CBD did not reduce pain in hand osteoarthritis or psoriatic arthritis compared to placebo | Research

The takeaway

In a rigorous trial of 136 patients, synthetic CBD (20-30 mg daily for 12 weeks) showed no clinically or statistically significant effect on pain in hand osteoarthritis or psoriatic arthritis compared to placebo.

People using CBD for arthritis pain, rheumatologists, and researchers studying cannabinoid analgesic effects.

Pain difference: 0.23 mm on 100 mm scale (p=0.96)

What the researchers found

Between-group difference in pain intensity at 12 weeks was 0.23 mm on a 0-100 mm scale (95% CI -9.41 to 9.90, p=0.96). 22% of CBD and 21% of placebo patients achieved clinically meaningful pain reduction (>30 mm). No effects on sleep, depression, anxiety, or pain catastrophizing.

Why it matters

Despite widespread use of CBD for pain, this is one of the few rigorous RCTs to test it in arthritis. The clearly negative result is important for consumers spending money on CBD for joint pain.

The numbers in context

136 randomized, 129 in primary analysis. Pain difference: 0.23 mm (p=0.96). Response rate: 22% CBD vs 21% placebo. No significant effects on PSQI, HADS, PCS, or HAQ-DI.

How the study worked

Randomized, double-blind, placebo-controlled trial of 136 patients with hand osteoarthritis or psoriatic arthritis experiencing moderate pain despite therapy. Patients received synthetic CBD 20-30 mg or placebo daily for 12 weeks.

What this study cannot tell us

CBD dose (20-30 mg) may have been too low. Only synthetic CBD was tested, which may differ from plant-derived products. Specific arthritis subtypes may not represent all chronic pain conditions.

How to read the evidence

Strong: randomized, double-blind, placebo-controlled trial with adequate sample size and standard validated outcomes.

When this study was published

Published in 2022.

The bigger picture

This trial adds to a pattern of negative results for CBD as an analgesic in controlled trials, contrasting sharply with the positive perception among users. The gap between anecdotal reports and trial evidence continues to widen.

Questions still open

Would higher CBD doses produce different results? Does the form of CBD (synthetic vs plant-derived, oral vs topical) matter for pain? Are there arthritis subtypes more responsive to CBD?

Common questions

Did CBD help with pain at all?

No. The difference between CBD and placebo was 0.23 mm on a 100 mm pain scale, which is essentially zero. Similar proportions of patients in both groups experienced meaningful pain relief (22% vs 21%).

Could the dose have been too low?

Possibly. The study used 20-30 mg of synthetic CBD daily. Some CBD products on the market contain much higher doses, though whether higher doses would be effective remains untested in this condition.

Does this mean CBD does not work for any pain?

This trial tested specific arthritis conditions at specific doses. Results may not generalize to all pain types. However, the International Association for the Study of Pain has noted a general lack of evidence for CBD as an analgesic.

Read the original research

Cannabidiol treatment in hand osteoarthritis and psoriatic arthritis: a randomized, double-blind, placebo-controlled trial.

Pain, 163(6), 1206-1214

View on PubMed ↗Publisher’s paper ↗

Citation

Vela, Jonathan; Dreyer, Lene; Petersen, Kristian Kjær; Arendt-Nielsen, Lars; Duch, Kirsten Skjærbæk; Kristensen, Salome. (2022). Cannabidiol treatment in hand osteoarthritis and psoriatic arthritis: a randomized, double-blind, placebo-controlled trial.. Pain, 163(6), 1206-1214. https://doi.org/10.1097/j.pain.0000000000002466