Evidence Update: Discouraging News for CBD & Arthritis in Dogs

I have been tracking the growing body of evidence concerning veterinary uses of CBD since 2018, and it is an exciting and fast-changing field. While there has only been a little clinical trial research in dogs and cats, there have been a couple of encouraging papers looking at CBD for treatment of canine arthritis. 

A 2018 study looked at 16 dogs taking either 2 mg/kg of CBD or a placebo twice daily and evaluated subjectively by blinded owners and veterinarians. The owner measures showed improvements in pain and function, while the veterinarian measures showed improvement in pain but not function.

A second study in 2020 evaluated 20 dogs in four groups: high-dose CBD (50mg/day), low-dose CBD (20mg/day), liposomally encapsulated CBD, and placebo.  Generally, owner and veterinarian subjective measures improved for the high-dose and liposomally encapsulated CBD groups and not for low-dose CBD or placebo, though there was some variation. 

These studies are small and have some significant limitations, but as preliminary evidence, they are encouraging, and I have been hopeful that eventually the data will be robust supporting the use of CBD for arthritis pain in dogs. However, a new study has dampened that hope somewhat.

Mejia, S. et al. (2021) ‘Evaluation of the Effect of Cannabidiol on Naturally Occurring Osteoarthritis-Associated Pain: A Pilot Study in Dogs.’, Journal of the American Animal Hospital Association. J Am Anim Hosp Assoc. doi: 10.5326/JAAHA-MS-7119.

In this study, 23 dogs were randomly assigned to begin treatment with 2.5 mg/kg twice daily of hemp oil with CBD or hemp oil without CBD, and then were crossed over to the other treatment after 6 weeks. Any effects were assessed by activity counts (essentially Fitbits for dogs), weight bearing using a pressure mat, and evaluation of gait by a blinded veterinarian.

Blood testing showed that dogs on the placebo had no measurable CBD or THC in their blood while dogs getting the active treatment had both. Unfortunately, no difference between the treatment and placebo was identified by any of the measures evaluated. As is common in studies of CBD, a few dogs had elevations of liver enzymes without apparent clinical symptoms on the drug, and a couple experienced vomiting when taking it, one of whom had serious enough symptoms to be removed from the study. A small placebo effect was detected by one measure of effect, but not by the others.

As always, individual studies are almost never the definitive word on any medical question. Just as the previous studies were encouraging but by no means absolute proof that CBD is helpful for arthritis in dogs, this study is discouraging, but it does not close the book on CBD as an arthritis treatment. There are several possible explanations for the lack of an effect in this study. The most obvious is that CBD doesn’t help dogs with arthritis, and that is certainly a possibility. However, it is also possible that no effect was seen because of the specific product or dose used, the lack of a washout period between CBD and placebo, the effects of other chemicals in the hemp oil or other treatments the dogs were receiving, or issues with the measurement tools used. 

The presence of adverse effects (vomiting and liver enzyme elevations) as well as the difference seen in blood CBD levels and the presence of some caregiver placebo effects are all good signs in that they indicate the study was using a treatment with significant biological effects and measurement tools that could distinguish, at least in part, between placebo effects and true treatment effects. Studies that show no adverse effects and no placebo effects raise a red flag that there may be something wrong with their methods or the treatment being tested.

This study also raises the issue of the Decline Effect. This is a phenomenon in science in which early research into a novel idea tends to show strongly positive findings. However, as more studies are done by a greater variety of scientists, the size of the effect tends to decline, sometimes to zero. This likely represents both the influence of bias in early studies caused by enthusiasm of scientists for their own new hypotheses and a gradual improvement in methods and reduction in overall positive bias as the scientific community studies new ideas over a period of time. 

It may be that the different findings of individual studies looking at CBD as a treatment for arthritis in dogs result from specific differences in study methods or the CBD products used. Or it may be that we are seeing the beginnings of the Decline Effect in action, and that there will turn out to be little benefit to this treatment, or less than we initially thought. The most important thing is that we continue to study the issue, refining our hypotheses and methods as we go along. This path provides the best chance of finding the real value, if any, of CBD for our arthritis canine companions.

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12 Responses to Evidence Update: Discouraging News for CBD & Arthritis in Dogs

  1. christopher h gunson says:

    Brennen is the authors claim that this paper represents the first oa/cbd study using objective measures and forced gait analysis?

