ATLANTA, SEPTEMBER 24, 2019 – As the leading organization for people with arthritis, the Arthritis Foundation has just released the first CBD guidance for adults with arthritis. CBD, or cannabidiol, a plant-based compound, has become popular among people with arthritis seeking to ease chronic joint pain. With no federal oversight of CBD products, a lack of scientific evidence for safety or effectiveness, and even uncertainty about its legality, there has been vast confusion for patients with arthritis and health care providers too.
“While CBD is controversial and its effectiveness inconclusive, people with arthritis aren’t waiting to try it to treat their pain,” said Cindy McDaniel, Arthritis Foundation senior vice president of consumer health and impact. “To help gain a deeper understanding about how people with arthritis feel about using CBD, we conducted a national survey in July. Our survey results confirmed the need to push for more regulation and provide useful CBD guidance.”
Of the 2,600 people who responded to the survey*, 79% are currently using CBD, have used it in the past or are considering using it as an alternative therapy to help manage their arthritis pain.
To develop the CBD guidance for adults with arthritis, the Arthritis Foundation partnered with leading CBD and arthritis pain experts – Daniel Clauw, MD, Mary-Ann Fitzcharles, MD, and Kevin Boehnke, PhD – to develop practical guidance that addresses top questions.
“Millions of people in the U.S. are likely trying to use cannabinoids to treat pain, and many are doing this in ways that might cause more harm than good, especially when they use high doses of THC,” said Daniel Clauw, MD, a professor of anesthesiology, rheumatology and psychiatry at the University of Michigan and director of the Chronic Pain and Fatigue Research Center. (CBD is one of the more than 100 cannabinoids, or active compounds, in cannabis. THC, another compound, is the chemical in marijuana that gets users high. CBD is not intoxicating.)
“It’s important that the Arthritis Foundation has taken a stand on CBD,” Dr. Clauw said. “Right now, it appears to be fairly safe and might help certain types of pain. It’s far better to give this guidance, even if preliminary, because otherwise people will have no guidance whatsoever.”
The Arthritis Foundation also sent a formal comment to the U.S. Food and Drug Administration (FDA) in July urging the agency to expedite the study and regulation of CBD products to help make them a safe option for the 54 million people with arthritis.
The official statement from the Arthritis Foundation reads:
As the largest organization representing the voice and needs of people with arthritis, the Arthritis Foundation has always welcomed new treatment options because no single drug, supplement or therapy works for everyone. We believe patients should be empowered to find safe management strategies that are appropriate for them. The more options available, the likelier it is that more people will benefit.
We are intrigued by the potential of CBD to help people find pain relief and are on record urging the FDA to expedite the study and regulation of these products. While currently there is limited scientific evidence about CBD’s ability to help ease arthritis symptoms, and no universal quality standards or regulations exist, we have listened to our constituents and consulted with leading experts** to develop these general recommendations for adults who are interested in trying CBD.
“Listening to people with arthritis – using data (surveys and Live Yes! INSIGHTS), patient listening sessions and testimonies – drives our work, from science to programming to setting our advocacy agenda,” said the Arthritis Foundation’s McDaniel.
The Arthritis Foundation continues to ask people with arthritis to raise their voice and share their day-to-day experiences via Live Yes! INSIGHTS, so the organization can continue to break down barriers to care, accelerate research and tailor local and national programs that fit the needs of people with arthritis.
“The Arthritis Foundation values the patient voice,” said Stacy Courtnay, rheumatoid arthritis patient and a member of the Arthritis Foundation Patient Leadership Council. “Some doctors aren’t open to discussing CBD with patients, and it’s fantastic and encouraging that the Arthritis Foundation is helping people with arthritis gain access to whatever treatments might help them.”
While there are no established clinical guidelines for CBD use, the medical experts who worked in partnership with the Arthritis Foundation agree on the following points:
Beyond providing CBD guidance for people with arthritis, the Arthritis Foundation has a track record for bringing important issues that people with arthritis face into the public dialogue, including authoring the Osteoarthritis (OA) Voice of the Patient Report that presented treatment options most important to patients with OA and helped influence the FDA’s updated osteoarthritis research and treatment guidance and legislation calling for transparency at the pharmacy counter.
