Topical cannabidiol is well tolerated in individuals with a history of elite physical performance and chronic lower extremity pain

Abstract

Introduction Cannabidiol (CBD) is a potential therapeutic for pain management. Yet, there exists a dearth of studies of its tolerability and efficacy, especially in special populations. Former elite athletes are a special population both susceptible to chronic pain and also highly trained and attuned to assess medication tolerability concerns. The purpose of the present open-label pilot study was to assess the tolerability of CBD in this population. Materials and methods Retrospective analysis was conducted in deidentified data from 20 individuals who were all previously professional athletes in US/American football, track and field, or basketball, with careers ranging from 4 to 10 years. Participants received topical CBD (10 mg twice daily by controlled dispenser) for chronic pain resulting from acute lower extremity injuries. Assessments of tolerability and secondary analyses of pain, pain-related disability, and activities of daily living were collected by self-report over the 6-week study period. Data were analyzed by descriptive statistics, pairwise t-test, and linear regression. Results Seventy percent of participants completed the study. Of the individuals who completed the study, 50% reported minor adverse effects, none of which required medical attention, and 50% did not report any adverse effects. The mostly commonly reported effects were skin dryness (43% of study completers) and skin rash (21% of study completers), which rapidly resolved. There was a significant improvement in self-reported pain levels (intake mean 3.5 ± 0.29; exit mean 1.7 ± 0.23; P < 0.001) and pain-related disability, including family and home responsibilities, life support activities, occupational activities, recreational activities, self-care, sexual function, and social activities (all P < 0.001). Discussion To the best of our knowledge, this is the first study to assess CBD treatment in elite athletes, who are disproportionally susceptible to disabling injuries. Topical administration of CBD was tolerated well by this population and resulted in only minor adverse effects. As elite athletes are trained and attuned to assess their own bodies due to their professional lives, this population is likely to detect tolerability concerns. However, this study was limited to a convenience sample and self-reported data. These pilot findings warrant further study of topical CBD in randomized and controlled studies of elite athletes.

Comment on “Hall et al., Topical cannabidiol is well tolerated in individuals with a history of elite physical performance and chronic lower extremity pain”

“…In their discussion, we agree with Hall and colleagues (Hall et al 2023 ) that there are several limitations that the study outcomes present and indeed caution is advised with interpretation of the data, a justified posit where Hall et al plausibly suggest that for the management of neuropathic limb pain, topical cannabis-based medicines could include THC for further efficacy. A recent report agrees; the review investigated the safe use of cannabinoids for the management of chronic neuropathic pain presenting an efficacy picture of clinical evidence that very much suggests that when THC alone or in combination with CBD was used there was a better suppression of chronic neuropathic pain than with CBD alone (Bennici et al 2021 ).…”

“…A recent study confirms that impression citing CBD alone was ineffective compared to placebo, concluding that there was no statistical difference in the state of neuropathic pain (Sainsbury et al 2021 ). Moreover, Hall and colleagues’ (Hall et al 2023 ) reference to nabiximols [a CBD to THC oro-mucosal spray in a ratio of 1:1] that shows promising results in the treatment of neuropathic pain is in our opinion not conclusive. Hall and colleagues support this view by citing a recent meta-analysis that determined that nabiximols was superior to placebo with a small effect size, improving chronic neuropathic pain (Dykukha et al 2021 ).…”

“…In the inclusion and exclusion criteria, Hall et al reported (Hall et al 2023 ) that the athletes, as is customary in clinical trials, were asked to discontinue all non-study treatment modalities that included any pharmacotherapy with opioids, NSAIDs, and acetaminophen. There was no information though as to whether the participants had previously or had recently used cannabis-based medicines to manage their pain, following retirement from their professional chosen sports.…”

“…Further, the authors (Hall et al 2023 ) refer specifically to neuropathic pain, which by definition is reported to be commonly triggered by an event or injury that evokes pain caused by a lesion or disease of the somatosensory nervous system (Finnerup et al 2021 ). Notwithstanding this, it is plausible that the pain mechanism for these athletes could have been a combination of neuropathic and nociceptive pain.…”

Cannabidiol in sports: insights on how CBD could improve performance and recovery

“…CBD can promote analgesia by activating transient receptor potential cation channel subfamily V (TRPV1) and serotonin receptors ( Naik and Trojian, 2021 ). The latest scientific data found a pain-reliever effect of topical application (2*10 mg/day) of CBD in elite athletes with only minor side effects (e.g., dry skin) ( Hall et al, 2023 ).…”