arthritis: Mechanisms of Action
The cannabis (marijuana) plant, or cannabis sativa, contains more than 540 chemical substances. These include over 100 active chemicals known as cannabinoids that are only found in the cannabis plant. The two most abundant cannabinoids are CBD (cannabidiol) and THC (delta-9-tetrahydrocannabinol).4
Evidence suggests modest benefits of cannabis for chronic pain, particularly neuropathic pain (pain associated with nerve injury or damage).4 CBD has demonstrated anti-inflammatory effects in several inflammatory conditions including arthritis.
CBD has pharmacological benefits without the psychotropic ‘high’ effect of THC. In conjunction with other, well-studied non-opioid pain treatment options, it may prove to be a beneficial treatment option for joint pain.5
More than 248,000 medical cannabis scripts have been approved for Australians since the inception of the national medicinal cannabis scheme in 2016. Approximately 65% of these approvals are to treat chronic non-cancer pain, which includes pain from arthritis.6
The Endocannabinoid System
The analgesic effects of cannabinoids are well established in preclinical models of pain. These effects arise primarily via interactions with the endocannabinoid system (ECS). The ECS is a cell-signalling system responsible for balancing and regulating body processes that control everything from our mood, sleep, immune system function, and metabolism.7
The ECS consists of cannabinoids produced naturally, called endocannabinoids, and cannabinoid receptors spread throughout our brain and nervous system. Cannabinoids such as CBD and THC act on these receptors to influence pain and inflammation.6
The important role for the ECS in pain and inflammation is seen from the effects of medicines that block an enzyme called fatty acid amide hydrolase (FAAH). FAAH breaks down endocannabinoids, molecules similar to cannabinoids except they’re produced by your body. Blocking FAAH leads to increased endocannabinoid concentrations and analgesic effects.8
Cannabis also contains terpenes. These are fragrant oils found in many plants that give it their distinct smell. They can interact with cannabinoid receptors to enhance or block the effects of cannabinoids such as THC and CBD. These effects are a result of the overall combination, or entourage, effect of cannabinoids and terpenes. Research shows that terpenes can offset the side effects of THC.9
Benefits of Medical Cannabis and CBD for Arthritis Pain
Table 2: Benefits and risks of CBD use in chronic pain10
|Well-tolerated||Limited evidence for long-term use|
|Improved quality of life||Pain-relieving effect is disease-specific|
|Fewer side effects|
|Effective for intractable pain (pain that standard medical care can’t control)|
A 2018 cross-sectional study found that among 1,483 participants who used CBD to treat a medical condition, chronic pain and arthritis/joint pain were the top two medical conditions treated. Regarding efficacy of CBD treatment for their medical condition:11
- almost 36% of participants reported that CBD treats their medical condition “very well by itself”
- almost 30% reported that CBD treats their medical condition “moderately well by itself”
- about 30% reported that CBD treats their medical condition “well in combination with conventional medicine”
- only 4% reported “not very well” regarding treatment with CBD for their medical condition.
A Swell Choice: Where Does Medical Cannabis Fit?
For many types of arthritis, there are treatments available that help you control your symptoms and prevent damage to your joints. Treatment options depend on:12
- the type of arthritis you have
- the joints that are affected
- the symptoms you have.
Table 3: Traditional medicines for arthritis7
|Traditional medicine class||Effect|
|Painkillers (analgesics)||Reduce pain|
|Non-steroidal anti-inflammatory drugs (NSAIDs)||Reduce inflammation|
|Corticosteroids||Reduce inflammation and supress immune system|
|Disease-modifying anti-rheumatic drugs (DMARDs)||Restrict immune system from attacking the joint|
In severe cases, surgery may be required to replace or repair damaged joints.12
While these medicines can be effective, their safety from long-term use is questionable. Repeated long-term use can damage your heart, liver, stomach, and kidneys, especially when doses are too high or taken for a prolonged period.7
Given the long-term course of progressive conditions like osteoarthritis, alternative treatment options like cannabis may have a place in therapy.13
Non-pharmacological treatment options to help manage your pain include:12
- maintaining a healthy lifestyle
- regular exercise to keep the joints moving
- pain management techniques and therapies like meditation, massage, acupuncture, and transcutaneous electrical nerve stimulation (TENS)
- hot (warm bath, heat pack, hot water bottle) or cold (cold pack) treatments throughout the day
- avoiding activities that worsen pain.
More patients are becoming aware of these alternative treatment options. Natural pharmacological alternatives such as medicinal cannabis are associated with fewer side effects than conventional medicines for arthritis.
