Cannabis for Arthritis
Each month Nurse Practitioner Eloise Theisen will explain how to use cannabis for a specific ailment or issue. Have a protocol you want outlined? Email firstname.lastname@example.org.
Arthritis is a common disease. There are over 100 different types of arthritis. The 2 most common ones I encounter are Osteoarthritis and Rheumatoid Arthritis. Many arthritis sufferers are looking to relieve pain and inflammation. Perhaps their traditional therapies are no longer working.
Osteoarthritis (OA) is a degenerative disease. As we age, many of will experience some symptoms from OA such as pain, swelling and immobility of the joints. OA can occur in any joint, however, it is most commonly seen in the knees, lower back, hips, neck and fingers or toes. According to the Arthritis Foundation, 1 out of 2 adults will develop OA knee symptoms, 1 out 4 adults will experience OA symptoms in the hip and 1 out 12 adults over 60 years old will experience hand OA.
Rheumatoid arthritis (RA) is an auto immune disease. Essentially, a person’s immune system will attack their own joints resulting in pain, swelling and stiffness. In some cases, RA can affect other body systems such as the eyes, skin, lungs, heart and blood vessels. With time, the swelling and inflammation within the joints can lead to joint deformity.
The severity and location of arthritis often determines the treatment. We know cannabis can help with the pain and inflammation associated with arthritis, but deciphering the right product to use can often be overwhelming.
More and more cannabis products are coming to market. With legalization, I expect to see even more products available in the next year. So where does one start?
Many people with OA will start with a topical. They can provide local relief with little chance of experiencing any side effects. A topical may provide pain relief in the hands, neck and ankles/feet. Deeper arthritic pain in the back, knees or hips will often not respond to a topical application and most likely needs to be treated systemically. The closer the joints are to the skin, the more effective the topical will be.
Topicals will only penetrate a few layers of the skin and therefore are often not able to reach the bloodstream to provide systemic relief. Because CBD will penetrate the skin 10 times better than THC, I recommend starting with a CBD dominant topical for pain. Overall, topicals are great when they work. Pain relief can start within minutes and last several hours. In cases where a topical has not been effective, other options such as tinctures, edibles, flowers and/or vape pens may provide better relief.
When arthritis is affecting the back, knees or hips, tinctures or edibles can be more effective than a topical. Ingesting cannabis can allow for more systemic relief. The effects last longer and over time may reduce inflammation. Many people report that when they use cannabis regularly and consistently, the severity and intensity of their symptoms are reduced. Some even find they can decrease their overall cannabis intake with time.
If the arthritic pain is constant and/or fluctuates in intensity, inhalation may be the best way to control the pain. Inhaling relieves pain quickly and gives people the most control over their dose.
THC vs. THCA vs. CBD vs. CBDA
With cannabis having powerful anti-inflammatory, analgesic properties, determining the right cannabinoids can be confusing.
THC is known to have psycho-active effects such as euphoria and many people are looking to use cannabis without experiencing any sort of high. However, small amounts of THC can provide pain relief and reduced inflammation without powerful psycho-active effects.
It is not necessary to experience psycho-activity in order to receive the pain reducing and anti-inflammatory benefits of cannabis. Arthritic pain in the back, hips and knees often require THC to achieve adequate relief.
THCa is less likely to have euphoric effects. It can help with inflammation and mild pain. If THCa is exposed to heat or to prolonged UV light, it will convert to THC. Keeping THCa in a cool, dark place can help protect it from converting to THC. Additionally, THCa is more water soluble than THC which means that people can use lower doses of THCa vs THC.
CBD has also shown to have anti-inflammatory properties. In addition to reducing inflammation, CBD can help to mitigate the unwanted effects from THC, like lethargy, dysphoria and short term-memory loss. On its own, CBD has been useful for mild pain. Many people will find CBD alone is not enough to control their pain. Because CBD can be alerting in some people, it is best not to take it too close to bed for the first time.
CBDa has not been studied as much as THC and CBD. It has known anti-inflammatory properties which may be helpful for arthritic pain. Observational reports have found CBDa to help with mild pain and fatigue. Keeping CBDa in a cool, dark place can help protect it from converting to CBD. Additionally, CBDa is more water soluble than CBD which means that people can use lower doses of CBDa vs CBD.
Formulating a Plan
It is not unusual to use multiple methods of consumption when addressing pain and inflammation. Constant arthritic pain may require a topical, an ingestible and inhalation all in the same day. Intermittent or less intense pain may respond best to a topical and/or inhalation.
Daytime use of THCa, CBD and/or CBDa may provide relief with minimal side effects, while improving energy. Evening use of THC may allow for better pain control as well improved sleep, which can often be disrupted from pain. As always, starting low and slow will not only help minimize the potential for unwanted side effects, it can also reduce the chances of building a tolerance to the effectiveness of the dose.
Experimenting with different cannabinoids, dosages and frequency allows people to individualize their treatment to best fit their lifestyle. If you are new to cannabis or have had a negative experience in the past, trying a THCa, CBD or CBDa product can be a gentle introduction into cannabis medicine. Cannabis is not a silver bullet and finding the right dose, frequency and product may take some time. Most of the time, people will get relief from cannabis so patience and persistence will pay off in the long run.
For over 17 years, Eloise Theisen has been a dedicated and patient-focused nurse specializing in aging, cancer, chronic pain, dementia, Alzheimers, Parkinsons, anxiety, depression, fibromyalgia, and various auto-immune and neurological diseases. The founder of Radicle Health (formerly Green Health Consultants), she started her career at John Muir Medical Center caring for patients suffering from cancer, terminal illnesses, respiratory failure/complaints, drug overdoses, acute alcohol ingestion, gastrointestinal bleeds, traumatic brain injury, and multiple traumas and from there worked her way up to management. Following that, her work with Aunt Zelda’s and the American Cannabis Nurses Association gained her an extensive knowledge of the Endocannabinoid system and how cannabis and cannabinoids can be used successfully to treat patients.
An East Bay, California native, Eloise is a passionate advocate for medical cannabis and cannabis oil alternatives after seeing the positive benefits it has had for patients. In partnership with Dr. R. David Ferrara MD, she started Radicle Health, a clinic dedicated to ensuring patients receive the qualified counseling they need to safely and effectively use cannabinoids to manage a health condition, cure an illness or reduce their intake of pharmaceuticals. She also provides education and training to other medical practitioners on the therapeutic potential of cannabis as a treatment option.
Eloise was a board director for the American Cannabis Nurses Association (ACNA) (2014-2016) where she helped develop the first on-line core curriculum program for nurses on cannabinoid therapeutics. She currently serves on the scope and standards committee for the ACNA. She is working to help further legalize and destigmatize therapeutic cannabis therapy. She’s a regular speaker at industry events and teaches classes at universities in the San Francisco Bay Area.
She has a Post Masters certification as an Adult-Geriatric nurse practitioner from University of Mass, Boston; an MSN in Nursing Administration from California State University; and a Bachelor of Science in Nursing from San Francisco State University.