Can Cannabis Help Ankylosing Spondylitis?

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.

Potential side effects of cannabis use

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.