[duncan]

It was Ondra's post that gave me the idea actually. Not convinced w.r.t. recovery, but there are some papers out there on inflammation, e.g.:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828614/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7463000/

Unfortunately they get complex quickly (certainly beyond my biology/chemistry) and often involve rats so I thought I'd defer to anecdote from ukb 

The bit about "CBD possesses anti-arthritic activity and might ameliorate arthritis via targeting synovial fibroblasts under inflammatory conditions." - caught my eye. I think Volker wrote my finger down as capsulitis rather than synovitis, but it's not clear to me how much cross over there is in diagnosis and likely impact of something like this..

The pharmacology is well outside my field.

On my home territory, CBD is a popular chronic pain medication.  This isn't surprising given how ineffective (and/or addictive/rife with nasty side effects) the other managements are. The image of a 'natural' and 'alternative' product untainted by Big Pharma plays well with many. Self-medicating with cannabis has been popular for ever. 

The meta-analyses give CBD for pain cautious support for a small effect, with a caveat that there are lots of small, low quality, low-power studies. This is very likely to exaggerate effectiveness. You could make a comparison with the status of glucosamine for joint pain c.10 years ago: vaguely plausible biochemical pathway, lots of breathless anecdote, a few small scale industry supported studies showing positive effects. Once the larger, independent, well-conducted studies were done it was clearly no better than placebo.

It's worth noting most over-the-counter products have a much lower dose than used in the trials and drug interactions (eg with alcohol) are largely unknown.

[SA Chris]

In my limited experience of completely spannering my back (I think exacerbated to above regular spannering levels by too many Florida thrill rides) getting some CBD Oil on it with a local Chiropractor (closest thing I could find to help in the local phone book) certainly got it back to manageable levels faster than anything else I've used before. (n=1 etc apply).

[abarro81]

Cheers all. I've ordered a few products (both oral and topical) to try so will report back on if there's any notable impact...

[Will Hunt]

too many Florida thrill rides

Is this more lingo? Anyone know how many gummies you can take without feeling like a couple of fortnights in a bad balloon?

[SA Chris]

Nothing like that! Just a week and a half at Disney and Universal.

[honroid]

You could always plant (illegal) some (legal) CBD self flowering seeds and watch them grow (illegal)........ 

[abarro81]

Just reporting back for future forum browsers who may be interested in experimenting with this:

I've been stacking up oral and topical CBD for the last 4 days. Baseline morning swelling in the joint is slightly (but noticeably) better than last week. Significant caveat: I have an undiagnosed* swelling flare-up in the adjacent finger which also started receding on the weekend, so my there are multiple things at play here.

*Happens sporadically, doesn't normally cause issues in the chronic injury, but then that's not been as bad as it currently is when I've had flare-ups in the past. GPs prescribe or test for various things, don't get an answer, then it goes away so I stop bothering them

[Johnny Brown]

The meta-analyses give CBD for pain cautious support for a small effect, with a caveat that there are lots of small, low quality, low-power studies. This is very likely to exaggerate effectiveness. You could make a comparison with the status of glucosamine for joint pain c.10 years ago: vaguely plausible biochemical pathway, lots of breathless anecdote, a few small scale industry supported studies showing positive effects. Once the larger, independent, well-conducted studies were done it was clearly no better than placebo.

Presumably this is pharmacology basics, but strikes me both could be right. I.e. how do studies control for the strength of the placebo effect? I take a few supplements (on and off) on the basis that they may well be no better than placebo, but coupled with me knowing there is a vaguely plausible biochemical pathway the placebo effect is likely to be stronger?

[duncan]

Presumably this is pharmacology basics, but strikes me both could be right. I.e. how do studies control for the strength of the placebo effect? I take a few supplements (on and off) on the basis that they may well be no better than placebo, but coupled with me knowing there is a vaguely plausible biochemical pathway the placebo effect is likely to be stronger?

Placebo seems to be an expectation effect (there are also blood biochemistry changes, it’s not just ‘in the mind’ if that’s important to people). More credible treatments have stronger effects. There are not many true placebo surgery trials (opening someone up and stitching them back together without doing anything has considerable ethical implications!) but, when done, surgery is a very strong placebo as it is a very credible treatment. Believing there is a plausible biochemical pathway in CBD will likely increase a placebo effect. (The converse, nocebo effects, are also common: headaches and chest pains are frequently reported by drug trial participants who got the sugar pill rather than the real thing because they expect this. Many drug side effects are likely to be nocebo.)

Controlling for placebo is really important. To do this effectively the sham treatment must be credible. The dirty secret of much research is when participants recognise the sham treatment is inferior. Many vaccine recipients have side effects which will tell them pretty clearly if they had the real treatment or not in vaccine research. The AZ covid trial got round this by using a hepatitis vaccine with similar side effects as control. One of the problems with lower quality studies is a failure of adequate hiding which is the sham treatment which overestimates the true effect as the real treatment is helped by placebo but the sham isn’t. I bet much CBD research falls down here.

[Fultonius]

Does the placebo effect still work when you don't expect / believe there will be a benefit? 

I'm aware that Nurofen works better than Asda Ibuprofen because people believe it's better.

My gf has had back issues on-off for years, and has been to various specialists, had scans, and measurements, potions and exercises. She was at a physio appointment that was meant to be with the physio she'd seen before, but had called in sick. The replacement guy said - "what is your issue"

"back"

"have you tried acupuncture"

"no, scared and not convinced it will work"

"i give you acupuncture".

"er, ok"

Back fixed. Strangely, she felt a real hotspot when he put the needle into the specific muscle that always spasms, it got very hot and tense then eased. Afterwards, she's barely had a relapse in a year and a half, and when she feels it come on, she seems to be able to fend it off now.

All very odd as we both don't really "believe" in acupuncture. I have wondered since if maybe it's something to do with conductivity and muscle motors, something that can maybe break an overly sensitive motor unit?

[SA Chris]

"have you tried acupuncture"
.....
All very odd as we both don't really "believe" in acupuncture. I have wondered since if maybe it's something to do with conductivity and muscle motors, something that can maybe break an overly sensitive motor unit?

Interesting. I went for a few sessions of acupuncture at a local "sports physio" for my tennis elbow and it helped fuck all. An incredibly painful massage from a different guy who loosened up all the muscles in my forearm did.

[tomtom]

RE: Acupuncture - I had/still have no belief in it - however had some on my lower back 5 years ago and it did more than any massage did...

[Johnny Brown]

Thanks Duncan, good info.

On Acupuncture, last time I looked it was on a more solid footing evidence-wise than, say, homeopathy, but as an actual physical intervention it presumably benefits from a strong placebo effect. I've found needling useful in the past, and studies where they needle randomly vs at the acupuncture points would seem to discount the 'theory' rather than the practice.

[jshaw]

Does the placebo effect still work when you don't expect / believe there will be a benefit? 

Yes it can do. Google 'open-label placebo'.