- Best Marijuana for Pain Relief: CBD or THC Strains?
- Why use cannabis for pain relief?
- What about NSAIDs?
- The history of cannabis: Weed and pain control
- What is the best marijuana for treating pain?
- Whole plant or THC only? The entourage effect
- Cannabis sativa and the entourage effect
- How CBD and THC influence the user experience together
- Benefits of high-CBD strains for treating pain
- Benefits of high-THC strains for treating pain
- Anecdotal evidence
- High THC or high CBD for pain?
- Best cannabis strains for pain
- CBD oil for pain
- CBD oil for nerve pain
- CBD oil for back pain
- CBD lotion for pain
- Dosage amounts of cannabis and CBD for pain
- Cannabis sativa is good for pain
- 5 Best Cannabis Strains for Pain Relief from Arthritis [2020 Update]
- Arthritis: What Is This Medical Condition
- What Are the Main Causes of Arthritis?
- Arthritis Treatment Methods
- Arthritis Affects Even the Famous
- Marijuana Treatment for Arthritis
- Cannabis Cannabinoids: THC vs CBD
- 5 Best Marijuana Strains for Arthritis
- Final Thoughts About Cannabis as a Treatment for Arthritis
- Marijuana for Rheumatoid Arthritis Joint Pain: Pros and Cons
- Who Uses Medical Marijuana for Pain?
- The Case for Marijuana Use In Rheumatoid Arthritis Treatment
- Specific Risks That Worry Rheumatologists
- Eight Things Rheumatologists Should Know About Medical Marijuana
- The GrowthOp
Best Marijuana for Pain Relief: CBD or THC Strains?
If you are struggling with chronic pain, one of the safest and most effective options could be marijuana.
Medical marijuana is becoming one of the most popular alternative treatments for chronic pain – this can range from pain caused by conditions such as migraines or arthritis to pain caused by injury. In fact, 94% of medicinal cannabis patients in Colorado indicated severe pain as to why they require cannabis.
Why use cannabis for pain relief?
With over 100 million Americans suffering from chronic pain, a safe and effective treatment is needed, and this does not exist with the presently available pharmaceutical options.
The two main treatments currently available for relieving pain include nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid prescription medications. These pain relievers are not nearly as safe as cannabis. (1,2)
Opioid drugs are one of the most addictive drugs available today, and their use can be fatal if abused: in the US alone, sixty people die every day from opioid overdose.
What about NSAIDs?
While NSAIDs are generally effective at reducing pain caused by inflammation, prolonged use is accompanied by many dangerous side effects. These include increased risk of heart attacks and strokes.
Medical marijuana is becoming a popular alternative to over-the-counter and prescription painkillers, and for good reason. As a remedy for pain, pot comes with fewer side effects and no risk of tolerance or overdose. Cannabis sativa and its constituents have proven to be both safe and effective when it comes to pain management.
With the legality of marijuana spreading across the United States and other countries, many people are now being given the opportunity to switch from dangerous, addictive medications to a natural, safer alternative.
Whether you are suffering from chronic nerve or body pain, or you are experiencing short-term pain from muscle strain, headaches, toothaches, or simply sore muscles, cannabis offers a safer and possibly more effective option than what is typically used for pain today.
The history of cannabis: Weed and pain control
Throughout history, cannabis has been cultivated and used for its medicinal purposes. Evidence suggests that it was cultivated by humans as far back as 12,000 years ago.
Throughout this time, the cannabis plant has been exalted as miraculous and cursed as a danger to the fabric of society. Yet, throughout this varied past, one thing has remained the same:
Cannabis has been used as a plant medicine for the treatment of an impressively wide array of diseases.
The earliest evidence of its medicinal use dates back to 2700 BC when Chinese Emperor Shen Nung documented the analgesic (pain-relieving) properties. Shen Nung is considered by many to be the father of Chinese medicine, which has helped to heal people through the use of natural remedies for thousands of years.
We have now entered a time where the benefits of this plant are beginning to come back to the forefront of the discussion. Indeed, countless individuals across the world have access to legal marijuana for chronic pain conditions.
Yet for these patients as well as cultivators and clinicians, the question is this:
What is the best marijuana for treating pain?
Should patients turn to singular compounds found in the plant, or turn to the plant itself? If using the whole plant, what marijuana strains are the best for providing relief from pain?
Whole plant or THC only? The entourage effect
When you compare Western medicine to traditional medicine the world over, one of the most striking differences is the need in the West to pinpoint one specific molecule that is responsible for treating a disease or symptom. This viewpoint stands contrary to the idea of holistic medicine, where you take something in its entirety for medicinal purposes.
The ‘entourage effect’ is a new term coined to describe the idea that all compounds found in the cannabis plant work synergistically, providing more benefit together than the individual compounds would provide alone.
Cannabis sativa and the entourage effect
The Cannabis sativa plant is one of the greatest present-day examples of this tug-of-war between Western medicine and traditional medicine.
If you live in a state where marijuana is legal, you may have noticed products being advertised as “isolates” or “whole plant extracts.” Proponents of the isolationist Western medicine theories would advocate for isolates, which are simply products containing just tetrahydrocannabinol (THC) or just cannabidiol (CBD), or far less commonly, any of the other individual phytocannabinoids.
THC is the psychotropic phytocannabinoid that is to thank for the “high” effect users get when they smoke weed. It has been found to have a variety of health-related benefits for the user.
CBD is the second most well-known cannabinoid found in cannabis, and like most of the other phytocannabinoids, it is non-psychotropic.
These are the two most abundant and well-studied cannabinoids in marijuana, and both have been found in numerous published studies to have pain-relieving properties in humans. While they may be the most abundant, THC and CBD are certainly not the only compounds found in cannabis that are known to exert positive effects on human health.
