Can Cannabis Help Ankylosing Spondylitis?
Dec 18, 2019
Cannabis treatment has been shown to have anti-inflammatory benefits and help treat common symptoms of ankylosing spondylitis (AS) such as pain. Currently, no studies have been published on cannabis as a treatment option specifically for AS. That being said, a randomized controlled trial is underway which is exploring the effects of the prime molecules in cannabis, such as CBD and THC, on AS symptoms.
Cannabis has been shown to help reduce pain associated with conditions that share symptoms with AS such as fibromyalgia, chronic back/neck pain, osteoarthritis, rheumatoid arthritis, migraines, and menstrual pain.
Reviews of studies have also confirmed that there is an overall positive association between cannabis use and pain relief. That being said, these studies examined the pain relief properties of cannabis in specific conditions, and not specifically for AS-related pain.
Additionally, there are many types of cannabis strains. Research is yet to confirm whether specific strains are more or less effective for treating specific diseases.
How Cannabis Works on Ankylosing Spondylitis
The endocannabinoid system (ECS) exists in all vertebrates and helps regulate crucial functions such as sleep, pain, and appetite. The human body produces its own cannabinoids, which modulate and activate its various functions, but as its name suggests, the endocannabinoid system can also be modulated and activated by cannabinoids found in the cannabis plant. Because the entire system was only discovered in the past 30 years, scientists still have much to learn about the myriad ways cannabis affects the human body.
The endocannabinoid system and its CB1 and CB2 receptors regulate pain and inflammatory processes. Cannabinoid receptors are dispersed around different areas of the body. Both CB1 and CB2 receptors can be influenced by cannabis.
CB1 receptors are abundant in the brain and central nervous system. They are found in regions of the peripheral and central nervous system where pain signaling occurs, and therefore modulates pain. Activating CB1 receptors may, therefore, help with pain relief.
CB2 receptors, on the other hand, are primarily expressed on immune cells. They are also found in the brain but in far lower concentrations and have also been found on bone and connective tissue cells. The activation of CB2 receptors has been shown to decrease several markers of inflammation.
Ankylosing spondylitis causes pain and inflammation, which are two functions the endocannabinoid system plays a role in regulating. The stimulation of the endocannabinoid system may, therefore, help with reducing symptoms such as pain and inflammation caused by AS.
Research on Ankylosing Spondylitis and Cannabis
Current research has established the positive benefits cannabis has for pain in conditions such as rheumatoid arthritis and fibromyalgia, which share some similarities to ankylosing spondylitis.
Cannabis has been approved for Crohn’s disease and ulcerative colitis, which are conditions that fall under a group of diseases known as PAIR that AS is also categorized under (psoriatic arthritis, ankylosing spondylitis, IBD (crohn’s disease and ulcerative colitis), and reactive arthritis).
The following studies — although not on AS specifically — shed light on the potential of cannabis to reduce symptoms of AS as it does in related conditions.
- This systematic review looked at the results of 28 studies on cannabis and chronic pain. The researchers concluded that “there was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain.” Overall, these results show that cannabis use tends to be associated with reductions in pain. That being said, the sample sizes of the selected studies were small.
- One study investigated the direct effects of cannabis on Crohn’s disease. Twenty-one out of 30 patients experienced significant improvements in their disease activity, use of medication, and need for surgery before and after cannabis use.
- In a 2018 report, the results of a randomized double-blind placebo controlled study showed that cannabidiol-rich treatment of patients with ulcerative colitis helped 59% of them experience remission rates of 28%. The study participants received a CBD-rich extract that contained 4% THC.
- One randomized controlled trial published in 2008 found that Nabilone (which mimics THC) improved pain from fibromyalgia compared to placebo over four weeks.
- In a 2006 randomized controlled trial, Sativex (1:1 THC:CBD) was shown to decrease pain in participants with rheumatoid arthritis. Out of 58 patients, 31 were given Sativex and 27 were given a placebo. Researchers found that patients using Sativex experienced decreases in pain on movement and improved sleep.