A 2020 review of CBD in the management of joint disease noted that due to the high number of side effects of conventional medicines for arthritis, it is reasonable to suggest that CBD is a safe, useful alternative or adjunct for the treatment of joint pain due to arthritis.13
Debunking the Rheumatoid: What Does the Research Say?
Animal studies suggest that CBD has pain-relieving and anti-inflammatory effects, but there is limited data from quality studies in humans.14
There is anecdotal evidence that some people with arthritis found that CBD provided noticeable improvements in arthritis-related symptoms, such as pain, insomnia and anxiety.14
Several animal studies suggest CBD could help treat arthritis and relieve pain and inflammation. The outcomes of these studies were:
- Schuelert et al. (2011): CBD reduced inflammatory joint pain in acute arthritis by affecting how pain receptors respond to stimuli.15
- Porta et al. (2014): CBD may be an effective treatment for osteoarthritis.16
- Hammell et al. (2016): Topical CBD had the potential to relieve pain and inflammation in arthritis.17
- Philpott et al. (2017): CBD may be a safe and useful treatment option for joint pain associated with osteoarthritis.18
Although the evidence so far is promising, more research is needed to confirm the effectiveness of CBD in arthritis.
A 2020 study found that CBD reduces the production of synovial fibroblasts in rheumatoid arthritis. These are molecules that contribute to the breakdown of cartilage. However, the mechanism of action for this is unclear, due to CBD binding to several receptors and enzymes.5
A 2017 systemic review and meta-analysis found that cannabis helped with chronic neuropathic pain, as well as improvements in quality of life and sleep with no major side effects.19
A 2020 review found that CBD may have benefits for relieving chronic pain, improving sleep, and reducing inflammation, which are symptoms commonly associated with arthritis.10
A 2021 study reviewed all available human studies examining the benefits of medicinal cannabis in the treatment of chronic non-cancer pain. This includes neuropathic pain, low back pain, osteoarthritis and rheumatoid arthritis. They concluded that with the limited evidence available, medicinal cannabis can be considered as a third-line therapy for treatment of these conditions.20
Terpenes for pain management and inflammation
Terpenes have been shown to assist with pain relief and inflammation. They are generally most effective when used with other terpenes and cannabinoids such as THC and CBD due to the entourage effect.
Table 4: Analgesic and anti-inflammatory effects of specific terpenes found in the cannabis plant
|Linalool||Reduces the excitability of spinal cord cells that transmit pain signals to the brain21 Potentially anti-inflammatory agent22|
|Myrcene (beta-myrcene)||Blocked by naloxone, suggesting an opioid-like mechanism of action23 Has anti-inflammatory effects via prostaglandin E2 (PGE-2), which is a pro-inflammatory substance24|
|Alpha-pinene||Alleviates pain and decreases inflammation via GABA and μ-opioid receptors in animal studies25 Decreases inflammation via inhibition of COX enzymes26|
|Limonene||Reduces pain intensity, nausea, and vomiting in pregnant women27|
|Beta-caryophyllene||Activates cannabinoid type 2 (CB2) receptors to decrease pain and inflammation28|
|Alpha humulene||Reduces inflammatory pain when applied topically29 Decreases inflammation both orally and topically in animal studies22|
How Do I to Take Cannabis for Arthritis?
There is limited evidence regarding which dosage form or dose of medicinal cannabis is most effective for treating pain from arthritis.
A 2013 study compared the effects of smoked cannabis (containing 3.56% THC) to oral dronabinol (synthetic THC) 20 mg for reducing pain. Both products similarly decreased pain sensitivity and increased pain tolerance compared to placebo. The effects of dronabinol were longer lasting.30
A 2018 study evaluated the safety and efficacy of 250–500 mg twice daily transdermal synthetic CBD gel for the treatment of knee pain due to osteoarthritis in adults over a period of 12 weeks.
The responder endpoint showed statistically significant differences between treatment and placebo. Both doses were well tolerated.31
Everyone reacts to medicinal cannabis differently. The recommendation is to ‘start low and go slow’. Adjust the dose (known as dose titration) depending on how your body reacts. This should be adjusted slowly over a period of as much as two weeks.
