Topical Pain Relief and Arthritis Creams: The Complete Guide

Table of Contents

-

Many people who suffer from pain, whether it be as simple as a headache, or a pulled muscle or chronic pain, will believe that the use of pain medication such as ibuprofen or acetaminophen will end their suffering.

These days, a new form of medication is gaining attention because of its efficient, targeted pain relief and minimal systemic effects: topical pain relievers. These medications are applied directly to the skin and typically take the form of a cream, gel, or ointment. An interesting sub-segment of topical pain relievers are those infused with cannabis. Once regarded as unconventional treatments for arthritis and other types of chronic pain, they are now gaining popularity for their non-psychoactive properties and therapeutic benefits.

In this guide, we will focus mainly on the benefits of cannabis-infused topicals and their ability to deliver safe and effective relief for chronic pain. We will also explore other methods of topical pain relief such as opioids and NSAIDs, and compare their effectiveness with cannabis-infused arthritis creams.

What are Topical Pain Relief Medications?

Topical medications are defined as liquids, gels, powders, creams, semisolids, emulsions, patches, foams, or aerosols containing an analgesic or anesthetic agent applied to the painful site.[1] They are available in many forms including creams, salves, balms, patches, and ointments. Patients looking for an alternative to oral medications often seek out topical pain relievers to help with acute and chronic pain from a variety of sources.

Topical preparations are preferred in many cases because they reduce the systemic absorption of medications. Since oral and intravenous medications can cause issues affiliated with gastric disturbances, topical creams can be a more comfortable treatment alternative.

Advantages of topical medications include reducing the drug concentration, increasing the absorption, maintaining the drug at the target site, and warranting less toxicity, less clearance, and greater analgesic effect.[2] Topical medications also reduce systemic absorption in the body without changing the desired effect, and can benefit chronic pain management in children.

What are Cannabis Topicals and How Do They Work?

Cannabis-infused topicals include cannabinoids such as THC and CBD. When absorbed by the skin, these infused lotions, salves, oils, sprays, and other transdermal methods of relief bind to a network of CB2 receptors in the skin. These receptors are activated either by the body’s naturally-occurring endocannabinoids or by cannabis compounds called phytocannabinoids.[3]

Patients often prefer cannabis-infused topicals over other topical pain relief options because they offer the high efficacy of THC and CBD while being non-psychoactive. This means that even if the products contain THC, they will not cause the user to feel the effects of “getting high”. How is this possible? Simply put, the cannabinoids in these topicals aren’t absorbed into the bloodstream. Instead, they bind to CB2 receptors in the skin which activate the endocannabinoid system.

Note: Transdermal patches are the exception to this process. They often use a delivery system which sends cannabinoids into the bloodstream with psychoactive side effects.

For those new to the medical marijuana industry, cannabis topicals often serve as an introduction to the space.[4] They are also a viable option for patients who do not want to smoke or ingest cannabis, and instead are willing to try minimally invasive topical applications. In addition, due to their targeted application, cannabis topicals provide a greater level of pain relief than smoking marijuana or eating cannabis-infused products.

What Symptoms Do Cannabis-Infused Topicals Address?

Cannabis-infused topical remedies are becoming increasingly popular in states that offer medical marijuana. In addition to providing relief from arthritis, rheumatism, and inflammation, cannabis topicals also help multiple sclerosis patients with central pain.

Cannabinoids, the active ingredients in cannabis-infused products, contain antioxidant properties which aid in the prevention of cell oxidation. They also serve as an analgesic for pain provoked by torn muscles. This feature is often appreciated by athletes who use cannabis-infused topicals during massages or CBD-infused soaks, to aid in recovery.

Marijuana-infused topical medications are also useful in the treatment of skin allergies. Patients can find relief from rashes, eczema, burns, and other skin conditions due to the anti-inflammatory properties of these products. It has also been shown that cannabis-infused topicals assist in the regulating immune responses in the skin[5].

Cannabis vs. Opioids

While cannabis infused topicals act directly on the site to which they are applied, topically applied opioids predominantly act by effecting signals in the brain and central nervous system. As a result, topically applied cannabis products are often considered to be safer than opioids because they do not have the same side effects and susceptibility for addiction.

What are Opioids and What Conditions Do They Treat?

Derived from poppy plants, opioids are prescription painkillers. They work by blocking the pain neurotransmitters in your brain. Recognized as one of the most commonly prescribed medications to this day, opioid based painkiller go by many names: OxyContin, Percocet, Vicodin, Morphine, etc. The drugs are prescribed for patients who need relief from chronic moderate to severe pain such as those who have undergone surgery, and who often experience chronic issues such as back pain, or are managing pain from cancer.

