How does CBD relieve pain in arthritis?
CBD acts via the endocannabinoid system, which is active on receptors found in multiple areas of the brain, and at spinal cord level, to stop the transmission of pain signals. It is 10-times as active as morphine in its effect on certain types of pain nerve cells, and also produces pain relief in response to stress. It produces peripheral pain relief as well by stimulation of CB1 receptors. CBD is chemically very similar to endocannabinoids like anandamide, or arachidonoylethanolamine, and 2-arachidonoylglycerol, that bind to ECS receptors. It increases the levels of anandamide at high doses, producing pain relief.
CBD also has powerful antioxidant activity, said to exceed that of vitamin C or vitamin E. It is thus claimed to be the first endocannabinoid modulator to be used in patients to relieve pain. It is also a TNF-α inhibitor, but does not cause gastric irritation or increase the risk of vascular disease like NSAIDs because it does not act on either of the cyclooxygenase enzymes (COX-1 and COX-2) that are inhibited by NSAID action. It also increases adenosine signaling and thus reduces inflammation and produces pain relief.
When topically applied in gel form, CBD reduces inflammation and hypersensitivity in rats with arthritis, being well absorbed with little inactivation by the liver. The absorption is directly proportional to the amount applied, with a potentially lower risk of systemic symptoms and increased local levels of CBD. Joint swelling and other signs of joint inflammation were reduced with this treatment. With oral use, too, there is a significant reduction in pain sensation in rat experiments. There is less inflammation and a lower concentration of inflammatory molecules in and around the joint space, which leads to improvement of symptoms, as well as preventing joint cartilage breakdown over time.
During joint inflammation, synovial membrane cells that are responsible for producing lubricating joint fluid and helping with local immunity are activated and begin to secrete inflammatory chemicals including TNF-α, IL1-α and others. These increase the sensitivity of the primary pain receptors in the joints but also recruit other cells to enhance the production of these cytokines, increasing the intensity of inflammation. CBD application appears to desensitize this pain system, called TRPV1, thus stopping further pain and progression. Smoking cannabis is a commonly reported method to ease arthritis pain, and forms the single largest reason cited by patients for medical use of the drug. In the absence of clinical trials, it remains a promising treatment which should be pursued seriously.
Using CBD wisely
A 2017 study performed on behalf of the US National Academy of Sciences found that cannabinoids produced a higher chance of pain reduction in patients with chronic pain. They did not differentiate between THC, CBD, and other chemicals in cannabis.
Without high-quality clinical studies on CBD in arthritis, however, it is difficult to predict clinical benefit, to recommend dosages for various arthritic conditions, or any formulation. Different formulations begin to act at different intervals, and may contain other ingredients that act via other mechanisms to relieve pain or inflammation. For instance, pain-relieving CBD ointment could contain menthol or capsaicin as well, both of which are also good at reducing mild pain. This makes it hard to decide how much of the observed effect was actually due to CBD from anecdotal reports, as opposed to properly designed trials.
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