Start with just a small amount of CBD in sublingual form twice a day. If pain relief is inadequate after 1 week, increase the dose by that same amount, going up in small increments over several weeks. If pain relief is adequate, continue with the dose twice daily to maintain a stable level of cannabis in your blood.14
The correct dose is the lowest dose that gives you the most pain relief from your arthritis without associated side effects.32
If you are taking a liquid form of CBD, keep in mind that CBD is mixed with a carrier oil. You will need to check the amount of the liquid product to take (the dose) as well as the amount of CBD in each dose.14
Keep daily doses of THC below 30 mg to limit side effects, preferably in conjunction with CBD. Try taking THC products at home or at night first, so you can sleep off any unwanted side effects.32
CBD Guidance for Adults With Arthritis
While there are no established clinical guidelines for cannabis use, the Arthritis Foundation, in collaboration with top experts in arthritis pain and CBD, have released a practical resource providing guidance for patients.33
Table 5: CBD guidance for adults with arthritis14
|Evidence||CBD may help with arthritis-related symptoms (such as pain, insomnia, anxiety), but there have been no rigorous clinical studies for people with arthritis to confirm this.|
|Safety||No major safety issues have been found with CBD when taken at moderate doses.|
|Use||Never use CBD to replace disease-modifying drugs that help prevent permanent joint damage in inflammatory types of arthritis.|
|Follow-up||Discuss CBD use with your doctor in advance, with follow-up evaluations every 3 months, as you would for any new treatment.|
|Dose||There are no established clinical guidelines for CBD dose in arthritis. Experts recommend starting with a low dose, and if relief is inadequate, increase in small increments weekly.|
|Source||Only purchase CBD from a pharmacy with a doctor’s prescription. This way you can ensure you are getting medication from a reputable company that has each batch tested for purity, potency, and safety by an independent laboratory.|
A Bone to Pick: Is Cannabis Safe to Use for Arthritis?
There are no serious safety concerns associated with moderate doses of CBD in arthritis.14 Overall, CBD is well-tolerated with only mild side effects.34
Although CBD is relatively safe, like any other treatment, it can still cause side effects. These include:35
- dry mouth.
CBD has potential interactions with some medicines that are commonly taken by people with arthritis. These include:14
- corticosteroids (used to reduce inflammation and supress immune system)
- tofacitinib (used for rheumatoid arthritis and psoriatic arthritis)
- some NSAIDs such as naproxen and celecoxib (used to reduce inflammation)
- tramadol (used to reduce pain)
- certain antidepressants, such as amitriptyline, citalopram, fluoxetine, mirtazapine, paroxetine, and sertraline
- gabapentin and pregabalin (used for neuropathic pain).
What Should Patients and Caregivers Know?
- Medicinal cannabis should be part of an overall pain management plan that includes non-pharmacological treatment options such as exercise and psychosocial support.35
- Start low and go slow, until the desired effect is achieved.
- Establish initial goals of treatment within a realistic time period, such as reducing your arthritic knee pain to allow you to walk for 15 minutes with two weeks of starting treatment. You can adjust your goals if you see improvement.35
- If you have rheumatoid arthritis, do not stop taking your regular medicines that may be protecting your joints from future damage if you plan to start taking medicinal cannabis. Discuss any changes with your health professional.35
What Are the Next Steps?
In most states in Australia, most GPs and specialists can prescribe medical cannabis including CBD oil. However, they will need to apply under the special access scheme.
If your doctor is unwilling to apply on your behalf or uncomfortable prescribing medical cannabis, they can refer you to our clinic. We do virtual consultations nationwide and in-person at our flagship clinic in Sydney.
Click here for a quick online eligibility test to see if you qualify.
You can also call us at (02) 9098 9128 or email us at firstname.lastname@example.org and we can advise if medical cannabis could be an option for your condition.
- Australian Centre for Cannabinoid Clinical and Research Excellence
- Centre for Medicinal Cannabis Research and Innovation
- Therapeutic Goods Administration (TGA) guidance for the use of medicinal cannabis in Australia patient information
- Arthritis Australia
- Arthritis Australia. What is arthritis? Areas of the body. Glebe, NSW: Arthritis Australia, 2017. https://arthritisaustralia.com.au/what-is-arthritis/areas-of-the-body/ (accessed 1 May 2022).
- Arthritis Australia. Arthritis Information Sheet. Glebe, NSW: Arthritis Australia, 2017. https://arthritisaustralia.com.au/wordpress/wp-content/uploads/2019/08/ArthAus_WhatisArthritis_1805-1.pdf (accessed 2 May 2022).
- Arthritis Asutralia. What is arthritis? Fast facts. Glebe, NSW: Arthritis Australia, 2017. https://arthritisaustralia.com.au/what-is-arthritis/fastfacts/ (accessed 2 May 2022).