In every cannabis plant, there is a unique mixture of hundreds of plant compounds, comprised of phytocannabinoids, terpenes, and flavonoids. Research suggests that these compounds too have an influence on our neurochemistry, and together they may work synergistically, producing better improvements in pain relief than anyone would produce on its own.
This research supports the idea that it is best to use the whole cannabis plant, with CBD, THC, and the natural medley of additional compounds. This harmony between the various plant chemicals found in marijuana is colloquially referred to as the entourage effect.
How CBD and THC influence the user experience together
The most well-studied compounds found in the marijuana plant that support the idea of the entourage effect are THC and CBD, which have been found to work differently together than when separate.
Using these two compounds in concert has been shown to help mitigate side effects and enhance efficacy, with CBD plus THC showing more benefit for some conditions than THC alone.
Studies have confirmed that CBD helps to counteract some of the sedative, “high” feeling, anxiety, and rapid heartbeat that is associated with THC consumption. It has also been found to extend the half-life of THC, which may help to extend the pain-relieving benefits. This has allowed the use of higher doses of THC in clinical trials for the treatment of pain caused by multiple sclerosis, peripheral neuropathic pain, intractable cancer pain, and rheumatoid arthritis. When used in concert, a greater efficacy in treating these types of pain have been observed.
You may be wondering, what is the ideal balance, or ratio, of CBD to THC?
Every strain of bud that you can purchase at a dispensary will be labeled with its THC and CBD content, which can be helpful when choosing which strain to choose for pain relief.
Benefits of high-CBD strains for treating pain
CBD has been found to exhibit enhancements in treating pain both when used on its own and when used in combination with THC. When used alone, CBD is largely best for inflammatory pain, such as that caused by arthritis or injuries.
In one animal study on arthritis pain, it was found that the topical application of CBD led to a reduction in inflammation and pain. Another animal study found that CBD helps to reduce neuropathic pain through the suppression of chronic inflammation.
CBD does not directly bind to the receptors found in the endocannabinoid system but rather works to modulate the effects of the endocannabinoids (the cannabinoids found naturally in our bodies) as well as working as a CB1 receptor antagonist.
The main mechanism by which CBD is thought to help mediate pain is by reducing inflammation, largely by blocking inflammatory mediators. It is also believed to potentiate glycine receptors, which help to regulate pain at the spinal level. This suppresses both neuropathic and inflammatory pain.
Benefits of high-THC strains for treating pain
THC is used clinically for the treatment of pain and studies find it helps relieve central and neuropathic pain. It is also used to help reduce pain in cancer, AIDS, and fibromyalgia patients, for which resistance to other pain treatments have been found.
The mode of action for THC is as a partial CB1 receptor agonist, which means that it will bind to these receptors but not fully which leads to the variability in effects documented when THC is present with other CB1 agonists, antagonists or both. It has been found to impact the serotonergic, dopaminergic, and glutamatergic systems – an action which may contribute to its pain-relieving benefits. Additionally, THC has been found to act as an anti-inflammatory agent.
While human studies have found benefits from the use of THC, CBD, and whole-plant marijuana in relieving pain, much of the evidence for this use comes from user reports and surveys.
In a survey of those suffering from chronic, non-cancer pain in Canada it was found that 35% of respondents reported using cannabis for pain relief.
Another study found that, out of nearly 3,000 patients using medical cannabis, 97% reported that they were able to decrease their use of opioids when also using medical marijuana, with most reporting that the relief they experienced with cannabis was on par with other pain medications.
High THC or high CBD for pain?
When searching for the best cannabis strains for pain relief, you will first want to consider how much THC and CBD is found in the strain. Generally, you will find the most relief from a strain that has large quantities of both CBD and THC, and a high CBD: THC ratio. This is because CBD can help to mediate the side effects of THC while also providing additional anti-inflammatory and analgesic properties.
There are certain times where you may prefer the effects of a higher THC or higher CBD strain. One example would be if you are experiencing inflammation, yet you are wanting to go about your day normally, without the psychotropic effects of THC. In this situation, a high-CBD low-THC strain can provide relief without much of an impact on mental function.
Other times you may be in enough pain that you would like something that takes your mind off the pain while also offering pain relief. In this situation, the greater “high” that you would experience with a high-THC strain could be of benefit.
Best cannabis strains for pain
There are a few things that you will want to consider outside of simple percentage CBD and THC. One of these considerations is the ‘type’ of cannabis you are purchasing.
There are three categories that your medical marijuana can fall into:
● Hybrid (a mixture of both indica and sativa)
While this is not an exact science, users tend to report more effective pain-relieving properties with indicas. In one survey, participants reported that indicas helped more than sativas when it came to headaches, joint pain, neuropathy, and spasticity. Users also reported indicas to be more helpful when it comes to sleep and sedation.
Lastly, there are countless user reports on specific strains of weed that have been found to be powerful for relieving pain. While some of these strains are high CBD, indica strains, some strains of weed used for pain do not fall into this category.
It may be that the other cannabinoids, terpenes, and flavonoids have come together in a harmonious balance that leads to strong pain-relieving properties.
Some of the most renowned pain-relieving strains per user reviews include:
|Strain||Category||CBD Content||THC Content||Description|
|ACDC||Hybrid||High||Low||Produces no noticeable high feeling due to very low THC content. Helps to relieve pain and even control stress.|
|Purple Kush||Indica dominant hybrid||Low||High||Produces a strong body high with associated reductions in pain. A very relaxed and sleepy high.|
|Harlequin||Mostly Sativa||High||High||Mellow psychoactive effects that are great for pain relief experienced with menstrual cramps and arthritis.|
Table 1. The characteristics of three of the cannabis strains most commonly used to relieve pain.
CBD oil for pain
Whether you live in a state where medical marijuana is not available, or you would like pain relief without any “high” feeling, CBD oil may be a good option for you.