The main problem with opioid drugs is that they are extremely addictive, and can even be toxic. According to the CDC, prescription opioid addiction is a nationwide epidemic that killed more than 28,000 people in 2014.[6] Opioid addiction is especially prominent in North America, where prescriptions have increased 400% percent since 1999.[7] In some cases, this dependency can lead to more serious substance abuse issues when the prescribed treatment is no longer available. It is estimated that 80% of people who use heroin were prescribed opioid pain relievers at some point[8].

As mentioned above, cannabis and opioids are similar in the fact that they both block pain signals and provide pain relief. However, opioid use does not offer the secondary benefits of cannabis such as inflammation reduction, or relaxation of damaged tissues.

It is a fact that many people who suffer from pain are relying on cannabis as a viable treatment. Also, many patients who have become dependent of opioids use cannabis to reduce pain and as a result, reduce their dependency. Perhaps the most important aspect of cannabis versus opioid use is that the use of marijuana has not resulted in a single overdose or death.

Cannabis Creams and Arthritis

What is Arthritis?

Arthritis is a condition that can be debilitating and involves a great deal of pain. There are multiple types of arthritis, and more than 50 million adults, (1 in 5 in the US), have arthritis that has been diagnosed by a doctor.[9] This condition is not only diagnosed in adults, but also in children. In fact, 1 in 250 children have some type of arthritis or rheumatic condition. It is estimated that by the year 2030, 67 million people will be diagnosed with arthritis.[10]

Arthritis is not a single disease, but rather, it is a condition which has about 100 types diagnosed through joint pain or joint disease. It’s a condition that is not fully understood by doctors and one that affects the joints and causes swelling, pain, and limited movement. Arthritis is most common among women and the elderly, but people of all ages and sexes can be diagnosed with arthritis.

The symptoms of arthritis can be extremely debilitating, and they can range from mild to severe. Sufferers of this condition experience pain, stiffness, and swelling in their joints. They also experience a decreased range of motion in the affected area. Arthritis symptoms come and go, often with no explanation or predictability. People who suffer from severe forms of arthritis may have trouble doing basic daily activities, and may not be able to walk or climb stairs at all. Their condition may also cause joint deformities such as knobby fingers and knees.

Two Main Types of Arthritis

There are two main types of arthritis: osteoarthritis and rheumatoid arthritis. Osteoarthritis is the most common form of arthritis, it is also referred to as degenerative or wear-and-tear and is often a result of previous injury. It is found to occur most commonly as people age. There are no drugs to fully treat osteoarthritis, therefore doctors usually prescribe Painkillers and anti-inflammatories for their patients with this condition. Osteoarthritis can be managed with regular exercise, appropriate rest, Hot and cold therapies and other anti-inflammatory creams, or over-the-counter pain relievers.

Rheumatoid arthritis involves a malfunctioning of the immune system. Common among the aging population, rheumatoid arthritis is also referred to as inflammatory arthritis. This condition triggers the immune system to mistakenly attack joints with uncontrolled inflammation instead of fighting off bacteria, leading to potential internal damage and erosion of the joints, bones, and cartilage. While the exact causes of rheumatoid arthritis are unknown, many researchers lean towards a combination of environmental factors – smoking and genetics.

How Can Cannabis Arthritis Creams Help Arthritis Sufferers?

Fortunately, cannabis arthritis creams have been shown to help with arthritis. Not only are CBD and THC from cannabis promising treatments that reduce pain and inflammation, they also offer benefits such as immune system modulation as well as bone growth and strengthening properties. Cannabis-based therapies are well-documented to combat arthritis pain either with cannabis on its own or in conjunction therapy with opioids[11],[12],[13].

Cannabis has been used as a treatment for pain long before the term “arthritis” was even coined. Marijuana was used as a medical treatment as early as 2000 BC, when one of the earliest uses of medical cannabis was recorded. Chinese texts revealed that cannabis was a therapy to undo the damage of rheumatoid arthritis. In Western medicine, cannabis was considered to be a viable treatment for musculoskeletal pain as far back as the 1700s.[14]

How Does Cannabis Work to Relieve Arthritis?

Generally speaking, marijuana offers many powerful anti-inflammatory properties and can modulate the immune system. Cannabis not only gives symptom relief, but it actually helps to reduce the pain of arthritis.

One of the two main types of cannabinoid receptors in the human body, CB2 receptors, act as binding sites for THC and CBD. When these cannabinoids bind to CB2 receptors, pain signals are blocked and the inflammation response is diminished

In rheumatoid arthritis patients, cannabis is a powerful anti-inflammatory that reduces pain. People with rheumatoid arthritis actually have more CB2 cannabinoid receptors on their cells than people who suffer from other kinds of arthritis. This seems to suggest that cannabis infused topicals could be one of the most natural and effective forms of reducing rheumatoid arthritis symptoms. It has also been proven that cannabis can greatly help in mobility improvement and the reduction of morning joint stiffness.

