Benefits Of Topical Cannabis?

4 min

Cannabis has been shown to be effective against migraines, chemo-related neuropathy, and sleep problems related to pain when inhaled, but the evidence is not as strong when it comes to topical applications – this despite the popularity of folk remedies such as extracts of whole cannabis in alcohol (much used in Mexico). There is some interesting research that suggests topical cannabis may be helpful for wound healing or skin health, but I would like to see more research on its effectiveness for pain.

I compared notes with Stephen Dahmer, M.D., the director of the Andrew Weil Center for Integrative Medicine at the University of Arizona, who shares my inquisitiveness about topical cannabis for treating pain. “Topical cannabinoids don’t penetrate deeply enough below the skin, or into the joints,” Dr. Dahmer says. Researchers have studied some cannabis-based products that include enhancers to improve penetration, and I’ve seen some early-stage animal studies that may hold promise for gels or patches.  (One gel formula was shown to have penetrated the abdominal skin of mice, with CBD making it to the muscle tissue below.) One human study in 2022 did find some self-reported relief in a small number of patients with painful arthritis in the thumb joint; I’d still like to see more research into topical formulations before I come to any conclusions.

A 2024 review article looked specifically at medical cannabis use for rheumatic diseases. The authors noted that, although musculoskeletal pain is the most common reason for medical use of cannabis, and despite promising preclinical and observational evidence that cannabis-derived therapies are useful in addressing rheumatic disease-related pain, there is very little solid scientific evidence that suggests it is reliably effective for joint pain. The Arthritis Foundation agrees, noting that evidence for joint pain relief from CBD is mixed at best, with a caution that CBD products are inconsistently — and often inaccurately — labeled, meaning that consumers don’t necessarily even know what they are purchasing. As a further wrinkle, topical CBD products may also contain menthol, capsaicin, or camphor, making it unclear which ingredient may be contributing to any reported pain relief.

One intriguing trial tested topical cannabis-based medicines on a small number of patients with venous leg ulcers, which are wounds caused by poor blood circulation. The standard of care for these ulcers is compression therapy, which can take many months to achieve healing. Eleven of the 14 patients studied, whose ulcers had been resistant to previous therapies, achieved complete wound healing within 34 days. (The other three patients had shown progress toward healing but did not complete the study.)

That report, plus other studies that have shown the potential benefits of topical cannabis for acne, psoriasis, and atopic dermatitis, among other conditions, suggest that skin ailments may be better targets than pain for creams and ointments.

Federal laws limiting cannabis access in the United States have made it difficult to conduct large-scale controlled research studies on its uses. As more states legalize cannabis, however, and as medical uses become more widespread, we are starting to gather more evidence from reliable sources.  I am hopeful that more data will support more evidence-based uses for cannabis products, which have a long history of therapeutic uses.

Andrew Weil, M.D.

Sources
Heineman JT, Forster GL, Stephens KL, Cottler PS, Timko MP, DeGeorge BR Jr. A Randomized Controlled Trial of Topical Cannabidiol for the Treatment of Thumb Basal Joint Arthritis. J Hand Surg Am. 2022 Jul;47(7):611-620. doi: 10.1016/j.jhsa.2022.03.002. Epub 2022 May 28. PMID: 35637038. pubmed.ncbi.nlm.nih/35637038/

In this single-center, randomized controlled trial, topical CBD treatment demonstrated significant improvements in thumb basal joint arthritis-related pain and disability without adverse events.

Bruni N, Della Pepa C, Oliaro-Bosso S, Pessione E, Gastaldi D, Dosio F. Cannabinoid Delivery Systems for Pain and Inflammation Treatment. Molecules. 2018 Sep 27;23(10):2478. doi: 10.3390/molecules23102478. PMID: 30262735; PMCID: PMC6222489. pubmed.ncbi.nlm.nih/30262735/

The in vivo occluded application of CBD ethosomes to the abdominal skin of nude mice resulted in high accumulation of the drug in the skin and the underlying muscle.

Clarke H, Miles S, Peer M, Fitzcharles MA. The Elusive Truth of Cannabinoids for Rheumatic Pain. Curr Rheumatol Rep. 2024 Nov;26(11):392-402. doi: 10.1007/s11926-024-01162-9. Epub 2024 Aug 9. PMID: 39120750. pubmed.ncbi.nlm.nih/39120750/

Despite promising preclinical and observational evidence that MC and cannabis-derived compounds are useful in the management of rheumatic disease-related pain, there remains limited high-quality clinical evidence to substantiate these findings.

Maida V, Shi RB, Fazzari FGT, Zomparelli L. Topical cannabis-based medicines – A novel adjuvant treatment for venous leg ulcers: An open-label trial. Exp Dermatol. 2021 Sep;30(9):1258-1267. doi: 10.1111/exd.14395. Epub 2021 Jun 3. PMID: 34013652. pubmed.ncbi.nlm.nih/34013652/

The rapid wound closure of previously non-healing venous leg ulcers among elderly and highly complex patients suggests that Topical Cannabis-Based Medicines may become effective adjuvants in conjunction with compression therapy.

Boehnke KF, Dean O, Haffajee RL, Hosanagar A. U.S. Trends in Registration for Medical Cannabis and Reasons for Use From 2016 to 2020 : An Observational Study. Ann Intern Med. 2022 Jul;175(7):945-951. doi: 10.7326/M22-0217. Epub 2022 Jun 14. PMID: 35696691; PMCID: PMC10233658. pmc.ncbi.nlm.nih/articles/PMC10233658/

Peyravian N, Deo S, Daunert S, Jimenez JJ. The Anti-Inflammatory Effects of Cannabidiol (CBD) on Acne. J Inflamm Res. 2022 May 3;15:2795-2801. doi: 10.2147/JIR.S355489. PMID: 35535052; PMCID: PMC9078861. pubmed.ncbi.nlm.nih/35535052/ https://pubmed.ncbi.nlm.nih.gov/35535052/

Filipiuc SI, Neagu AN, Uritu CM, Tamba BI, Filipiuc LE, Tudorancea IM, Boca AN, Hâncu MF, Porumb V, Bild W. The Skin and Natural Cannabinoids-Topical and Transdermal Applications. Pharmaceuticals (Basel). 2023 Jul 24;16(7):1049. doi: 10.3390/ph16071049. PMID: 37513960; PMCID: PMC10386449. pubmed.ncbi.nlm.nih/37513960/

Arthritis Foundation: CBD for Arthritis Pain: What you should know:
mpp/issues/medical-marijuana/federal-obstruction-of-medical-marijuana-research/

my.clevelandclinic/health/diseases/23357-stasis-ulcer

pmc.ncbi.nlm.nih/articles/PMC7949496/#:~:text=Compression%20therapy%20is%20widely%20accepted,risk%20of%20recurrence%2012%2C%2013.

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