There are limited studies examining the effect of CBD alone on pain in humans. Most of the studies out there examine the benefits of THC and CBD together, or whole Cannabis sativa plant, for pain. When it comes to CBD only studies, the majority are preclinical or animal studies. That said, the research conducted thus far, along with countless user reports, suggests that CBD itself may be able to help relieve pain.
Activation of cannabinoid receptors has been linked to the inhibition of pain. The exact mechanisms of action are still being researched, however, CBD has been found to increase the levels of endocannabinoids in the body, specifically anandamide. It is plausible that this increase in endogenous endocannabinoids could have an impact on pain. Another study suggests that CBD in rats induced suppression of chronic inflammation and neuropathic pain through potentiating glycine receptors.
Here we will examine the limited scientific evidence, along with theories relating to the use of CBD for pain.
CBD oil for nerve pain
Neuropathic pain, also known as nerve pain, is a unique type of pain that is caused by injured, dysfunctional, or irritated nerves. This pain tends to be chronic and severe, and with no known cure or remedy, every individual is left to try numerous strategies to find something that works for them.
Some of the most common sources of neuropathy include diabetes, injury, cancer, infections, alcoholism, and autoimmune disorders. While there have been human clinical trials that support the benefits of THC and CBD for nerve pain, there have been fewer studies examining just CBD. In an animal study, researchers found that oral supplementation of CBD led to improvements in neuropathic pain in rats.
CBD oil for back pain
Back pain is one of the most common forms of both acute and chronic pain. Acute back pain tends to be caused by an injury, such as by falling or lifting something heavy. Chronic back pain is that which lasts more than three months and is often caused by a ruptured or bulging disc, arthritis, osteoporosis, scoliosis, or nerve pain.
Some back pain is partly caused by inflammation, and numerous preclinical and animal studies have found benefits of CBD for inflammation. Through possible reductions in both nerve and inflammatory pain, CBD may help relieve back pain.
CBD lotion for pain
When it comes to localized pain, topical CBD lotion or creams may be a great option. By applying the CBD directly to problem areas, concentrated CBD is delivered to exactly where you need it the most.
While human studies on the efficacy of CBD lotion are lacking, there are plenty of animal studies and personal accounts to support this use. In one study, researchers found that rats with arthritis treated with transdermal CBD experienced reductions in pain-related behaviors and inflammation.
Dosage amounts of cannabis and CBD for pain
Cannabis and CBD dosing for pain are highly individual. Studies have found a bell-shaped dose-response curve with cannabis extract, meaning that it slowly becomes more effective until it hits a certain point, and then the effectiveness decreases. To further complicate matters, the effective dose found in human studies varies greatly from one condition and one study to the next.
For example, in migraines, the effective dose of THC and CBD was found to be 200 mg/day, with no benefits found at 100 mg/day. However, doses of Sativex, an oral spray that delivers 2.7 mg THC and 2.5 mg CBD per spray, was found to be effective in the treatment of central neuropathic pain in Multiple Sclerosis at doses of around 20-30 mg/day CBD + 22-32 mg/day THC.
CBD dosage for pain has not been examined in any human studies. Like the Cannabis sativa extract, studies have found that exceeding the optimal dose of CBD can lead to a reduction in efficacy. In a study examining the effect of CBD on anxiety, 100 mg and 900 mg were not effective, where 300 mg was.
So where, then, should you start when it comes to dosing Cannabis sativa or CBD oil? Follow these steps when adding in a cannabis or CBD oil product:
1. Choose the product that you would like to take
2. Start at the lowest recommended dosage
3. Split this dose between 2-3 doses throughout the day
4. Stay at the same dose for 3 or more days, evaluating your response
5. Increase your dose until you find the best dose for you
Cannabis sativa is good for pain
Studies and anecdotal reports have shown that cannabis is good for pain. Whether you enjoy smoking weed or not, there are numerous products available for you to use if you live in a state where pot is legal.
Some products that may help if you want something other than bud itself include:
● Lotions or creams
● Tinctures (dropper bottles with cannabis-infused oils)
● Capsules or pills
● Edibles (chocolates, candies, teas, or other foods infused with cannabis)
When looking at these products it is important to choose one that is a full-plant extract. This allows you to access the full potential of the wide array of healthful and anti-inflammatory compounds found in the Cannabis sativa plant.
5 Best Cannabis Strains for Pain Relief from Arthritis [2020 Update]
In the U.S. arthritis is the most common form of disability and medical cannabis is slowly penetrating the market gaining acknowledgment as an effective medical treatment. But before we explain the benefits of cannabis as a treatment, let’s understand a little bit about arthritis.
Arthritis is so common that it affects 350 million people worldwide and around 40 million people in the States. Out of those, 2.1 million Americans suffer from rheumatoid arthritis which is seen to be the most common form of the disease worldwide.
While most people think that arthritis is just about the aches and pains associated with getter older, that is far from the truth. Two-thirds of people who suffer are under the age of 65, and there are hundreds if not thousands of children worldwide who suffer from some form of arthritis.
Arthritis: What Is This Medical Condition
Arthritis is a term that describes a group of diseases that affect the joints in our body. Some forms of arthritis will even affect your connective tissues and organs, including your skin.
Those that suffer from arthritis will often experience:
- Swollen or stiff joints
- Reddish joints that are tender and warm
- Mobility problems
- Find it hard to do everyday tasks
There are different types of arthritis, but the most common forms are osteoarthritis, which is a form of degenerative arthritis and rheumatoid arthritis which falls under the category of inflammatory arthritis.
Over time, the cushioning surface on the ends of the bones wears away causing pain, swelling, and stiffness. As time goes on these pains may become chronic. Degenerative arthritis is often caused by aging, excessive weight and can be hereditary. Severe cases of degenerative arthritis may lead to chronic pain resulting in limited mobility and affecting qualify of life. Degenerative arthritis can be prevented by staying active and maintaining a healthy diet.
