Does Topical CBD work for Muscle and Joint Pain?

Michael J. Scherer Asked

I have A-fib and looking for a cream or something Topical to help with my muscular and joint pain. Tried CBD oil (400mg)and had little to no effect. Need something I can use daytime without brain fog.

Answer

Cannabidiol (CBD) is one of the most popular supplements in the United States with OTC (over-the-counter) sales projected to reach $20 billion in the near future

CBD is one of many constituents of cannabis (i.e. marijuana) and is the active ingredient in the FDA-approved prescription drug, Epidiolex. Epidiolex is available as an oral solution and is used to treat rare seizure disorders. 

CBD products are widely available as dietary supplements, topicals, and infused foods and drinks, despite their questionable regulatory status.

Topical CBD specifically, is most commonly used for muscle and joint pain, rashes, and other skin conditions.

Unfortunately, there's no high-quality evidence that supports topical CBD as an effective treatment for muscle and joint pain. Part of this is because we've really just begun to investigate CBD in-depth, but its legal status also makes it difficult to conduct research on the compound. 

Nevertheless, studies of topical CBD in animals suggest it may be beneficial for muscle and joint pain. It’s important to note that these experiments involve animal models of disease and do not always mean the same effects will occur in humans. Therefore, these types of studies need to be evaluated with a small measure of discernment.

 

What Causes Muscle and Joint Pain?

Muscle and joint pain can be caused by a variety of factors. Some common causes include injury or overuse of muscles or joints, arthritis, fibromyalgia, lupus, and infections such as the flu or Lyme disease. In some cases, muscle and joint pain can also be a side effect of medication or a symptom of an underlying medical condition. It's important to speak with a healthcare professional to determine the cause of your specific symptoms and to receive appropriate treatment. 

 

Does Topical CBD Work For Muscle and Joint Pain?

Very few studies using topical CBD for joint pain have been carried out to date. CBD has poor absorption when taken orally, so using topical CBD may more effectively deliver CBD to painful joints.

Animal studies suggest that transdermal delivery of CBD results in better absorption than CBD taken orally.

“The transdermal administration of CBD has also been observed to provide better absorption than the oral administration route…”
Molecules. 2018 Oct; 23(10): 2478

Topical and transdermal dosage forms are both applied to the skin, but topical dosage forms affect the site of application whereas transdermal dosage forms are intended to be absorbed and have a more widespread effect.

Topical CBD products often contain other potentially active ingredients such as camphor, menthol, essential oils, and other aromatic compounds. Due to the multiple potentially active ingredients in these products, it’s hard to determine if an effect is due to CBD, or other ingredients present in the product.

 

How Does Topical CBD Work For Joint Pain?

CBD has a variety of effects, but we will focus here on its mechanism behind a potential reduction in muscle and joint pain.

CBD binds and activates a receptor on our nerve endings called the transient receptor potential vanilloid-1 (TRPV1). TRPV1 receptors are expressed on nerve fibers in our skin and are involved in pain perception. Qutenza (capsaicin) is a transdermal patch that’s approved by the FDA for the treatment of neuropathic pain.

Capsaicin works by activating TRPV1 receptors, which might initially increase pain, but then decreases the amount of TRPV1 receptors on nerve endings resulting in a reduction of pain.

This mechanism of CBD holds the most weight in my opinion because it’s been verified to work in clinical trials by the FDA and because the evidence supporting CBD’s affinity to bind and activate the TRPV1 receptor is well documented:

“(CBD) behaved as a full agonist as compared to capsaicin…The efficacy was almost identical to that of a maximal concentration of capsaicin.”
Br J Pharmacol. 2001 Oct; 134(4): 845–852.

In theory, topical CBD may activate TRPV1 receptors in the skin and reduce joint pain similar to how capsaicin works, but more evidence is needed to confirm this mediates pain relief in humans.

In addition to binding TRPV1 receptors, CBD may work to reduce pain in other ways. Topical CBD reduced two markers of inflammation in an animal model of osteoarthritis.

“Topical treatment with CBD reduced leukocyte trafficking and joint hyperemia…”
Pain. 2017 Dec; 158(12): 2442–2451

A reduction of leukocyte (white blood cell) trafficking and hyperemia (excess blood volume) may have contributed to pain relief observed in the same study:

“…local CBD administration inhibited pain and peripheral sensitization in established OA (Osteoarthritis).”
Pain. 2017 Dec; 158(12): 2442–2451

CBD is also known to have neuroprotective effects. This means it preserves the structure and function of nerves. Again, the same study mentioned above showed that CBD used before osteoarthritis prevented a form of nerve damage called demyelination.

“Prophylactic CBD reduces joint nerve demyelination in MIA-induced OA”
Pain. 2017 Dec; 158(12): 2442–2451

While studies in humans are limited, some animal studies show that topical CBD may be effective for joint pain due to osteoarthritis and neuropathic pain. Although preliminary animal studies have shown promise, more large, well-designed studies in humans are necessary.

Is topical CBD safe if I have Atrial Fibrillation?

Atrial fibrillation (A.Fib) is an irregular and often fast heartbeat that can lead to blood clots in the heart. Topical CBD is likely safe if you have Atrial fibrillation. Topical products are intended to have local effects and are not intended to be systemically absorbed. 

Are all Cannabis Products Safe if I have Atrial Fibrillation?

All cannabis products are not safe to use if you have atrial fibrillation. Products that are high in delta-9-tetrahydrocannabinol (THC) can increase your heart rate, blood pressure, and cardiac demand. Therefore, products high in THC should be avoided if you have A.Fib. 

The topical CBD products you asked about are likely a much safer option for you given your history of A.Fib. 

 

Can Topical CBD Cause Brain Fog?

CBD isn't likely to cause brain fog even with systemic administration. So topical CBD won't likely cause any brain fog symptoms either. 

 

Conclusion

Although no strong research supports topical CBD’s effectiveness for muscle and joint pain. Animal studies suggest that topical CBD may work by binding to TRPV1 receptors and through less established anti-inflammatory and neuroprotective pathways.

More studies are needed to further understand CBD’s effectiveness for joint and muscle pain. Be sure to talk with your doctor before using topical CBD.