To impact the future of arthritis, visit Live Yes! INSIGHTS.
*Read the survey results, “Patients Tell Us About CBD Use.”
**Our gratitude to the following experts for their partnership and guidance:
Kevin Boehnke, PhD, a researcher at the Chronic Pain and Fatigue Research Center at the University of Michigan, focuses on medical cannabis as an analgesic and opioid substitute in chronic pain.
Daniel Clauw, MD, a professor of anesthesiology, rheumatology and psychiatry at the University of Michigan and director of the Chronic Pain and Fatigue Research Center, leads research on arthritis pain and fibromyalgia, and the effects of cannabis, particularly CBD, in pain.
Mary-Ann Fitzcharles, MD, an associate professor of medicine in the Division of Rheumatology at McGill University in Montreal, Quebec, conducts research on pain and rheumatic diseases. She is the lead author of the 2019 Canadian Rheumatology Association (CRA) position statement for medical cannabis.
About the Arthritis Foundation:
The Arthritis Foundation is the Champion of Yes. Leading the fight for the arthritis community, the Foundation helps conquer everyday battles through life-changing information and resources, access to optimal care, advancements in science and community connections. The Arthritis Foundation’s goal is to chart a winning course, guiding families in developing personalized plans for living a full life – and making each day another stride towards a cure. The Foundation also publishes Arthritis Today, the award-winning magazine that reaches 4 million readers.
Managing the chronic pain of arthritis every day can be a major balancing act. Those suffering from arthritis are desperate to find ways to decrease pain and improve sleep and their overall ability to function. Today, it’s common for people with arthritis to be asked: “Have you tried CBD for your arthritis pain?”
The Arthritis Foundation recently asked this question in a survey, and more than 2,600 arthritis patients answered. People with many different types of arthritis responded — the majority of whom have been living with osteoarthritis (52%) or rheumatoid arthritis (45%) for 10 or more years.
The results were clear: People with arthritis are curious to learn more about CBD. Cannabidiol, or CBD for short, is extracted from the hemp plant, a variety of cannabis that does not have the psychoactive effects of the variety grown for marijuana. CBD-based products are booming and have become increasingly easy to buy online and in local stores and clinics. Industry reports show that people who buy CBD cite arthritis and/or pain from arthritis as one of the most common reasons for purchasing CBD.
How are people with arthritis using CBD today? And what questions do patients have about the therapy? Here’s what you shared:
1. Many people with arthritis are using CBD or have used it.
There is no cure for arthritis, but people with arthritis want to take control by managing their symptoms.
2. Patients are using complementary and alternative therapies to relieve their pain.
Most people currently using CBD report relief of pain, the #1 arthritis symptom.
3. Respondents report a variety of benefits beyond pain relief from using CBD.
While pain is consistently cited as the most oppressive arthritis symptom in all past surveys, the disease causes many troubling effects. Of those currently using CBD to manage arthritis symptoms, roughly 3 out of 4 report it was either effective or very effective in relieving several symptoms.
4. People report improvements in overall well-being, too.
CBD may be beneficial for the body, mind and spirit. People who have used or are currently using CBD report emotional and mental health benefits, in addition to relief of physical pain.
5. People with arthritis have questions and uncertainties about CBD and want more information from their doctor and from resources they can trust.
Your priorities are our mission at the Arthritis Foundation. Your patient insights are powerful — from influencing decision-makers at the FDA to informing articles in Arthritis Today magazine. Your priorities are our priorities.
Clove CBD pain cream contains five essential oils, Clove, Lemon, Eucalyptus, Rosemary and Cinnamon
By Mary Biles on June 23, 2020
I’m stressed. There I said it. Almost three months into this global pandemic and my nerves are getting rather frayed at the edges.
In general terms I’ve been lucky – I’ve not been ill, nor has anyone in my immediate circle. And, unlike many others, at this point I’m not struggling to pay my rent. But lockdown is definitely taking its toll on my inner world as well as my outer. I’m pretty sure I’m not alone in feeling this way and it is no doubt why only last month the World Health Organization announced the gloomy prospect of an impending, pandemic-related mental health crisis.