Rheumatoid arthritis and psoriatic arthritis are examples of inflammatory arthritis. This type of arthritis appears when the body’s immune system is not able to fight off infections and diseases, by generating controlled inflammation, and instead, the body goes haywire with uncontrolled inflammation. The inflammation causes joint erosion and can damage internal organs. With any type of inflammatory arthritis, early diagnosis and aggressive treatment are critical.
This form of arthritis is initiated by a virus or fungus that enters the body and triggers inflammation. Salmonella, Shigella, chlamydia, and hepatitis C are examples of viruses that can lead to arthritis.
Metabolic arthritis is caused by high levels of uric acid that humans naturally produce. Uric acid is formed as the body breaks down purines, a substance found in many foods and human cells. In cases where the body produces high levels of Uric acid, the acid forms crystals in the joints resulting in joint pain.
What Are the Main Causes of Arthritis?
While most forms of arthritis remains a mystery to most doctors, studies have found that the following causes may increase your chances of getting it;
It has been found that specific forms of arthritis, for example, rheumatoid arthritis are linked to certain genes.
According to recent statistics, most types of arthritis are more common in women. 60% of people with arthritis are women. Gout is more common in men.
By default as you begin to age your joints start to wear down. It is important to exercise frequently to avoid this.
Those that carry excess weight force their joints and body to work harder than usual. The extra pounds tends to lead to arthritis in the knees.
Although injuries aren’t always in our control, they may cause joint damage that leads to specific forms of arthritis.
Arthritis Treatment Methods
Today there are many forms of Arthritis treatments including cannabis. Even though most won’t fully heal the condition, they will provide pain relief. Some analgesics include Tylenol, Percocet, and Vicodin. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil, Motrin, or Aleve may also be taken to reduce pain and inflammation.
Inflammatory arthritis is often treated with disease-modifying anti-rheumatic drugs (DMARDs). Corticosteroids like cortisone are often prescribed by doctors to reduce inflammation.
Maintaining a healthy diet and exercising regularly can significantly reduce the risks of getting arthritis and it is often recommended by dietitians to eat less sugary foods that only aggravate inflammation.
Arthritis Affects Even the Famous
According to a recent publication by the Telegraph, Oxford University is preparing to launch a £10m research program around the effects of medical marijuana.
The program will be funded by Kingsley Capital Partners, who are expected to help expand the University’s marijuana cannabinoid research in specific medical conditions such as pain, cancer, and inflammatory diseases.
We all know Sir Patrick Stewart, the head of Kingsley Capital Partners, as Professor X, but unlike his fictional character that has superpowers, Stewart has been suffering from ortho-arthritis for years and has been using medical cannabis to help his condition.
According to Stewart, cannabis even helps him in such a way that he can now make fists and sleep at night.
Marijuana Treatment for Arthritis
Over the last couple of years, marijuana has become a popular form of treatment for arthritis patients who want to avoid the potentially awful side effects of using pharmaceutical pain relievers such as prescription opioids and over-the-counter NSAIDS.
While it has been common knowledge in eastern countries that cannabis can effectively treat arthritis-related pain, now scientific studies around the cannabis plant are beginning to confirm those thoughts.
In recent studies, cannabis has been shown to reduce inflammation and pain in patients with the most common types of arthritis. Thanks to the two major cannabinoids, THC and CBD, patients expressed an ease in their pain after using cannabis.
Furthermore, only a few years ago, researchers from the University of South Carolina discovered that THC, one of the cannabis plant’s cannabinoids, can change critical molecules of epigenome, leading to suppression of inflammation.
Another study published in the journal Rheumatology by Dr. Sheng-Ming Dai of China’s Second Military Medical University found that unusually high levels of CB2 receptors were found in joint tissues of arthritis patients. This led them to conclude that the use of cannabis had a positive effect in combating inflammation by activating the pathways of CB2 receptors.
Cannabis Cannabinoids: THC vs CBD
While there are over 100 different cannabinoids, the two most popular ones are Delta-9 tetrahydrocannabinol, commonly referred to as THC, and cannabidiol, known as CBD. THC is the primary psychoactive component of cannabis which gives the effect of what recreational users call the “high.” CBD is considered to be a non-psychoactive component of cannabis that acts as a counter ingredient against THC. It basically helps reduce the high. What most people don’t realize is that both cannabinoids have healing properties.
THC is a strong anti-inflammatory and pain killer and has been shown to assist patients suffering from arthritis. THC is also an antispasmodic, bronchodilator, muscle relaxant – a powerful neuroprotectant and antioxidant. As a matter of fact, it has twice the anti-inflammatory power of hydrocortisone and 20 times of aspirin.
Similar to THC, CBD comes in all levels but is generally no more than 12% of the cannabinoid content of the cannabis plant. Unlike THC, CBD provides potent therapeutic benefits without the euphoria.
THC and CBD are believed to have a synergistic effect meaning that when they are both present at therapeutic levels in a marijuana strain, they are more effective than simply alone.
While CBD was once constantly in the shadows, giving THC all the spotlight, it is now slowly coming into the light due to its healing properties. Similar to THC it has versatile benefits and is helping patients who suffer from conditions such as diabetes, rheumatoid arthritis, alcoholism, epilepsy, antibiotic-resistant infections, PTSD, and neurological disorders.
One of the most amazing aspects of CBD is its combined strong anti-inflammatory, anti-oxidant and neuro-protective properties which assist in the treatment of Alzheimer’s and Arthritis. Cannabis is now thought to be one of the most effective treatments for these conditions.
