Cannabidiol (CBD)
250 mg of CBD will be dissolved in 1 ml of Castor Oil. Participants will use 1ml of this solution on each knee BID
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Osteoarthritis of the knee is a common cause of pain in the US. The currently available medicines for knee osteoarthritis sometimes are not effective at relieving the pain or have unacceptable side effects. Thus, alternate pain relieving treatments are needed. CBD, an active chemical from the hemp derived cannabis sativa plant, has received a lot of attention for its potential pain relieving properties, but there has been limited research to find out if topically applied CBD can decrease pain from knee osteoarthritis. CBD lacks the psychoactive effects seen with marijuana use, because it does not contain THC which is responsible for those effects in marijuana. It is legal to use CBD in the State of Tennessee (site of study). The CBD Knee Study is sponsored by the University of Tennessee Health Science Center and is a collaborative effort between doctors at UT and Campbell Clinic. In the CBD Knee Study, the investigators are examining whether topically applied CBD dissolved in Castor Oil will relieve knee pain in persons with knee osteoarthritis. Persons who take part in the study would need to come for study visits, fill out questionnaires about their health and knee pain, and would be asked to use the topical study oil on their knees. Taking part in the CBD Knee Study is voluntary.
Locally preserved from ClinicalTrials.govOpen ClinicalTrials.govlast source update 2026-06-10
What this record can show
This locally preserved record separates the registered protocol from source-reported registry results. Neither is a treatment recommendation.
Registry facts
Chronic pain is an enormous burden worldwide, impacting more than 30% of the population. Osteoarthritis (OA) is the most common form of joint disfunction and pain, affecting 33 million people in the United States. OA is a prominent cause of pain for older individuals, particularly knee pain. Due to the chronic and progressive nature of OA pain, many patients require long-term analgesic management. Non-steroidal anti-inflammatory drugs (NSAIDs), are commonly used to treat moderate pain from OA, but side effects and numerous potential drug interactions limit use in many individuals. Not surprisingly, opioids became a part of treatment for OA pain in the early 2000s, and have been commonly used for many years even though opioids are not recommend for use by osteoarthritis guideline committees due to their potential risk of misuse, abuse and overdose. With limitations on currently available treatments such as NSAIDs and opioids, the field is now exploring alternative analgesics to manage chronic osteoarthritis pain. Medical marijuana and cannabis have long been used to treat chronic pain disorders and there is increasing interest to explore cannabinoids as alternate pain therapy. Cannabidiol (CBD), an active cannabinoid from hemp derived cannabis sativa, has garnered attention as a strong pharmaceutical candidate for analgesia. For example, in two recent systematic reviews, CBD was found to be beneficial for treating chronic pain and appeared to improve sleep and Quality of Life (QOL) for persons with chronic pain. CBD lacks the psychoactive effects seen with marijuana use, because it does not contain Δ9- tetrahydrocannabinol (THC) responsible for those effects in marijuana. These properties make CBD a clear candidate for an alternative treatment for chronic pain syndromes such as knee OA. However, rigorous CBD research is limited in certain chronic pain populations such as persons with OA, but there are some data suggesting benefits. A cross-sectional study, in a large sample of individuals who used oral CBD for arthritis (n=428), showed that 83% reported a reduction in pain following CBD use, and 61% reported a reduction or cessation of other medications, including opioids (18%). There are, however, notable limitations in previous research on CBD for chronic pain that should be acknowledged. Many previous CBD research studies have focused primarily on orally administered CBD often at low doses, which undergoes first-pass metabolism in the liver, reducing bioavailability and potentially diminishing therapeutic effects. Additionally, much of the research relied on the use of over the counter (OTC) CBD products at lower doses, with unverified or untested purity and quality. Thus, additional research on CBD for pain relief is warranted in persons with knee OA. Topical CBD that avoids the first pass metabolism of oral routes has also been shown to reduce chronic pain. In a small randomized clinical trial (n=15) in patients with symptomatic peripheral neuropathy pain, topical CBD Oil use (250 mg / 3 fl. Oz - Higher Dose) resulted in a statistically significant reduction in intense pain, sharp pain and cold/itchy sensations compared with a placebo with no adverse events reported. In another placebo controlled crossover clinical trial in thumb basal joint osteoarthritis, patients had significant reductions in pain after 2 weeks of topical CBD (6.2 mg/ml BID - Lower Dose) administration vs. shea butter (placebo). Another pilot study (n=18) in individuals with hand OA found that topical transdermal CBD gel applied three times daily significantly decreased pain scores (p\<0.0001), improved grip strength (p\<0.0001), and alleviated stiffness. These findings suggest that topical CBD could represent a promising option for managing chronic localized pain conditions like knee OA. Despite this promising preliminary work, to our knowledge there are no studies using topical CBD at therapeutic doses to treat knee pain in persons with OA to definitively establish efficacy. There is also a need for a vehicle to deliver the topical CBD dose to the knee area for maximal