Psychological stress from any source is known to increase the chances of depression and anxiety.
It’s possible, though, that the stress stemming from coronavirus lockdown may come with its own mental health challenges. Indeed, in a strange parallel to our current corona-normal, one method researchers employ to recreate chronic stress in the lab is to subject animals to repeated restraint.
Unsurprisingly, the stress caused by restraining rodents (and most probably humans) eventually sends them into a state of depression.
It also causes a significant drop in anandamide – the ‘bliss endocannabinoid’ – in the corticolimbic brain regions.
This shouldn’t be a surprise as chronic stress is known to impair the endocannabinoid system (ECS), making us more vulnerable to illness, both mental and physical.
Could my recent emotional dip (and no doubt one shared by millions of people around the world) be partly explained by an endocannabinoid system slowly depleted after three months of confinement? And if the answer is yes, should we all be taking proactive steps to support optimal endocannabinoid function?
To see whether my theory has any validity, I decided to speak to someone with a deeper understanding of our ECS – and who better than neuroscientist and friend of Project CBD, Greg Gerdemen, PhD.
“The physiological stress response throughout the brain and endocrine system seems to be modulated by the endocannabinoids,” explains Dr. Gerdeman. “When you have a high amount of stress and you get that fight or flight response. Endocannabinoids going up in certain key brain areas, like the thalamus and the hypothalamus, are part of what turns that stress response off.”
Chronic stress is known to impair the endocannabinoid system (ECS), making us more vulnerable to illness, both mental and physical.
In basic terms, when functioning optimally the endocannabinoids anandamide and 2-AG activate cannabinoid receptor signaling throughout the body, which helps us adapt to stress and keeps us physiologically within the parameters of healthy homeostasis.
“Animals learn to get past traumatic fear using endocannabinoid signaling,” says Gerdeman. “The very perception of threat is in some way sort of gated by endocannabinoids like a safety switch on a fire alarm. Animals with a higher anandamide level in the amygdala, an area of the brain’s fear center, are less reactive to threat. And if you put a human being in an MRI brain scanner and give them a low dose of THC, those brain areas will be less hyper-reactive to fear of threatening stimuli. The neuroendocrine, physiological circuit of stress is regulated at every point by this endocannabinoid system.”
It’s possible then in our current, much-reduced COVID-19 worlds, rather like the physically restrained rodent, depleted endocannabinoid levels could make us more reactive to the threats, perceived or otherwise, around us.
Lower than normal endocannabinoid levels are also commonly found in the collection of diseases such as fibromyalgia, irritable bowel syndrome, and migraines coming under the umbrella of Clinical Endocannabinoid Deficiency.
Unfortunately, measuring levels of endocannabinoids is no easy task as these compounds are generally produced on demand and are broken down rather quickly once their work is done.
Assuming we’re all probably a little endocannabinoid-challenged at the moment, there are various ways of moving from deficient to balanced.
In their paper, “Care and Feeding of the Endocannabinoid System: A Systematic Review of Potential Clinical Interventions that Upregulate the Endocannabinoid System,” John M. McPartland, Geffrey W. Guy, and Vincenzo Di Marzo discuss several healing modalities – such as diet, exercise, osteopathy, and acupuncture – that can improve ECS function by increasing the production of endocannabinoids; decreasing endocannabinoid breakdown; or augmenting (or decreasing) receptor density or signaling.
“The cannabis plant is nature’s queen of supporting the endocannabinoid system.”
Readers of Project CBD are likely familiar with the cannabis plant’s unique ability to interact with and support the endocannabinoid system. Indeed, without the cannabis plant, the ECS might not have been discovered in the first place.
As Dr. Gerdeman explains: “The pursuit to understand how cannabis works led to the discovery of the receptors that THC and other cannabinoids interact with, especially THC. And that led to that first ‘aha’ moment because these receptors are all over the brain. I mean, our brains are exquisitely wired to be responsive to cannabinoids.
“There is a huge body of research that supports the endocannabinoid system working in this multifaceted way to support homeostasis and wellness. And the cannabis plant is nature’s queen of supporting the endocannabinoid system.”
