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What’s All this Talk About CBD?

As physical therapists, we work with people who are in pain for various reasons.  As a result, we often field questions regarding the effectiveness of various alternative treatments, supplements, ointments, etc..  A physical therapist should definitely stick to their scope of expertise, however, it is helpful to have a basic understanding of options that exist outside of traditional physical therapy interventions.

Recently, I have had a number of people ask me about my thoughts on CBD (Cannabidiol) since it has become so popular in recent years as a potential treatment option or remedy for a variety of symptoms and conditions.  Cannabidiol is directly derived from the hemp plant which is a cousin of the marijuana plant.  CBD is a component of marijuana, however, it is important to note that CBD does not contain the psychoactive component of THC which gives cannabis users a drug-induced “high”.  Therefore, it is important to understand that CBD is not cannabis, but is instead one of 480 natural components within the marijuana sativa plant and is termed a cannabinoid (66 of the 480 components have been classified as cannabinoids).  CBD derived from the hemp plant (a cousin of the marijuana plant) is legal and this is what is sold in stores.  All 50 states have laws that legalize CBD, but to varying degrees or with varying restrictions.  Regardless of any restrictions that may exist, it seems like CBD’s popularity is on the rise everywhere, even in states that have not legalized marijuana for medical or recreational use.

I certainly have heard the many claims that are out there regarding CBD with people swearing it has helped with everything from joint pain, anxiety, and even seizures and sleeplessness.   While it appears there is some promise that CBD can benefit people in a number of ways, I have found that most articles and studies discussing the effects of CBD almost always include something to the effect of “more research in humans is needed”.  Although it is frequently suggested that CBD can be effectively used for a wide range of conditions, the research is not yet conclusive.  One area that does show considerable promise is with managing seizures.  An oral medication called Epidiolex was approved by the FDA in 2018 to treat the rare forms of epilepsy by slowing messages sent to the brain and affecting calcium and inflammatory levels in the brain according to the webpage by Northwestern Medicine.

Within the realm of pain management, research in animals has concluded that CBD oil administered to dogs with osteoarthritis resulted in reduced pain levels and greater levels of activity.  Different studies have shown improved management of inflammation and neuropathic pain.  Other proposed uses for CBD oil are widespread and include the management of anxiety, PTSD, and cancer side effects.  However, the transferability of these benefits to humans is less established in the research.

In summary, it sounds like CBD could be beneficial for a variety of conditions.  However, the established efficacy of CBD for many of these is still a work in progress.  As with any medication or supplement, it is important to consider any negative or unintended effects.  In an article posted by Harvard Health, side effects of CBD include nausea, fatigue, and irritability.  CBD can also elevate coumadin levels in your blood which may result in additional thinning of the blood resulting in increased bleeding risk.  This may also act to increase levels of other medications in your bloodstream which can result in unintended consequences.  Another area of concern is the quality of CBD products on the market.  Not all CBD products are created equal and the quality or purity of each product should be established before purchase.  With quality standards lacking, some products will be marketed as a CBD product, but primarily consist of hemp oil. While CBD oil is derived from the hemp plant, it is chemically different from hemp oil and should not be regarded as the same.

As always, when you are considering adding a medication or supplement you should discuss this with your physician and/or pharmacist, shop around, and once deemed safe for you individually, find a reputable product that gives you the quality and purity of the product you are seeking.

Matt Vetter, PT, CSCS

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Alcohol and Drug Abuse Institute.  University of Washington.

Northwestern Medicine.

Harvard Health Publishing.  Harvard Medical School.

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