Wednesday’s Ask Dr. Walt — Knee Pain? CBD or Something Else?

Dear Dr. Walt,

Is CBD salve helpful for knee pain? I had a total knee replacement in 2008 and it has always hurt, sometimes worse than the other. I want to make sure topical CBD is safe and pure.

—Inflamed in Indiana

Dear Tender,

Cannabidiol (CBD) is a compound derived from cannabis (a hemp plant more commonly known as marijuana). However, unlike other chemical compounds found in cannabis, called cannabinoids, such as THC (tetrahydrocannabinolic acid), CBD is not psychoactive and does not affect perception or behavior. But does it work for knee arthritis?

According to the Natural Medicines Comprehensive Database there is “insufficient reliable evidence to rate” CBD topically for pain or inflammation. Even if it did work, it’s very hard to find quality CBD over-the-counter or on the Internet. One 2017 study showed “only 31% of CBD extracts sold online were found to contain their listed amounts of CBD.” So, the bottom line is I do not recommend CBD topically for joint pain.

However, there are a least two FDA approved topical products that have been shown to be safe and effective, especially for single-joint inflammation/pain, especially of the knees.

Topical NSAIDs: Many doctors recommend topical nonsteroidal anti-inflammatory drugs (NSAIDs) rather than oral NSAIDs for folks with mild to moderate osteoarthritis, especially OA involving the knees or hands. Studies show 60% of patients achieve at least 50% improvement in pain. In addition, the risk of gastrointestinal, renal, and cardiovascular side effects is much lower with topical as compared with oral formulations of NSAIDS. I usually recommend diclofenac gel, but the choice of topical agent may vary according to local availability and cost.

Topical capsaicin: Capsaicin is a substance derived from hot chili peppers that has been proven to help joint pain. Studies show at least a 33% pain reduction; however, it can take days to weeks to build up its effects. A local burning sensation is the most common side effect and occurs in over half of patients but is usually mild and improves with continued application. One warning: use gloves to apply the substance or wash your hands immediately after applying. Topical capsaicin can burn mucous membranes, abraded skin, eyes, or genital area skin.

© Copyright WLL, INC. 2018. This blog provides a wide variety of general health information only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment from your regular physician. If you are concerned about your health, take what you learn from this blog and meet with your personal doctor to discuss your concerns.
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