  2. skeptvet says:

    Yes, I believe they are saying that the activity monitor and assessment of weight bearing have not been used in the two previous canine clinical trials, which used observational instruments.

  3. Jill says:

    I have a dog with multiple health problems including epilepsy and eosinophilic gastrointestinal disorder/IBD (probably autoimmune). Managing his needs is challenging to say the least. And if I never hear “have you tried CBD oil???” EVER AGAIN it will be too soon.

    The people who think they have some magical cure for this very complicated case just slay me.

  4. Jill. Early in my medical career, 25 years ago, my 14 year old suffered from joint pain. Many humans and Vet types alike asked “have you ever tried Glucosamine?” Thank goodness people like those types did not roll their eyes at the hype and simply just offered another option. Thank goodness that us CBD Veterinary types care zero about the rolling anyone’s eyes. Literally thinking outside of the box is how an electric car and prosthetic arms were made. You may still prefer to hop on a horse to the grocery store but don’t discount the potential of the magical cures that have not yet been discovered.

  5. skeptvet says:

    We’ve know for. long time that glucosamine does next to nothing, so it’s a shame that caregiver placebo effects like this leave animals suffering because their caretakers believe in magic. It isn’t brave to believe without evidence, and it isn’t the best way to take care of our animal companions.

    Lots of reasons to doubt what you think you see:

    Why Anecdotes Can’t be Trusted

    Anmecdote

  6. Pingback: 17 of the Best Veterinary Blog Sites for Veterinary Practices

  7. Wendy Schultz says:

    SkeptVet, Do you believe Dasaquin is ineffective for arthritis in dogs. (hips) If so, what do you suggest for an 8 year old lab mix with arthritis in the hips? I tried the Nzymes that I just read about on your site. My dog was taking Dasaquin per the vet and this past fall started becoming very stiff. I tried Nzymes and actually noticed a huge improvement. However, recently he has had stomach upset (gurgling noises and clearly un-well). He improved after a week (bland rice/chicken diet…stopped Dasaquin and Nzymes). Started probiotic. I started wondering if the soy granules were becoming a problem. My own stomach doesn’t tolerate soy milk if I drink it regularly. I’m going to discontinue the Nzymes and see if his stiffness returns.

  8. skeptvet says:

    The evidence for most of the ingredients is way (ASU) or outright negative (glucosamine), so I doubt it does very much. Weight loss, pain relief (especially NSAIDs), and physical therapy/exercise are the most effective therapies in humans, and the same is likely true for dogs. The evidence for most supplements is poor, so each one is a roll of the dice.

  9. Belissa Cohen says:

    Please post any/more research about CBD and animals/pets. I thought about using it, because as you know EVERYONE recommends it, and of course found that it’s not proven effective or safe for much, and there’s the issue about THC possibly needing to be present, that because it’s unregulated no one knows what’ they’re getting, etc. I love to point out these issues to people and would love more supportive evidence either pro or con. This is an extremely hot topic right now!

  10. Sarah says:

    Scientist who works on human clinical trials and inference here, with a dog recently diagnosed with DJD from elbow dysplasia. I cannot believe these sample sizes. It’s immensely concerning to me that such studies get published. Are they at least pre-registered? Is there a veterinary Cochrane Reviews? It would be so nice if the meta-analyses were not left as an exercise for the reader.

  11. skeptvet says:

    Yes, the economics of veterinary medicine are very different from human medicine. The lower social value of companion animals translates into dramatically smaller resources for research nd, consequently, over quality evidence. The largest vet Pharma has an annual R&D expenditure of about $500 million in 2021, as opposed to 414.7 billion for the largest human Pharma, so no surprise research quality is lower, as is the stringency of regulatory guidelines. That is the economic reality that sets thee evidentiary environment.

    I was part of an effort to promote pre-registration of all veterinary clinical trials, but this has not been successful, though to be fair, this is not as well adhered to in human medicine as it should be either.

    As I tell my students, part of the task of a vet practicing EBM is to make rational decisions based on the evidence we have, not the evidence we wish we had. Biologic plausibility and low-quality evidence necessarily carry more weight in the absence of robust RCTs.

  12. art malernee dvm says:

    has the avma every commented on why they do not publish open source like the Canada does
    cmj.https://www.cmaj.ca/content/about-cmaj
    and require pre registration of journal clinical trial publication? sure would save paper and cost of veterinary journals and make people think twice about failing to pre register trials.

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