By now, you’ve surely heard some buzz about CBD, the cannabis-derived ingredient that’s been touted as a miracle worker, serving as an anti-inflammatory agent, an anti-anxiety treatment, and everything in between. You can find it in oral tinctures, gummy candies, body oils and creams sold in your mainstream brick-and-mortar stores—no longer just your local health food or vitamin shop.
“Sales data indicate that the CBD market is growing rapidly, and there are plenty of internet forums where those who use these products discuss that they work for them,” says Tory Spindle, Ph.D., a researcher in the Behavioral Pharmacology Research Unit at the Johns Hopkins Bayview Medical Center. So, if you deal with chronic muscle and joint pain from, say, rheumatoid arthritis or multiple sclerosis, you may be wondering if slathering some directly on your achy areas can help you get some relief as an alternative to typical pain meds.
We asked top docs to weed out the speculation from the real science, so you can decide if CBD is for you.
First, What Is CBD Exactly?
Short for cannabidiol, CBD is a compound (a.k.a. phytocannabinoid) found in the cannabis sativa plant. Unlike its cousin, tetrahydrocannabinol (THC), another well-known cannabinoid found in the marijuana plant, CBD doesn’t get you high. It’s not a psychoactive. You can get CBD from both the hemp and marijuana plants (side note: these two shrubs are in the same plant family), but when derived from hemp, there’s only trace amounts of THC (the legal limit is .3%). CBD from marijuana will obviously contain a bit more THC. CBD has been linked to many benefits including helping with insomnia, anxiety, depression, cancer-related side effects, and pain relief.
How Does CBD Work on Chronic Joint and Muscle Pain?
“We have an endogenous cannabinoid system [a.k.a. endocannabinoid system] within our bodies,” says Bruce Solitar, M.D., rheumatologist and clinical associate professor of medicine at NYU Grossman School of Medicine in New York City. “That means we have cannabinoid receptors throughout our organs and tissue,” he says.
They’re in your skin, as well as the lungs and brain. (This is the reason why marijuana gives you the munchies or makes you sleepy—the phtyocannabinoid THC interacts with those brain receptors.) “As a rheumatologist, I’ve been interested in this because there are cannabinoid receptors in the joints and nerves.”
We don’t know for sure, but CBD likely blocks some of the effect in those nerves, resulting in less pain, he says. CBD may work similarly to other medications we take for pain, or even topical analgesics, but the plant-based ingredient may be more appealing for someone who prefers to take a natural approach to pain management.
What Does Science Say About CBD and Chronic Pain?
Experts are quick to point out that the research on CBD for chronic pain, especially topical CBD, is pretty limited. A review in the journal Antioxidants has confirmed that CBD can reduce inflammation, but can it help when applied topically? The research is slim. The closest we’ve come: One animal study in the European Journal of Pain showed that when CBD gel was applied transdermally to the skin of rats with arthritis, it cut down on knee pain, swelling, and inflammation.
It’s important to note that a transdermal application is a patch designed to deliver ingredients into bloodstream via the skin—a cream likely won’t do that. Another small study on humans showed that CBD oil applied topically made a significant improvement in the pain, itch, and cold sensations in those with peripheral neuropathy (nerve damage that causes pain and numbness in their lower extremities). Not so promising: A phase 2 trial of a prescription CBD gel that’s applied with a transdermal patch didn’t significantly reduce pain in people with knee osteoarthritis compared to the placebo.
So, until more large-scale, peer-reviewed studies are done, physicians are skeptical of topical CBD. “Especially with commercial products, there’s just not enough clinical evidence to back up any claims for joint and muscle pain,” says Dr. Spindle. “That’s not to say they’re not effective, but there are no clinical studies to prove they are,” he says.
The other issue with topical CBD is its lack of regulation. The only FDA-approved CBD product is a pharmaceutical drug made for epilepsy patients. That means all the creams, oils, and balms you see on shelves aren’t FDA-approved.
Right now, there are no clear guidelines about how much CBD should be in a product, how much to apply, when to apply, etc. “These products are very inaccurately labeled a lot of times,” says Dr. Spindle. “People often spend a good amount of money on them, and you may not even know the amount of CBD in the product,” he says. One study in JAMA showed that of 31 CBD-containing products, only 1/3 of them actually contained the amount of CBD listed on the label.
So, if You’re Going to Try It, What Should You Look for?
“The formulation of the product, amount applied, application site, and other factors may very well influence absorption and effects, but without any real data, it’s hard to speculate,” says Dr. Spindle. In the meantime, there are some helpful tips you can use:
You want to see the word cannabidiol (or CBD) on the ingredient list. You may see words like hemp, hemp seed oil, or hemp butter, but those terms don’t necessarily mean your product contains pure CBD. Ideally, you want to get your CBD products from a reputable source with a third-party lab certificate to verify that it actually contains what it says it does (the label will likely say it has a certificate of authenticity or COA, typically available on the site’s website, or include a QR code to view).
As for how much CBD your product should contain? Experts don’t know yet. That rat study mentioned above included a pretty hefty dosage (up to 62 mg for a little rat), likely more than you’ll find in a cream at your local drugstore.
Are There Any Risks?
Because formulations will vary greatly, finding a CBD topical that helps with your achy joints and muscles may take some trial and error. Still, Dr. Solitar says, “in the scheme of things, topical CBD is probably low risk, fairly high potential for reward.” But be wary of allergic reactions, especially if you have sensitive skin, and you don’t want to apply topical treatments to open wounds or if you have a skin condition such as psoriasis, he adds.
Experts say topical creams and ointments should pose far less risk than oral CBD products, but, still, if you’re dealing with a chronic condition, just run it by your physician before using.