What Is It? | Is It Legal? | CBD Forms | Choosing a Product | Safety | Effectiveness | Personal Accounts | Take-Home Messages | Get Support

If you are living with ankylosing spondylitis (AS) — a severe subtype of axial spondyloarthritis — you may be considering different types of complementary and alternative medicine (CAM) to help manage symptoms like lower back pain. Some members of MySpondylitisTeam, the online support network for people with spondylitis, have asked about cannabidiol (CBD) products for spondylitis — usually as a complement to their medical treatments.

One MySpondylitisTeam member posed the question, “Seeing a chiropractor and feeling better. Also, I’m going to try CBD oil. Any thoughts on CBD oil?”

CBD is a compound derived from marijuana (also known as cannabis) that can be used to improve sleep quality and reduce nausea, anxiety, and pain. According to a 2019 Gallup Poll, an estimated 14 percent of Americans reported that they use CBD products. In a 2019 survey of more than 2,600 people living with arthritis from the Arthritis Foundation, 29 percent of respondents said they’re currently using CBD to manage their arthritis symptoms. However, CBD is not currently approved by the U.S. Food and Drug Administration (FDA) to treat ankylosing spondylitis.

It’s possible that your doctor may recommend CBD products to complement your current treatment for spondylitis. Here, we describe the safety, effectiveness, and legality of CBD for ankylosing spondylitis.

What Is CBD?

CBD is an active compound derived from the cannabis plant (or marijuana), and it’s becoming an increasingly popular treatment for ailments like pain, sleeping problems, and anxiety. Cannabis plants contain hundreds of compounds. Two of the best-known compounds are CBD and tetrahydrocannabinol (THC). Among their differences, CBD doesn’t induce a “high” the way THC does.

People have long used these two compounds for recreational purposes and to self-medicate for various ailments. Following years of research studies on animals and humans, some health care providers are now recommending these compounds as medical agents. Moreover, in 2019, the Arthritis Foundation released its own CBD guidance for adults living with arthritis.

Importantly for people living with ankylosing spondylitis and other inflammatory pain disorders, CBD has been shown to have anti-inflammatory, antidepressant, and antioxidant abilities.

MySpondylitisTeam members frequently discuss using CBD, as well as other medical marijuana products. CBD comes in a number of forms, brands, and formulations, so it is essential to learn more before using this substance.

Is CBD Legal?

CBD is legal in most U.S. states for those over the age of 18. Specifically, recreational and medicinal use of CBD is legal in 17 states. It is legal with restrictions in some other states. To be certain, check your state laws before trying to purchase CBD.

Recently, the FDA eased regulations on medical cannabis, including CBD, so that researchers can study its safety and effectiveness in treating various conditions. CBD isn’t currently FDA-approved for the treatment of AS. However, if research studies were to find that it had significant benefits for people with AS, it is possible these types of treatments could become available in the future.

Forms of CBD

You can take CBD in many different forms.

CBD can be taken orally, either as an oil, capsule, edible, beverage, or liquid. CBD products that are eaten are absorbed through the digestive tract, and they generally take one to two hours to start working. It is not known how different foods or stomach acids interact with CBD taken orally. CBD oil applied under the tongue takes about 45 minutes to kick in.

CBD can also be applied to the skin as a topical cream, balm, or ointment. This strategy can be used to target joint and back pain due to spondylitis. It is absorbed directly through skin receptors. These versions of CBD are usually mixed with other ingredients, such as menthol, which may amplify anti-inflammatory, analgesic (pain-relieving) effects. Effects may be felt within 15 to 45 minutes.

You can also inhale CBD oil through a vaporizer (vape). However, the FDA and Centers for Disease Control and Prevention (CDC) do not recommend vaping of any substance.

Choosing a Product

Since most products containing CBD are not regulated in the U.S. market, choosing a safe, trustworthy product may be difficult. Some products may, for example, contain toxic metals, pesticides, and THC.

Here are some tips to consider when choosing a product with CBD:

• Try to find American brands with ingredients coming from the U.S.
• Research whether the manufacturer tests each batch for quality.
• Choose products that are clearly labeled as to how much CBD or how many doses they contain.
• Be cautious of products that claim to have disease benefits.

When in doubt, ask your doctor to look over a product you are considering to ensure it is a safe, reputable option.

Safety of CBD for Ankylosing Spondylitis

CBD, like any CAM, can present the risk of adverse side effects. When testing Epidiolex, a drug that contains CBD for the treatment of severe epilepsy, some common side effects were sleepiness, decreased appetite, elevated liver enzymes, fatigue, rash, and infections.