So without further ado, here is our list of best marijuana strains that help patients worldwide combat Arthritis
5 Best Marijuana Strains for Arthritis
#1 The Girl Scout Cookies Cannabis Strain
Girl Scout Cookies, aka GSC, is one of the best cannabis strains on the market to treat pain. This amazing hybrid strain is known for its high THC content that produces powerful, full-body pain relief.
#2 The Cannatonic Cannabis Strain
Go into any dispensary and ask about his marijuana strain and you’ll get and immediate response; “This cannabis strain is great to treat pain and inflammation.” Cannatonic has a low THC, high CBD content and produces a mellow high that is typically short-lived. It’s the perfect marijuana strain for pain relief and won’t get you couch-locked.
#3 The Famous ACDC Cannabis Strain
As the rock band put it, this is the T.N.T. of all strains. It’s the ultimate powerhouse strain that will blow that pain away. ACDC is a Sativa-dominant strain and originates from Cannatonic. ACDC stands out for its low THC, high CBD ratio providing its patients with immediate pain relief without the high.
#4 The Harlequin Marijuana Strain
For those of you who need to function during the day and want to avoid a euphoric high, Harlequin is the perfect strain. This Harlequin sativa dominant cannabis strain usually has a 5:2 CBD: THC ratio which makes it a super effective strain for treating conditions such as arthritis pain.
#5 The Canna Tsu Cannabis Strain
Due to this strain’s magical CBD powers, it has become a popular strain used to fight inflammation. Packed with a high CBD, low THC ratio, this strain will keep a clear head and allow you to focus on other things apart from the pain associated with arthritis.
Over the last couple of weeks, we’ve received a ton of emails telling us about the benefits of raw juicing cannabis. Raw cannabis juices and are packed with antioxidant and anti-inflammatory compounds. By juicing cannabis, you can also benefit from Cannabinoid acids and larger doses of vital nutrients.
Final Thoughts About Cannabis as a Treatment for Arthritis
Medical marijuana is only now coming into the light in regards to its therapeutic benefits and how it is helping people with their day to day conditions. One of those conditions is arthritis. Share your experience with us by commenting below or tell your story on our Facebook post.
Here’s how it works: Cannabis contains dozens of cannabinoids, chemicals that interact with our body’s own endocannabinoid system, which regulates inflammation and pain. THC is the most well-known (it’s what gets you high) and CBD is another. “The THC in cannabis is the primary pain reliever, so what I do as a doctor is find the smallest dose of the THC or cannabis that will do the job with the minimum side effects,” Dr. Tishler says. The most common side effect, unsurprisingly, is getting stoned. “All pain medications have side effects and cannabis is no different,” he says.
Like any other clinician, Dr. Tishler helps arthritis patients manage side effects through dosing, timing, and route of delivery. For example, for chronic pain, he might recommend an edible with 5 mg THC twice a day for long-lasting coverage, and a vaporizer for acute relief on an as-needed basis.
“One cannabinoid called THC-A—which is different from THC—is a better anti-inflammatory than THC or CBD,” he says. “When I treat somebody with an autoimmune disease like rheumatoid arthritis, I often try to add THC-A to the THC so that we’re covering the underlying inflammation as well as deriving pain control.” Dr. Tishler supplements THC-A through an extract; Seritt gets her dose of THC-A and THC from a paste made from fresh plants that she grows herself.
Watch Our Interview with Dr. Tishler.
Why Do Medical Marijuana Programs Matter?
When it comes to CBD for arthritis, Dr. Tishler is unconvinced that the extract is particularly useful for pain at the available doses. (The most compelling research so far has been in rodents, not humans.)
“There’s also the issue of how harmful hemp-derived CBD oils may be. Not because of the CBD, but because of whatever else might be in that bottle,” says Dr. Tishler, who cites traces of everything from pesticides and heavy metals to fentanyl.
The 2018 Farm Bill loosened regulations on hemp-derived CBD by removing hemp products from the list of Schedule 1 drugs. There’s only one CBD drug that’s been approved by the U.S. Food and Drug Administration (FDA) — Epidiolex for severe epilepsy — and the FDA doesn’t regulate supplements, so scams are rampant. Recent research from Penn Medicine revealed that 70% of CBD products available online mislabeled their CBD content. These are precisely the types of shenanigans medical marijuana laws are meant to prevent, and why medical programs are important, even for states with legal recreational cannabis.
“Medical patients are not the same as recreational cannabis users,” says Dr. Tishler. An arthritis patient wants medicine that’s easy to take, precisely dosed, and provides reliable results with the least intoxication. (Not exactly a recreational user’s idea of a party.)
Having a medical system in place allows physicians to follow up on what patients are purchasing through the registry system. Medical dispensaries and dual-licensed shops are best equipped to answer patient questions about how to dose cannabis or what contraindications there might be.
Marijuana for Rheumatoid Arthritis Joint Pain: Pros and Cons
Who Uses Medical Marijuana for Pain?
But people living with rheumatic diseases — conditions that affect joints and connective tissue, like rheumatoid arthritis — often endure severe pain, and many of them use marijuana. One study published in the September-October 2009 issue of the Journal of Opioid Management found that 80 percent of medical marijuana users in a U.S. pain clinic were using cannabis to treat myofascial pain — pain that affects muscle and tissue. Among medicinal marijuana users in Canada, 65 percent said they use medicinal marijuana for severe arthritis.
The Case for Marijuana Use In Rheumatoid Arthritis Treatment
And medical marijuana scientific advocates say there’s absolutely nothing wrong with that. “Chronic pain is a symptom of rheumatoid arthritis, and when it comes to chronic pain, we have 9,000 patient years of data showing that THC effectively treats it,” says Jahan Marcu, PhD, chief scientific officer for Americans for Safe Access, an organization that works to ensure safe and legal access to cannabis for therapeutic use and research. “Cannabinoids stop the transmission of pain and decrease inflammation, and that’s very important for people with joint issues.”