- In a randomized controlled trial, researchers administered inhaled cannabis containing 9.4% THC to patients with neuropathic pain. The treatment resulted in significant reductions in pain compared to the placebo group.
Cannabis appears to be effective for relieving neuropathic pain, reducing inflammation, and decreasing pain from rheumatoid arthritis, fibromyalgia, and improving other conditions related to AS such as Crohn’s disease and ulcerative colitis.
While cannabis is beneficial for other conditions, more clinical research that examines the effectiveness of cannabis in AS should be done.
CBD and Ankylosing Spondylitis
Human and animal studies show CBD is effective for reducing pain in several conditions. Animal studies — but not human studies — show CBD helps reduce arthritic pain. AS is a form of arthritis, and therefore CBD may help with symptoms in humans.
- The results from a 2018 review showed that CBD was effective for relieving neuropathic pain, cancer pain, and fibromyalgia pain.
- In one 2017 study, researchers looked at how CBD affects joint degeneration and inflammation. Researchers induced osteoarthritis in rats, and then administered a CBD treatment and examined the effects. CBD was found to prevent further pain development and nerve damage in joints.
- One 2014 review on the existing animal research concluded that CBD may be effective for treating osteoarthritis.
- A 2011 study looked at how CBD affects the response of pain receptors in rat models. Researchers found that CBD was able to decrease inflammatory pain.
The promising research on CBD and pain has given scientists enough confidence to pursue a clinical trial to confirm the effects CBD has on AS patients.
In a double-blind randomized placebo-controlled study, researchers from Denmark will be testing whether CBD helps chronic pain in patients with rheumatoid arthritis or AS. An oral CBD treatment in the experiment group will be compared to a placebo over 12 weeks. There will be a 12-week observational period that will follow with the add-on of THC for CBD ‘non-responders’. Physiological and psychological markers will be collected after 12 and 24 weeks of treatment with a final follow up at 36 weeks.
The aim of the study is to test whether CBD and THC help with pain and also to assess the effect of cannabis treatments on cognitive function and sleep. Testing other factors besides pain will help researchers understand the viability of cannabis as a treatment for both conditions.
CBD is effective for pain, but we need to wait for the results of this CBD-AS trial to be published for a definite answer.
Cannabis is well-tolerated and safe to use as a treatment for pain.
Cannabis has been shown to cause short-term side effects such as impaired concentration, fatigue, changes to mood, appetite, and perception.
The long-term side effects of cannabis are largely contingent on the extent of one’s use, the age at which one starts using cannabis, and genetic predispositions to developing mental health conditions such as schizophrenia, substance abuse disorder, and bipolar disorder).
When considering the use of cannabis for symptoms of AS, it’s critical to consult with your doctor before starting treatment.
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About Ankylosing Spondylitis
Ankylosing spondylitis or AS, is a type of inflammatory arthritis that mainly affects the bones and joints in the spine. The inflammation makes your spine stiff and can cause the small bones to fuse together so that they don’t move easily. “Ankylosis” means fused bones or hard tissue, and “spondylitis” means an inflammation of your vertebrae. Sometimes it’s also called “axial SpA.”
Ankylosing spondylitis usually begins in the lower back and can spread up your spine to your neck, and sometimes to other parts of the body too. It generally first appears between the ages of 17 and 35, although it can develop in childhood as well and affects men more than women.
95% of people who get AS are aged under 45, an age when no one expects arthritis to appear. As a result, ankylosing spondylitis often goes undiagnosed, a delay that allows the inflammation to cause irreversible damage to the spine.
AS affects 1 out of every 200 people in the UK, over 6 million people across Europe and Asia, and almost half a million people in the US. There’s no cure for ankylosing spondylitis and no way to undo the damage it causes to the spine, but the right treatments can reduce your symptoms and slow down the progression of the disease.
The symptoms of ankylosing spondylitis can vary greatly from one person to the next because there’s no way to predict how the disease will progress. One person might have just one flare-up of inflammation, and then nothing for a long time, while someone else could have ongoing flare-ups. The symptoms can also come and go at different times.