While consuming cannabis is certainly a direct, efficacious route to giving our ECS a boost, it’s not the only way. If we dig a little deeper into the role the ECS has played in our evolution as a species, we find a few clues on how else we can maintain endocannabinoid health.
Back then our survival depended on procreation, hunting, feeding, and social contact, and it just so happens all these activities - reaching orgasm,
running long distances to catch our prey, eating, and engaging in social play, give us a blissful endocannabinoid hit as a reward, making us more likely to do them all again.
Dr. Gerdeman himself was involved in a study
that showed anandamide levels significantly rise during high intensity endurance running, with the researchers concluding this played a key role in our evolution as a species that’s “wired to run.” For ancient humans, being able to run after game and away from predators was vital for survival. In essence, we survived long ago by becoming endurance athletes.
Gerdeman explains: “Our hominid ancestors were much more tree adapted like other primates that are arboreal. And during a time period [when] widespread forests were starting to shrink and become more of the savanna habitat in eastern Africa, there was an adaptive need for foraging greater distances [for] hunting that was probably endurance based – hunting where you can run animals to exhaustion, so there were certain incentives to run.
“There’s also good evidence that anandamide enhances the palatability of food. So I think about it in terms of like a hunter forager. It’s not just that running for 30 minutes makes you feel good, but you run and get to the foraging space and you start harvesting those yummy berries or you successfully capture prey and you get food. And there’s also a perfectly good reason scientifically to think that the anandamide levels that help to mitigate the aches and pains also motivate the running behavior. It also makes the food reward when you get there, just that much more pleasurable and that much more rewarding.”
So, for Dr. Gerdeman, to maintain endocannabinoid health in the context of the coronavirus, “It’s really important to get up and moving. Finding exercise routines, even if you’re in an apartment, is an important way of feeding the endocannabinoid system and promoting balance.”
His advice is backed up by a 2019 study in which women with major depressive disorder exercising on a bike for twenty minutes at a prescribed moderate speed showed both significant increases in anandamide and improvements in mood.
Exploring whether activities other than pounding a treadmill increase endocannabinoids and in turn boost our mood was the subject of a UK study
commissioned by the BBC television series, ‘Trust Me I’m a Doctor.’ Healthy female volunteers recruited from a local choir took part in four different types of activities on separate days: singing, dancing, cycling on an exercise bike, and the control activity, reading dishwasher and boiler manuals.
Perhaps unsurprisingly, the choir members found their mood significantly improved after the singing activity, which was incidentally led by their choir director. Not only did singing make them feel happier, but it also increased anandamide by 42%. Dancing didn’t fare too badly either, showing an overall upward trend in endocannabinoid levels.
The results of the study would suggest that as well as increasing overall enjoyment, a subject’s preference for an activity may play a role in how much endocannabinoid reward is experienced. My own personal pleasure is dancing, particularly the ecstatic variety. I suspect the joy I feel after a few hours of rhythmically moving my body without any stimulants apart from some damn good music, has a lot to do with a serious spike of anandamide. Or maybe my sheer delight in dancing makes me produce more endocannabinoids in the first place?
“I think it can become kind of circular,” says Dr Gerdeman, himself a seasoned djembe drummer, “is your anandamide promoting your joy or vice versa?”
“You know, there’s a certain way of being naturally high when I get into a zone,” he shares, “and I really just feel something musically. Of course, there’s high activity when you’re hitting a drum as well. But will that elevate endocannabinoid levels? I have no doubt that it would.”
Perhaps the takeaway from all this is despite or even because of the restrictions placed during the coronavirus pandemic, we’d all do well to find ways of expressing our own joy. So jump on that trampoline, join an online Zumba class, bust out your ukulele. Just do whatever it takes to make your soul sing, and your endocannabinoid system will thank you.
To listen to the full interview with Greg Gerdeman, go here.
Mary Biles, a Project CBD contributing writer, is a journalist, blogger and educator with a background in holistic health and TV production. She is author of The CBD Book: The Essential Guide to CBD Oil and hosts the podcast Cannabis Voices. Her website is here.
Copyright, Project CBD. May not be reprinted without permission.
Revision date: Jun 23, 2020