Specific Risks That Worry Rheumatologists
But many rheumatologists remain cautious. Mahsa Tehrani, MD, a rheumatologist in Washington, D.C., doesn’t recommend medical marijuana to her patients because of the dearth of reliable evidence — and the risk of mental and heart-related side effects. Some of these issues, such as depression and heart disease, are serious health conditions — complications for which people with rheumatoid arthritis already face an increased risk.
“Given the known risks of psychiatric side effects as well as heart problems reported with marijuana, recommending this drug for rheumatic conditions seems questionable,” said Dr. Tehrani, who wasn’t involved in the 2014 review.
If you live in a state where medical marijuana is available, have a conversation with your doctors to see if it’s a treatment therapy they would recommend for you.
Eight Things Rheumatologists Should Know About Medical Marijuana
1. Marijuana is the dried leaves and flowers of the plant Cannabis sativa that contains over 450 different compounds. Two of these, THC and cannabidiol, are of greatest interest at present.
Medicinal and psychoactive properties have been attributed to flowering plants of the genus Cannabis for thousands of years, but herbal cannabis remains mostly outside mainstream medicine. Its clinical status is prejudiced by the fact that 4% of the global population uses (or misuses) marijuana as a “recreational” drug.
At least 70 of the 450 compounds in the plant Cannabis sativa are classified as phytocannabinoids, but the therapeutic effects of these molecules are not yet fully understood.1 Two are of particular significance to medicine:
• Tetrahydrocannabinol (THC), produced by the action of heat on the acid precursor of delta-9-tetrahydrocannabinol (D9-THC), is known for its psychoactive and pain-relieving properties.
• Cannabidiol has potential therapeutic application due to its effect on immunological function and its potential to counteract the negative psychoactive effects of THC.
2. Receptors that engage cannabinoid molecules are ubiquitous throughout the human body.
These receptors are located in the central and peripheral nervous system, as well as on immune, bone, and synovial cells. They interact with cannabinoid molecules that can be found in three setings:
1) Synthetic tricyclic terpenes;2
2) Phytocannabinoids, including THC and cannabidiol;
3) Endocannabinoids, endogenenous ligands derived from the breakdown of phospholipids in a pathway distinct from the inflammatory prostaglandin pathway.3
Cannabinoid actions are mainly mediated via the two best-explored endocannabinoid receptors. This is not a simple on/off process, but rather a complex phenomenon involving endogenous and exogenous ligands, cross-reactions with non-cannabinoid receptors, and plasticity of response dependent upon local tissue characteristics or the presence of other molecules such as opioids.4
3. In the setting of arthritis, the endocannabinoid system is activated locally in response to tissue changes and functions as an endogenous pain modulator.
Examined mainly in laboratory studies, the endocannabinoid system has an impact on pain mechanisms, immune function, inflammation, and bone health. Many effects are still poorly understood, and are the subject of active study.
Cannabinoids exert their physiological effect through binding to two G protein-coupled receptors (CB1 and CB2) as well as a recently described putative third receptor, GPR55.5 Animal study has shown that joints affected by both degenerative and inflammatory arthritis actively express these cannabinoid receptors and produce endocannabinoids.
• In a rat model of osteoarthritis, exposing the CB1 receptor to the agonist arachidonyl-2-chloroethylamide (ACEA) resulted in increased synovial blood flow and reduced hypersensitivity of joint nociceptors (pain sensing neurons).6
• Interestingly, a paradoxical response was observed for the response of the CB2 receptor. An agonist to the CB2 receptor inhibited nociceptor activity in control (normal) joints, but caused sensitization of osteoarthritis joint afferents.7 These paradoxical findings emphasize the complexity of the cannabinoid system.
• Human synovial fluid from osteoarthritis and rheumatoid arthritis joints, but not from normal controls, contained the endocannabinoids anandamide and 2-arachidonyl glycerol, confirming that endocannabinoids are synthesized following tissue injury.8
The immunosuppressive and anti-inflammatory actions of the cannabinoid system are less clearly understood, but believed to be mediated via the CB2 receptor, with effects on apoptosis, inflammatory cell proliferation and trafficking, cytokine production and regulation of T cells.9 The postulated effects of CBD are both anti-inflammatory and anti-oxidative.10
4. Many rheumatology patients may seek cannabinoids to relieve pain, but solid evidence for effectiveness is lacking.
“Severe pain” is cited as the most common reason persons in North America provide when using herbal cannabis medically. Commonly, they identify musculoskeletal conditions as the specific medical condition causing the pain.11,12 As rheumatic diseases are not curable, many patients may self-medicate with herbal cannabis under the impression that it is a safe complementary treatment, encouraged by the current societal perception of effect.
However, to date, not a single published randomized controlled trial has examined the dosing, efficacy, or side effect profile of herbal cannabis in patients with rheumatic diseases.13 The only sources for information about the effects of herbal cannabis or similar compounds in rheumatic diseases are:
• anecdotal reports,
• two small epidemiological studies,14, 15
• a single study in patients with rheumatoid arthritis of the oro-mucosal spray of nabiximols, a combination of D9-THC and cannabidiol,16 and
• two studies of nabilone, a synthetic analogue of THC, in fibromyalgia.17,18
5. The groundswell of advocacy driving the use of medicinal herbal cannabis is contrary to medical opinion.
Herbal cannabis has been catapulted into disease management by a groundswell of public advocacy, propelling regulatory bodies worldwide to consider legalizing herbal cannabis for medicinal use. This was done irrespectively of the limited scientific basis to support statements about either effect or risk. Thus, physicians may be required to provide care for patients who self-medicate with herbal cannabis or request guidance regarding potential use of this agent.