So far, researchers have found no serious safety concerns related to CBD use. Mild to moderate side effects of CBD can include an upset stomach, tiredness, and mood changes. Compared to many painkillers like opioids and nonsteroidal anti-inflammatory drugs (NSAIDs), CBD appears relatively safe and seems to have very few adverse outcomes. There is very little risk of overdose and addiction. Also, as noted, CBD products do not induce the sort of high that THC does.

CBD has the potential to interact negatively with the following common arthritis medications:

• Corticosteroids (such as prednisone)
• Tofacitinib (sold as Xeljanz)
• Naproxen (such as Aleve)
• Celecoxib (Celebrex)
• Tramadol (Ultram)
• Certain antidepressants

Speak to your doctor if you are taking any of these medications before trying CBD.

Although CBD has few risks, be sure to have a conversation with your health care provider before trying it. Your physician can help you determine whether CBD is safe for your particular condition and what dosage would be appropriate for you.

Effectiveness of CBD for Ankylosing Spondylitis

While some people with arthritis have reported that CBD helped reduce their arthritis pain, these claims are anecdotal and have not been validated in quality human research studies. Similarly, there isn’t enough research to confirm whether CBD is effective in treating symptoms of ankylosing spondylitis.

One notable current study includes a multisite randomized controlled trial assessing the effectiveness of CBD in relieving symptoms of rheumatoid arthritis (RA) and AS. The results of this study have yet to be published, but will soon reveal whether CBD has a significantly bigger impact on arthritis pain than the placebo (sham treatment) in AS populations.

More research has been done on the impact of CBD on RA symptoms. One study explored the way CBD affects inflammatory responses of people living with RA. CBD was shown to reduce inflammation and to possess anti-arthritic activity due to the activation of cells called synovial fibroblasts. Similar mechanisms may be responsible for the anti-inflammatory properties of CBD in people with AS and similar inflammatory disorders.

Personal Accounts of CBD for Ankylosing Spondylitis

Because there is a lack of research, we can look at the personal experiences of people living with AS and other inflammatory chronic pain diseases.

In its 2019 survey, the Arthritis Foundation found that 80 percent of respondents said that they were either using CBD, considering using it, or had used it in the past. In the same survey, 29 percent of respondents reported that they currently use CBD, and among them:

• 94 percent said their primary reason for using CBD was to relieve pain
• 77 reported a reduction in anxiety
• 71 percent said it helped them sleep better
• 67 percent reported improved physical function
• 41 percent said they have a general overall sense of well-being
• More than 30 percent said it provided morning-stiffness relief and help with getting moving
• More than 30 percent reported improvements in fatigue

Importantly, this was a survey and not a controlled research study where scientists could subjectively measure these reported benefits against a control group.

MySpondylitisTeam members have reported mixed experiences about the effectiveness of CBD. One member shared, “I have tried CBD from three different companies. Only one product provided some anxiety relief. None of them helped with pain management. Plus they were pretty expensive at higher doses.”

Another member had a positive experience, saying, “It works great for my neuropathy. However, not all CBD oil is equal.”

Many members agreed that CBD does not have a strong effect on their pain relief. As one person put it, “CBD gummies, oil, and muscle rub help more for calming than they do for inflammation or pain.”

In general, CAM therapies will not help reduce the progression of AS, but they may help address your symptoms. That is why it is important to keep taking your prescribed spondylitis medication, such as disease-modifying therapy, while trying CAM.

If you choose to try CBD, do so alongside your normal medications and with the supervision of your rheumatologist. Start off with small doses and take careful note of how the products and brands you try make you feel. Slowly increase your dosage over time. If you feel that, after a few weeks, you have found no relief of any of your spondylitis symptoms, you may decide that CBD is not effective for you.

Take-Home Messages

CBD is a relatively safe and sometimes effective CAM that is used by some people living with ankylosing spondylitis. CBD should not be used in place of your prescribed spondylitis treatment regimen. Consult your doctor to determine if CBD could pose any risks to you given your current treatment, history of medical conditions, and health status.

Talk With Others Who Understand

MySpondylitisTeam is the social network for people with ankylosing spondylitis and their loved ones. On MySpondylitisTeam, more than 86,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.

Have you used CBD to alleviate your inflammatory back pain? Have CBD products improved your quality of life with spondylitis? Share your experience in the comments below, or start a conversation by posting on MySpondylitisTeam.