The immune-modulating ability of cannabis is also another benefit that rheumatoid arthritis sufferers can experience. Cannabinoids are extremely important for bone. Studies have shown reduced endocannabinoid receptors (CB1 and CB2) contributes to weaker bones and increases the risk of osteoporosis. Moreover, there have also been studies that show a correlation between bone disease and dysfunctions or mutations in the CB2 receptor[15].

Currently, arthritis sufferers are generally recommended an over the counter arthritis cream, or prescribed opioid-based treatment for their pain. Meanwhile, despite its under-use the analgesic effects of cannabis-based pain relief treatments are second to none for those who suffer from arthritis.

Other Types of Topical Pain Relief

Opioids

Topically applied opioids predominantly act by effecting signals in the brain and central nervous system. Therefore, it is important to distinguish transdermal opioids such as buprenorphine and fentanyl and topical drugs acting locally like Anesthetics and Lidocaine, which have a primary role on the affected area to which they are applied. These will be discussed in detail below. 

Buprenorphine

prescribed to help people overcome a heroin or opiate addiction, buprenorphine is a semisynthetic opioid available in injectable and transdermal forms. Buprenorphine use was not common initially because of safety issues. Research has shown that the medication helps diminish chronic pain and is safer than morphine or methadone. Still, it can produce effects such as euphoria or respiratory depression. Side effects of buprenorphine are similar to opioids, and include nausea, sleep problems, muscle aches, dizziness, and constipation.

Buprenorphine decreases the withdrawal symptoms associated with physical dependency to opioids. It has a ceiling effect which lowers side effects and the risk of dependency. Buprenorphine is often misused by those without an opioid dependency. A patch is used by cancer patients who suffer from severe pain, and also provides them with relief from musculoskeletal pain.

Fentanyl

Fentanyl is a schedule II prescription drug used to manage severe chronic pain. A powerful synthetic opioid analgesic, fentanyl is at least 50 times more potent than morphine. It is marketed as a patch, as well as a nasal spray and inhaler. The fentanyl patch is only prescribed for patients who require continuous treatment over a substantial amount of time. Due to its low molecular weight, fentanyl is ideal as a transdermal medication. It works by changing how your body feels and responds to pain.

Fentanyl is mainly used for severe chronic cancer pain. While these patients are in severe need of relief, there are many possible side effects with this medication, including: Respiratory depression, nausea, and headaches. Excessive use and abuse of fentanyl can ultimately lead to fatalistic result[16].

Anesthetics

Topical anesthetic drugs work by blocking nerve conduction near the administration site, which results in a temporary loss of sensation in the area. Available in creams, patches, sprays, and ointments, anesthetics are useful for precise applications, however skin absorption is highly variable. Topical anesthetics are used for various skin and mucous membrane conditions, including minor burns, and skin eruptions such as insect bites and sunburn[17].

Lidocaine

Lidocaine in topical form is a numbing medication that blocks nerve signals in the body. Lidocaine patches were found to be effective for treating chronic low back pain when they were used every day for 6 weeks.[18] Side effects are generally mild but include, high blood pressure, swelling, sweating, or irritation at treatment site and mild gastrointestinal issues[19][20]. Due to its effectiveness and safety, lidocaine patches are a viable treatment for the elderly, bringing positive effects on quality of life.

NSAIDs

Nonsteroidal anti-inflammatory drugs, generally known as NSAIDs, are some of the most commonly used pain relievers in the world for for acute and chronic musculoskeletal conditions. More than 30 million Americans use NSAIDs (including diclofenac, ibuprofen, and ketoprofen) for relief from aches and sprains, menstrual cramps, and arthritis symptoms on a daily basis[21]

Sold over the counter, these drugs provide common pain through chemical effects by blocking enzyme functions, resulting in decreased pain and swelling. Topical NSAIDs come in many forms: creams, gels, sprays, etc. Topical NSAIDs offer pain relief for chronic rheumatic diseases and acute musculoskeletal conditions such as sprains. The main drawbacks for topical NSAID users are that they may lack effectiveness and may increase the risk of an “overdose” through regular application.

Diclofenac

Diclofenac is a nonsteroidal anti-inflammatory drug that treats rheumatoid arthritis and osteoarthritis, as well as mild to moderate pain and inflammation. It also comes in a powdered form called Cambia that is used to treat migraines.

The use of diclofenac has potential side effects including an increased risk of heart attack or stroke, especially when it is taken in high doses or for a long period of time. This is true for patients who may or may not have risk factors for heart disease. Diclofenac can also cause fatal stomach bleeding in older patients.