Recent surveys report that physicians lack confidence in their knowledge of cannabinoids in general, and in their perceived competence to advise patients effectively about use.12
• In a survey of family physicians in Colorado, only 19% thought that physicians should recommend medical marijuana, and 92% reported a need for more education.12
• Two thirds of Canadian rheumatologists expressed poor confidence in their knowledge of cannabinoid medical use. Fully 70% stated that there is currently no role for herbal cannabis in the treatment of rheumatic complaints.19
It is also increasingly recognized that sanctioning use of herbal cannabis for therapeutic reasons is currently provided by a small number of physicians for the majority of patients.12 In Colorado, 15 physicians accounted for almost half of recommendations for medical marijuana. Motives for this medical behavior should be questioned, and raise ethical concerns.
6. Smoking cannabis cannot be recommended.
While herbal cannabis may be either ingested or inhaled, inhalation is the preferred method of administration by most users as inhaled cannabis acts rapidly within a few minutes. However, smoking cannabis is not recommended because:
• It delivers noxious compounds such as polycyclic aromatic hydrocarbons, tar, and carbon monoxide. The risk for lung cancer has been debated, but with increasing evidence for true risk when studies have been controlled for cigarette smoking.20-22 In a longitudinal study of Swedish military conscripts followed for 40 years from the ages of 18 to 20, the risk for lung cancer was doubled if they had used cannabis on at least 50 occasions (hazard ratio 2.12, 95% CI 1.08 – 4.14).22
• It is impossible to estimate the dose delivered. Plasma concentrations of THC are extremely variable after smoking a “joint.” Blood levels after smoking 0.5-1.0 grams of dried substance vary between 7-100ng/mL, and are affected by the frequency, depth, volume and holding time of inhalation as well as the concentration of THC in the herbal product.23, 24 The THC concentration in illicit marijuana has doubled over the past decade, with measured concentrations varying between 1 to 30%,25 and thus the bioavailable concentrations of THC can vary from 2 to 56%.26 There is also discordance between the measured THC plasma peak and the maximum subjective psychoactive effects which occur an hour later, and can be augmented by opioids.
Oral administration could be preferred, offering a more delayed effect, lower peak plasma levels, more protracted pharmacologic effects, and fewer psychoactive effects that may lead to abuse.27 However, gastrointestinal absorption is erratic and much of the ingested cannabinoid is eliminated by first-pass metabolism in the liver.27
7. Contrary to common belief, herbal cannabis is not an innocuous substance, either for short- or long-term use, and its effects undermine the primary goals for treatment of rheumatic pain, namely reduction of symptoms and maintenance of function.
• Even in regular recreational users, acute administration impairs reaction time, selective attention, short-term memory, and motor control for up to 5 hours, with increasing effects for increasing doses.28 Acute cannabis use was associated with at least a doubling of risks for serious and fatal motor vehicle collisions according to a recent systematic review and meta-analysis of 9 studies involving 49,000 participants.29 Health Canada has warned that the ability to drive or perform activities requiring alertness or coordination may be impaired for up to 24 hours after consuming herbal cannabis.30 This risk may be compounded by the presence of other medications, especially analgesics.
• Hypotension and tachycardia shown to follow acute administration of herbal cannabis could compromise cardiovascular health in rheumatology patients with underlying heart disease, and be an added risk for cardiovascular events.31 Acute cannabis use increases the risk for myocardial infarction five-fold and reduces the exercise capacity of those with angina pectoris by half.
• Cannabis has adverse acute and chronic effects on mental health. The immediate psychiatric effects include acute anxiety and agitation, suicidal ideation, and acute psychosis.32, 33 The long-term effect on mood and especially depression are less clear, but evidence is increasing that depression is more prevalent in current cannabis users.34 Herbal cannabis is well recognized to aggravate or unmask serious psychiatric disease such as psychosis and schizophrenia.35 The addictive potential is another risk: Over a 3 year period the cumulative incidence of cannabis dependence was 37.2% (95% CI 30.7-43.8%) for young recreational users.36 Once a person is addicted to a substance, potential for use of other addictive substances remains a concern, with the initial substance acting as a gateway drug. Finally, recreational use of cannabis could result in working memory deficits that is associated with various subcortical neuroanatomical changes.37
8. How can physicians advise or care for patients with rheumatic disease who are using or proposing to use herbal cannabis for pain relief?
• Consider their motives with careful scrutiny. Many persons using marijuana for medical reasons are former recreational users. Is the patient misusing a medical diagnosis to justify use primarily for non-medical reasons?12, 14, 15
• Remain empathic and caring, but inform patients about the lack of sound evidence for either positive or negative effects of herbal cannabis in rheumatic conditions, adding that the long-term risks are troubling and have not been fully explored.
• Advise patients not to drive for at least 24 hours after using marijuana.
• Tell patients that while there are no grounds on which to recommend herbal cannabis use for rheumatic disease, numerous other pain-management options can be explored.
Physicians, rheumatologists in particular, must be proactive in voicing concerns about the current increasing use of herbal cannabis for treatment of rheumatic complaints, and advocate for further study of individual cannabinoid molecules using standard scientific methods to control dosing and assess efficacy and safety.
Although arthritis is thought to be a disease of 65-year-olds and older, you’ll be surprised to learn that it can affect people of any age, and sometimes even children. There are many medications and ointments that can help with the pain, but they don’t work for everyone, which is why an increasing number of patients want to try medical marijuana.
I wanted to find out more about the weed-arthritis connection, so I figured that the best way to start is to learn all I possibly can about arthritis before hitting Google Scholar and the like. Once I dug through the studies, I visited Reddit for user feedback and, finally, I read strain review websites to find out what people suffering from arthritis actually need in a strain.
Here’s what I’ve found.
