Integrative, functional and holistic healing practitioners such as chiropractors often admit they were unaware of just how powerful the endocannabinoid system (ECS) is in optimizing the health of so many organ systems and addressing conditions until they begin using cannabidiol-rich agricultural hemp extract.
The nuances and inter-individual patient responses to cannabidiol (CBD) make it incumbent to work with a reliable brand that emphasizes professional and consumer education, quality control, and a secure “seed-to-shelf” supply chain. These measures provide reassurance to practitioners, retailers and consumers alike that these products not only meet but far exceed federal regulatory compliance requirements.
The ECS is an endogenous regulator of the adaptogenic set of lipid-based endocannabinoids, with specific receptors and enzymes responsible for synthesizing and degrading these compounds. This system plays a critical role in the health of both the central and peripheral nervous systems, and the immune and endocrine systems.
There is a clear role for endocannabinoid compounds and CBD in the restoration of normal bone, tendon, ligament, muscular and connective tissue integrity by promoting a healthy inflammatory and resolution response. Chiropractors are well positioned to benefit from adding tools such as CBD oil, or phytocannabinoid-rich agricultural hemp to help patients optimize their ECS.
The science behind CBD
A preclinical animal study demonstrated accelerated healing in rodent femoral fractures treated with CBD, in part by activating the lysyl oxidase enzyme in bone-building osteoblastic cells responsible for crosslinking collagen protein fibers.1 Moreover, direct receptors that endocannabinoids interact with such as TRPV1 (which controls inflammation and pain sensitivity), the PPAR family (which controls nutrient metabolism), and GPR55 (which controls nociception) may assist in accelerating the healing of tissue injuries, and managing the pain or discomfort associated with injury and rehabilitation exercise.
Chiropractic treatment focuses on providing relief to the spine and musculoskeletal system, and it employs manual therapies, spinal adjustments, therapeutic and corrective exercises, modalities such as therapeutic heat, ice, electrical stim, photobiomodulation and pulsed electromagnetic frequency treatment. Therefore, it is no surprise that chiropractors who integrate the strategic use of CBD-rich hemp extract are noticing improved outcomes on the structure and function of the spine and orthopedic conditions.
Similarly, acupuncturists employ mechanical and electrical stimulation of their characterized meridian points to treat a variety of conditions, mostly related to acute and chronic pain. Research has revealed that acupuncture treatment results in neurophysiologic responses across many of the same neurotransmitters (e.g., TRPV1, 5-HTP, and neuropeptides) and peripheral and central nervous system centers (e.g., C-fibers, A-delta fibers, supraspinal and neural areas like the amygdala, caudate nucleus, insula and periaqueductal gray). It also affects the inflammatory pathways that are regulated in large part by the ECS.
It follows, then, that acupuncturists and chiropractors may want to augment or integrate their practice with the strategic use of CBD-rich hemp extract, such as CBD oil for optimizing the ECS, and thereby improve the efficacy of care and potential outcomes of their patients.
What the research tells us
The potential of the ECS to modulate pain and discomfort is enormous, and this is a timely fact, given that many clinicians are concerned about the overuse of NSAIDs based on their potential negative effects resulting from COX-1 inhibition (gastrointestinal ulcers and bleeding) and COX-2 inhibition (myocardial infarction and cerebrovascular accidents). As noted by Stott, et al., CBD inhibits neither of these enzymes at pharmacologically relevant doses.2
Not surprisingly then, phytocannabinoid-rich agricultural hemp and CBD are soaring in popularity for “difficult-to-treat” pain and discomfort. Experimental data from a variety of studies provide mechanistic insights. For example, more than 20 years ago, researchers noted the importance of the ECS in modulating pain control by demonstrating the ability of rimonabant (a CB-1 antagonist) to produce hyperalgesia in mice.3
Moreover, in the ventro posterolateral nucleus of the thalamus, some cannabinoids are 10 times more potent than morphine.4 Another study in a rodent model of rheumatoid arthritis reported the CBD inhibited tumor necrosis factor-alpha, a pro-inflammatory cytokine most often linked with neuropathic pain.5
It has been shown that joint pain resulting from arthritic conditions often manifests as a combination of inflammatory, nociceptive, and neuropathic pain.6 Traditional medicine would attempt to treat each of these pain subtypes with modality-specific analgesics, whereas optimizing the ECS with phytocannabinoid-rich agricultural hemp and CBD has the potential to address all of them simultaneously.
A spectrum of application
Ultimately, any professional working in the rehabilitation, treatment or performance improvement of the spine, musculoskeletal system, nervous system and connective tissue can help their patients by optimizing their ECS. This would include chiropractors, physical medicine and rehabilitation physicians, physiatrists, pain physicians, neurologists, physical or occupational therapists, and even trainers and strength and conditioning coaches.
Supplementing with a phytocannabinoid-rich CBD hemp extract product may complement lifestyle factors for optimizing the ECS, such as routine exercise, adequate sleep, stress management, and a diet focused on the consumption of high-quality fats (weighted toward omega-3s) and complete proteins. And perhaps most importantly, this approach also fits well with the core philosophical principle: “The power that made the body heals the body.”
Hector Lopez, MD, CSCS, FAAPMR, FISSN, is the CMO and partner of the Center for Applied Health Sciences, an interdisciplinary clinical research organization focused on elevating the body of evidence within the dietary supplement, natural product, functional medicine and functional foods industry. He is a product developer and consultant to professional athletes from the NFL, NBA, UEFA and MLB. He consults with CV Sciences, Inc., makers of PlusCBD Oil.
1 Kogan NM, Melamed E, Wasserman E, et al., Cannabidiol, a Major Non-Psychotropic Cannabis Constituent Enhances Fracture Healing and Stimulates Lysyl Hydroxylase Activity in Osteoblasts. J Bone Miner Res. 2015;30(10):1905-13.
2 Stott CG, Guy GW, Wright S, et al. The effects of cannabis extracts Tetranabinex and Nabidiolex on human cyclo-oxygenase (COX) activity. In: Conference on the Cannabinoids, Clearwater (FL): International Cannabinoid Research Society; 2005.
3 Richardson JD, Aanonsen L, Hargreaves KM. SR 141716A, a cannabinoid receptor antagonist, produces hyperalgesia in untreated mice. [ITAL]Eur J Pharmacol.[/ITAL] 1997;319(2-3):R3-4.
4 Martin WJ, Hohmann AG, Walker JM. Suppression of noxious stimulus-evoked activity in the ventral posterolateral nucleus of the thalamus by a cannabinoid agonist: Correlation between electrophysiological and antinociceptive effects. [ITAL]J Neurosci.[/ITAL] 1996;16:6601-11.
5 Malfait AM, Gallily R, Sumariwalla PF, et al. The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis. [ITAL]Proc Natl Acad Sci USA.[/ITAL] 2000;97:9561-6.
6 Melissa O’Brien, Jason J McDougall. Cannabis and joints: scientific evidence for the alleviation of osteoarthritis pain by cannabinoids. [ITAL]Curr Opin Pharmacol.[/ITAL] 2018;40:104-109.