Advertisement

A Randomized Controlled Trial of Topical Cannabidiol for the Treatment of Thumb Basal Joint Arthritis

      Purpose

      Since the passage of the Agricultural Improvement Act of 2018, hand surgeons have increasingly encountered patients seeking counseling on over-the-counter, topical cannabidiol (CBD) for the treatment of pain. To this end, we designed a human clinical trial to investigate the therapeutic potential of CBD for the treatment of pain associated with thumb basal joint arthritis.

      Methods

      Following Food and Drug Administration and institutional approval, a phase 1 skin test was completed with 10 healthy participants monitored for 1 week after twice-daily application of 1 mL of topical CBD (6.2 mg/mL) with shea butter. After no adverse events were identified, we proceeded with a phase 2, double-blinded, randomized controlled trial. Eighteen participants with symptomatic thumb basal joint arthritis were randomized to 2 weeks of twice-daily treatment with CBD (6.2 mg/mL CBD with shea butter) or shea butter alone, followed by a 1-week washout period and then crossover for 2 weeks with the other treatment. Safety data and physical examination measurements were obtained at baseline and after completion of each treatment arm.

      Results

      Cannabidiol treatment resulted in improvements from baseline among patient-reported outcome measures, including Visual Analog Scale pain; Disabilities of the Arm, Shoulder, and Hand; and Single Assessment Numeric Evaluation scores, compared to the control arm during the study period. There were similar physical parameters identified with range of motion, grip, and pinch strength.

      Conclusions

      In this single-center, randomized controlled trial, topical CBD treatment demonstrated significant improvements in thumb basal joint arthritis-related pain and disability without adverse events.

      Type of study/level of evidence

      Therapeutic II.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Russo E.B.
        Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects.
        Br J Pharmacol. 2011; 163: 1344-1364
        • Grotenhermen F.
        • Russo E.
        • Zuardi A.W.
        Even high doses of oral cannabidiol do not cause THC-like effects.
        Cannabis Cannabinoid Res. 2017; 2: 1-4
        • National Conference of State Legislatures
        Cannabis Overview.
        • Mechoulam R.
        • Hanus L.
        Cannabidiol: an overview of some chemical and pharmacological aspects. Part I: chemical aspects.
        Chem Phys Lipids. 2002; 121: 35-43
        • Baron E.P.
        • Lucas P.
        • Eades J.
        • Hogue O.
        Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort.
        J Headache Pain. 2018; 19: 37
        • Bruni N.
        • Della Pepa C.
        • Oliaro-Bosso S.
        • Pessione E.
        • Gastaldi D.
        • Dosio F.
        Cannabinoid delivery systems for pain and inflammation treatment.
        Molecules. 2018; 232478
        • Chen J.W.
        • Borgelt L.M.
        • Blackmer A.B.
        Cannabidiol: a new hope for patients with Dravet or Lennox-Gastaut syndromes.
        Ann Pharmacother. 2019; 53: 603-611
        • Stockings E.
        • Zagic D.
        • Campbell G.
        • et al.
        Evidence for cannabis and cannabinoids for epilepsy: a systematic review of controlled and observational evidence.
        J Neurol Neurosurg Psychiatry. 2018; 89: 741-753
        • Laun A.S.
        • Shrader S.H.
        • Brown K.J.
        • Song Z.H.
        GPR3, GPR6, and GPR12 as novel molecular targets: their biological functions and interaction with cannabidiol.
        Acta Pharmacol Sin. 2019; 40: 300-308
        • Russo E.B.
        • Burnett A.
        • Hall B.
        • Parker K.K.
        Agonistic properties of cannabidiol at 5-HT1A receptors.
        Neurochem Res. 2005; 30: 1037-1043
        • Campos A.C.
        • Moreira F.A.
        • Gomes F.V.
        • Del Bel E.A.
        • Guimarães F.S.
        Multiple mechanisms involved in the large-spectrum therapeutic potential of cannabidiol in psychiatric disorders.
        Philos Trans R Soc Lond B Biol Sci. 2012; 367: 3364-3378
        • Dunn S.L.
        • Wilkinson J.M.
        • Crawford A.
        • Bunning R.A.D.
        • Le Maitre C.L.
        Expression of cannabinoid receptors in human osteoarthritic cartilage: implications for future therapies.
        Cannabis Cannabinoid Res. 2016; 1: 3-15
      1. Fader L, Scharf Z, DeGeorge BR. Assessment of medical cannabis in patients with osteoarthritis of the thumb basal joint J Hand Surg Am. Published online December 7, 2021. https://doi.org/10.1016/j.jhsa.2021.10.018

        • Gamble L.J.
        • Boesch J.M.
        • Frye C.W.
        • et al.
        Pharmacokinetics, safety, and clinical efficacy of cannabidiol treatment in osteoarthritic dogs.
        Front Vet Sci. 2018; 5: 165
        • Hammell D.C.
        • Zhang L.P.
        • Ma F.
        • et al.
        Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis.
        Eur J Pain. 2016; 20: 936-948
        • Malfait A.M.
        • Gallily R.
        • Sumariwalla P.F.
        • et al.
        The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis.
        Proc Natl Acad Sci U S A. 2000; 97: 9561-9566
        • Costa B.
        • Colleoni M.
        • Conti S.
        • et al.
        Oral anti-inflammatory activity of cannabidiol, a non-psychoactive constituent of cannabis, in acute carrageenan-induced inflammation in the rat paw.
        Naunyn Schmiedebergs Arch Pharmacol. 2004; 369: 294-299
        • Blake D.R.
        • Robson P.
        • Ho M.
        • Judd R.W.
        • McCabe C.S.
        Preliminary assessment of the efficacy, tolerability, and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis.
        Rheumatology. 2006; 45: 50-52
        • Capano A.
        • Weaver R.
        • Burkman E.
        Evaluation of the effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients: a prospective cohort study.
        Postgrad Med. 2020; 132: 56-61
        • Philpott H.T.
        • O’Brien M.
        • McDougall J.J.
        Attention of early phase inflammation by cannabidiol prevents pain and nerve damage in rat osteoarthritis.
        Pain. 2017; 158: 2442-2451
        • Nitecka-Buchta A.
        • Nowak-Wachol A.
        • Wachol K.
        • et al.
        Myorelaxant effect of transdermal cannabidiol application in patients with TMD: a randomized, double-blind trial.
        J Clin Med. 2019; 8: 1886-1903
        • Xu D.H.
        • Cullen B.D.
        • Tang M.
        • Fang Y.
        The effectiveness of topical cannabidiol oil in symptomatic relief of peripheral neuropathy of the lower extremities.
        Curr Pharm Biotechnol. 2020; 21: 390-402