A quick introduction to arthritis
Arthritis is inflammation of the joints which causes pain and several other symptoms, but it’s not just one single disease, as many people think. Although the term arthritis is used to refer to joint pain, the actual condition includes up to 200 different joint conditions and diseases, like rheumatoid arthritis (RA), fibromyalgia, gout, lupus, osteoarthritis (OA) and many more.
The statistics say that around 15% of Canadians and 23% of Americans suffer from some form of arthritis. And this number is on a steady rise. Arthritis is a common condition among the aging population (over the age of 65), but it also affects younger people—as much as 56% of arthritis patients in Canada are under 65.
The initial symptoms of arthritis are usually stiffness, especially in the morning, pain and swelling around the joints. Then the other symptoms become more evident: you get tired more quickly than you used to, restless sleep becomes typical, and over time it progressively becomes difficult to move joints and even to use your own hands. There are many different types of arthritis, and equally many causes: improperly healed injuries lead to degenerative arthritis, genetic factors are usually the main cause of osteoporosis, a dysfunctional immune system can lead to lupus or RA, abnormal functioning of metabolism causes gout.
Once again, there is no cure for arthritis. Depending on the type of the disease itself, there are a few more or less effective treatment options. Here are some medications that can be used to keep this condition in check:
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Counterirritants (creams with menthol and capsaicin)
How exactly can cannabis help with arthritis
Over the past few years, cannabis has become a popular supplement among people suffering from arthritis. In every country where the plant has been legalized for medical use, arthritis is on the list of medical conditions that allow for the use of cannabis.
Arthritis is caused by the inflammation of the joint tissue, and cannabis is known as a great anti-inflammatory agent. There are many cannabinoids in the plant, but THC and CBD are the ones “in charge” for fighting pain and inflammation.
When researchers first noticed that cannabis has some potential in treating chronic pain, they basically didn’t have a clue how that actually happens. They first discovered that the joints of people suffering from arthritis have extremely high levels of CB1 receptors. That led them to conclude that the substances in marijuana which trigger the activation of those receptors have the potential to reduce inflammation, as well to reduce pain.
The fact that THC was the one binding to those receptors and that it was so effective in reducing inflammation, triggered the further curiosity of scientists. So, in another study, a group of researchers discovered that THC was able to change molecules, leading to suppression of inflammation.
The second most prevalent cannabinoid in marijuana called cannabidiol (or just CBD), has shown to be effective in treating arthritis symptoms as well. According to a study done by the University of Kentucky, applying CBD topically can relieve inflammation as well as pain in conditions connected to arthritis. What is also important, besides the great therapeutic potential, is that CBD provides relief without any side-effects. Another study found that early CBD treatment can prevent pain and nerve damage in osteoarthritic joints.
What we can take away from these studies is that THC and CBD work in unison, but that high CBD marijuana strains may be the best choice, in this case, giving us the best of both worlds—pain relief with clear headedness and without strong psychoactive effects.
Arthritis patients’ experiences with cannabis
When it comes to experiences of real patients, there are more than a few interesting stories online. Here are just a few of the more interesting ones shared by arthritis patients, but feel free to investigate this yourself.
Best strains for arthritis
Before you start experimenting with different strains for arthritis, think about your lifestyle and what you would like to achieve. What time of the day do your symptoms occur? Would you rather treat inflammation or the pain? Do you have difficulties sleeping? The key here is to choose the right strain: some are energizing, some are sedative, some have a lot of THC, while some are high in CBD. To speed up your search, I made a list of different kinds of strains, for different occasions.
Please take these recommendations with a grain of salt, as the effects of cannabis are notoriously subjective.
Cannatonic: One of the most popular medical hybrid strains, Cannatonic is known for its high CBD levels and low THC content. It’s mainly used for treating all sorts of pain as well as muscle spasms, which makes it one of the favorites among arthritis patients. It’s great for relaxing during the day.
Anesthesia: The name says it all—it kills any type of pain in no time. Anesthesia is an indica strain recommended for nighttime use since it’s very sedating. It will give you a strong body-high and a cerebral buzz, so the best time to use it is only after you have finished with your day.
GSC: Also known as Girl Scout Cookies, GSC is a hybrid known for its high THC levels. It’s usually recommended for severe pain. Besides pain, GSC is good for beating stress and depression (a common condition for arthritis patients).
Harmonia: Although it’s an indica, Harmonia will not make you as sedated and locked to your couch as you would expect. And this is because this strain has slightly higher levels of CBD than THC, which diminishes its psychoactive effects. You’ll be clear-headed and ready for your daily challenges.
Harlequin: What’s so great about this strain is that it relaxes without sedation and intoxication. Harlequin is a sativa-dominant hybrid, with high CBD content. It’s a popular strain for fighting inflammation and pain, especially pain caused by arthritis.
Remedy: A high CBD indica, Remedy has been primarily used for treating nerve inflammation pain. We can freely say that there are almost no psychoactive effects with this strain. Arthritis patients looking for relief can use Remedy during the day without worrying about feeling “high’.
ACDC: One more sativa-dominant hybrid that doesn’t alter the mood and mind. ACDC is a popular daytime strain with plenty of medical properties and almost no psychoactivity at all. What is so special about this strain is that it flushes pain out almost immediately.
Pennywise: A fine choice for an afternoon use, since it provides a mild psychoactive effect. This strain not only blocks pain, but it also helps other conditions and symptoms that come with arthritis, like neurological disorders.
Death Star: A very powerful indica that will make you quite high. Death Star is a perfect late afternoon choice, with high THC levels to take care of pain and will help you fall asleep.
Power Plant: Being a pure sativa, Power Plant is a perfect way to start your day. This strain has bone-protecting properties and, combined with pain-relieving features, is one of the best strains for arthritis patients.
Greencamp.com is an educational website dedicated to shedding the light on many unexplored sides of medical and recreational cannabis. Aside from informing people of safe cannabis use, Greencamp also provides technology for finding optimal cannabis treatment.