- National Center for Complementary and Integrative Health. Cannabis (marijuana) and cannabinoids: what you need to know. USA: NIH, 2019. https://www.nccih.nih.gov/health/cannabis-marijuana-and-cannabinoids-what-you-need-to-know (accessed 2 May 2022).
- Lowin T, Tingting R, Zurmahr J, et al. Cannabidiol (CBD): a killer for inflammatory rheumatoid arthritis synovial fibroblasts. Cell Death Dis 2020;11:714. https://www.ncbi.nlm.nih.gov/pubmed/32873774
- Henderson LA, Kotsirilos V, Cairns EA, et al. Medicinal cannabis in the treatment of chronic pain. Aust J Gen Pract 2021;50:724-32. https://www.ncbi.nlm.nih.gov/pubmed/34590094
- Open Access Government. CBD oil for pain: what the research shows. UK: Open Access Government, 2021. https://www.openaccessgovernment.org/cbd-oil-for-pain-what-the-research-shows/113198/ (accessed 2 May 2022).
- Soliman N, Haroutounian S, Hohmann AG, et al. Systematic review and meta-analysis of cannabinoids, cannabis-based medicines, and endocannabinoid system modulators tested for antinociceptive effects in animal models of injury-related or pathological persistent pain. Pain 2021;162:S26-S44. https://www.ncbi.nlm.nih.gov/pubmed/33729209
- Russo EB. Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br J Pharmacol 2011;163:1344-64. https://www.ncbi.nlm.nih.gov/pubmed/21749363
- Argueta DA, Ventura CM, Kiven S, et al. A balanced approach for cannabidiol use in chronic pain. Front Pharmacol 2020;11:561. https://www.ncbi.nlm.nih.gov/pubmed/32425793
- Corroon J, Phillips JA. A cross-sectional study of cannabidiol users. Cannabis Cannabinoid Res 2018;3:152-61. https://www.ncbi.nlm.nih.gov/pubmed/30014038
- healthdirect. Arthritis. Haymarket, NSW: Healthdirect Australia, 2020. https://www.healthdirect.gov.au/arthritis (accessed 2 May 2022).
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- Arthritis Foundation. CBD for arthritis pain: what you should know. USA: Arthritis Foundation, 2022. https://www.arthritis.org/health-wellness/healthy-living/managing-pain/pain-relief-solutions/cbd-for-arthritis-pain (accessed 2 May 2022).
- Schuelert N, McDougall JJ. The abnormal cannabidiol analogue O-1602 reduces nociception in a rat model of acute arthritis via the putative cannabinoid receptor GPR55. Neurosci Lett 2011;500:72-6. https://www.ncbi.nlm.nih.gov/pubmed/21683763
- La Porta C, Bura SA, Negrete R, et al. Involvement of the endocannabinoid system in osteoarthritis pain. Eur J Neurosci 2014;39:485-500. https://www.ncbi.nlm.nih.gov/pubmed/24494687
- Hammell DC, Zhang LP, Ma F, et al. Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis. Eur J Pain 2016;20:936-48. https://www.ncbi.nlm.nih.gov/pubmed/26517407
- Philpott HT, O’Brien M, McDougall JJ. Attenuation of early phase inflammation by cannabidiol prevents pain and nerve damage in rat osteoarthritis. Pain 2017;158:2442-51. https://www.ncbi.nlm.nih.gov/pubmed/28885454
- Meng H, Johnston B, Englesakis M, et al. Selective cannabinoids for chronic neuropathic pain: a systematic review and meta-analysis. Anesth Analg 2017;125:1638-52. https://www.ncbi.nlm.nih.gov/pubmed/28537982
- Chang Y, Zhu M, Vannabouathong C, et al. Medical cannabis for chronic noncancer pain: a systematic review of health care recommendations. Pain Res Manag 2021;2021:8857948. https://www.ncbi.nlm.nih.gov/pubmed/33613794
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- Hunter D, Oldfield G, Messenheimer J, et al. Synthetic transdermal cannabidiol for the treatment of knee pain due to osteoarthritis. Osteoarthritis and Cartilage 2018;26:S26. https://doi.org/10.1016/j.joca.2018.02.067
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- Arthritis Foundation. Arthritis Foundation releases first CBD guidance for adults with arthritis. USA: Arthritis Foundation, 2019. https://www.arthritis.org/about-us/news-and-updates/cbd (accessed 2 May 2022).
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