Ketoprofen

Ketoprofen is a nonsteroidal anti-inflammatory drug typically prescribed to treat pain or inflammation caused by arthritis. Commercially available as a patch or gel, ketoprofen reduces inflammation-causing hormones in the body. It has side effects that are similar to diclofenac. Generally, this medication reduces joint pain, inflammation, and stiffness from arthritis.

Ibuprofen

One of the most widely used NSAIDs, ibuprofen is a nonsteroidal anti-inflammatory drug that reduces inflammation in the body. Ibuprofin is now available in a patch as well as a topical gel form? This concentrated ibuprofen works directly at the location of pain rather than through the bloodstream.

Capsaicin

Derived from chili peppers, capsaicin is a pain reliever which works by slightly increasing the pain at first, and then results in decreasing the pain signal intensity. Capsaicin stimulates the release of a compound that blocks the communication of pain signals between the nerves in the spinal cord and other parts of the body.[22] Topical capsaicin is used to treat arthritis, headaches, and nervous symptom problems. Due to the burning sensation it produces and the fact that it must be applied many times daily, capsaicin is not widely used as a topical medication. The concentration required to have a pain killing effect can be highly irritating to the skin.

Medication Adherence and Topical Pain Relief

When an individual fails to take their medications correctly, they reduce effectiveness and increase potential health risks. Due to the fear of side effects, or incapability to take medication, many patients have failed to take their required prescriptions as directed by their physicians. Medication adherence is the responsibility of the patient and is a decision that they must make for themselves.

In the case of topical pain relief and anti-inflammatory creams, medication adherence seems to be fairly manageable. This is due to the ease of application as well as its recognizable decrease in side effects.

Conclusion

Perhaps the most compelling aspect of topical pain relievers, and the one that makes them superior to oral alternatives is that they are in fact safer. Many researchers and physicians believe that oral medications have more potential side effects than topical treatments. Research has suggested that topical medications, including cannabis-infused creams and products, can be just as effective as pills and other oral medications but with less central nervous system effects and minimal drug regimen burden.

With that being said, it is up to the patient to experiment with different topical pain relievers and anti-inflammatory creams to see what works best for them. Medical marijuana is beginning to be recognized as a leading remedy for pain which is why many states have already legalized it, while others are on their determined paths for its legalization. This means that there is a growing industry for medical marijuana and very shortly, there will be many options available for topical pain relievers. If you suffer from arthritis or other forms of pain and inflammation, it’s well worth exploring these options!

References 

[1] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048583/

[2] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048583/

[3] https://www.leafly.com/news/cannabis-101/what-are-cannabis-topicals/ 

[4] http://www.medicalmarijuanainc.com/why-use-a-cannabis-topical/

[5] Croxford JL, Yamamura T (2005) Cannabinoids and the immune system: Potential for the treatment of inflammatory diseases? Journal of Neuroimmunology 166(1-2) PP: 3-18

[6] https://www.cdc.gov/drugoverdose/

[7] https://www.leafly.com/news/health/cannabis-for-chronic-pain-vs-opioids/

[8] Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry. 2014;71(7):821-826.

[9] http://www.arthritis.org/about-arthritis/understanding-arthritis/arthritis-statistics-facts.php

[10] http://www.arthritis.org/about-arthritis/understanding-arthritis/arthritis-statistics-facts.php

[11] Malfait et al (2000) The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis PNAS 97(17): 9561-9566

[12] Blake et al (2006) Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis Rheumatology 45(1)

[13]Ware et al (2004) The medicinal use of cannabis in the UK: results of a nationwide survey. IJCP 59(3): 291-295

[14] http://www.safeaccessnow.org/arthritis_booklet#arthritis

[15] Ofek et al (2006) Peripheral cannabinoid receptor, CB2, regulates bone mass PNAS 103(3): 696-701

[16] Payne et al (1998) Quality of life and cancer pain: satisfaction and side effects with transdermal fentanyl versus oral morphine. Journal of Clinical Oncology 16, no. 4 1588-1593

[17] http://reference.medscape.com/article/109673-overview#showall

[18] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048583/

[19] Sh, Tahernejad, and H. Darvishi. "The Evaluation of Post Spinal Anesthesia Nausea and Vomiting Incidence with Lidocaine Versus Lidocaine Plus Epinephrine for Cesarean Delivery in Alghadir Hospital in 2004." J Basic Appl Sci Res 2.9 (2012): 9063-9067.

[20] Stoelting, Robert K. "Blood pressure and heart rate changes during short-duration laryngoscopy for tracheal intubation: influence of viscous or intravenous lidocaine." Anesthesia & Analgesia 57.2 (1978): 197-199.

[21] http://www.webmd.com/arthritis/features/pain-relief-how-nsaids-work#1

[22] http://www.webmd.com/pain-management/tc/capsaicin-topic-overview