The main symptoms of AS are back pain and stiffness, which don’t improve with rest, although they might get a little better when you exercise. It most commonly affects:
- The vertebrae of the lower back
- The joint between the pelvis and the base of the spine
The pain and inflammation of AS can also spread to your hip and shoulder joints. Additionally, if the vertebrae of your ribcage are affected, you could have difficulty breathing.
AS can cause pain from an inflammation called enthesitis, which is where a bone joins a tendon. It’s usually felt:
- Behind the heel (at the Achilles tendon)
- Underneath the heel
- Where the ribs join the breastbone
- At the top of the shin bone
Finally, people with ankylosing spondylitis are likely to feel extremely tired, because of the effort of coping with the inflammation.
If you have severe ankylosing spondylitis, you could find that your body grows new bone that connects the vertebrae of your spine together inflexibly, so that you can’t bend and move properly. It usually only happens in your lower back and/or your rib cage.
Severe ankylosing spondylitis can also cause these complications:
- Eye inflammation (uveitis), which causes pain in the eyes, sensitivity to light, and blurred vision.
- Compression fractures from osteoporosis, particularly in the spine, because the AS makes your bones thin and they crumble easily.
- Heart problems due to inflammation in the aorta, the largest artery in your body, which can lead to heart disease.
- Cauda equina syndrome is a rare condition that develops in some people who have AS. It causes the nerves at the bottom of your spine to become compressed, affecting bladder and bowel control, and causing pain in the bottom of the spine, buttocks, and upper legs.
Because ankylosing spondylitis is a type of arthritis that appears at a relatively young age, it often goes undiagnosed for a long time. People wait an average of 8.5 years from when their symptoms first appear until they get a diagnosis.
You can expect your doctor to ask you about your symptoms, especially details about your back pain and whether it gets better after rest. Your doctor will do a full physical examination, and ask you to bend in various places to see the range of movement in your back.
Although there’s no definitive test to confirm AS, your doctor will probably order some or all of these tests:
- Blood tests to check for signs of inflammation in the blood.
- X-rays and MRI scans to look for changes in your bones and joints.
- Genetic testing for the HLA-B27 gene, which is often found in people with AS. However, it’s not a reliable test because not everyone with AS has this genetic variation and some people who do have it never develop AS.
There’s no known cause for ankylosing spondylitis, although scientists have noticed that most people who develop AS also have the HLA-B27 gene. There’s nothing you can do to prevent AS from developing.
Once the disease has damaged your spine or other joints, there’s no way to reverse that damage. However, there are treatments that can slow down the progression of the disease and help to prevent it from causing more damage and also ways to relieve the pain and stiffness brought on by AS.
AS is mostly treated by a combination of medication and physical therapy.
If you have a severe flare-up, you might be prescribed corticosteroid injections, which work quickly to reduce inflammation but aren’t recommended for long-term use.
In the long term, you’ll be prescribed:
- Non-steroidal anti-inflammatory drugs (NSAIDs) are the first line of defense for treating AS. These include ibuprofen, naproxen, and indomethacin.
- If NSAIDs don’t help, you might be prescribed a stronger painkiller, like codeine.
Biologic medication can also significantly help treat AS, and potentially stop the disease in its tracks.
- Tumor necrosis factor (TNF) blockers, like adalimumab, certolizumab and etanercept target a cell protein that provokes inflammation in the body.
- Interleukin-17 (IL-17) inhibitors, like secukinumab and ixekizumab, help the body defend itself against infection and inflammation.
Physical therapy and gentle regular exercise are important for treating AS. It helps to reduce pain, increase flexibility, and improve your strength. As well as doing regular exercise, you should consult a physical therapist for stretches and other exercises to improve your range of movement and posture.
Surgery is rarely recommended for people with AS but it can be needed. For example, if it causes your hip joint to wear out, you might need hip replacement surgery. Very occasionally, someone with AS will need corrective surgery to straighten the spine.