effect. Castor Oil is an excellent choice. Castor Oil is an odorless vegetable oil made from the seeds of the Castor plant. Castor Oil is already used as a vehicle to assist with delivery of FDA approved topical pain relief medications such as diclofenac sodium (NSAID) to the area of intended use. The main constituent of Castor Oil is ricinoleic acid, which may also have anti-inflammatory and analgesic effects. Thus, Castor Oil is a clear choice as a vehicle to deliver topical CBD to the site of pain in persons with knee OA. Given healthcare challenges to manage chronic pain, including avoiding opioids because of their addictive potential, investigation of topically applied CBD dissolved in a vehicle such as Castor Oil may provide a promising alternative therapy for the reduction of OA pain of the knee, while having an exceptional safety profile. However, additional research on topical CBD+Castor Oil using rigorous study designs is needed to document efficacy and safety for the treatment of OA pain of the knee. To address this issue, the investigators will conduct a pilot randomized crossover clinical trial to examine the analgesic efficacy of topical CBD+Castor Oil compared to a topical Castor Oil alone. 30 patients with OA pain of the knee will be randomized. The investigators anticipate 60 patients will sign consent and screen to randomize 30 patients. SPECIFIC AIMS Aim 1: Examine medication analgesic efficacy within subjects (n=30) in a balanced crossover design where each participant receives both treatments in randomized order with a 2-week washout period in between. Participants will be randomized to (1) CBD+Castor Oil followed by Castor Oil alone; or 2) Castor Oil alone followed by CBD+Castor Oil. Each oil will be used for a total of 1 month. Hypothesis 1: CBD+Castor Oil will have reduced knee pain scores compare to Castor Oil alone. Aim 2: Examine changes in knee function, sleep, and knee Quality Of Life (QOL) by medication condition. Hypothesis 2: CBD+Castor Oil will have higher knee function, reduced sleep disturbance scores, and higher QOL than Castor Oil alone. The investigators hypothesize that with adequate analgesic properties and low safety concerns, topical CBD+Castor Oil may be extremely useful to manage chronic OA knee pain while improving knee function, QOL, and sleep.
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Research network
Interventions
250 mg of CBD will be dissolved in 1 ml of Castor Oil. Participants will use 1ml of this solution on each knee BID
1 ml of Castor oil alone will be applied to each knee BID as the placebo
Eligibility
primary outcomes
Time frame: Day 1 - Baseline One Visit, Day 30 - Follow-up One Visit, Day 44 - Baseline Two Visit, and Day 74 - Follow-up Two Visit
The investigators will use ecological momentary assessment to collect knee pain scores and develop pain trajectories. A Visual Analog Scale of Self-Reported Pain will be assessed at study visits and up to once a day via text message using the Wong-Baker visual analogue scale. A score of 0 is no pain and a score of 10 is severe pain. Please note this is crossover clinical trial and there are 2 Baseline Visits (One and Two). Knee Pain will be assessed at the Screening Visit as an eligibility criteria and at Baseline One Visit (Day 1), Follow-up One Visit (Day 30), Baseline Two Visit (Day 44), and Follow-up Two Visit (Day 74). The Baseline One Visit will occur 2 weeks after the Screening Visit. Change in knee pain scores on the Visual Analog Scale of Self-Reported Pain will be assessed from the Baseline One Visit to the the Follow-up One Visit and from the Baseline Two Visit to the the Follow-up Two Visit.
secondary outcomes
Time frame: Day 1 - Baseline One Visit, Day 30 - Follow-up One Visit, Day 44 - Baseline Two Visit, and Day 74 - Follow-up Two Visit
The PROMIS (Patient-Reported Outcomes Information System) Sleep Questionnaire will be used to assess sleep disturbance and sleep related impairment over the past 7 days. The questionnaire is divided into two distinct short-form assessments: 1) PROMIS Sleep Disturbance and 2) PROMIS Sleep-Related Impairment. The PROMIS sleep questionnaire utilizes a standardized T-score metric where the general U.S. population average is 50, with a standard deviation of 10. Higher scores indicate a greater severity of the concept being measured (e.g., more sleep disturbance or more sleep-related impairment). Below 55 is within normal limits, 55-59.9 is mild, 60-69.9 is moderate, and 70 and above is severe. Please note this is crossover clinical trial and there are 2 Baseline Visits (One and Two). Sleep will be assessed at the Baseline One Visit (Day 1), Follow-up One Visit (Day 30), Baseline Two Visit (Day 44), and Follow-up Two Visit (Day 74).
Time frame: Day 1 - Baseline One Visit, Day 30 - Follow-up One Visit, Day 44 - Baseline Two Visit, and Day 74 - Follow-up Two Visit
The Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire will be used to assess five knee dimensions: pain, symptoms, activities of daily living (ADL), sport and recreation function, and knee-related quality of life. Each dimension is scored from 0 to 100, with 0 indicating extreme problems and 100 indicating no problems. Please note this is crossover clinical trial and there are 2 Baseline Visits (One and Two). Knee Related Quality of Life and Function as measured by the KOOS questionnaire will be assessed at the Baseline One Visit (Day 1), Follow-up One Visit (Day 30), Baseline Two Visit (Day 44), and Follow-up Two Visit (Day 74). The Baseline One Visit will occur 2 weeks after the Screening Visit. The Follow-up One Visit will occur 1 month after the Baseline One Visit. The Baseline Two Visit will occur 2 weeks after the Follow-up One Visit. The Follow-up Two Visit will occur 1 month after the Baseline Two Visit.
other outcomes
Time frame: Day 1 - Baseline One Visit, Day 30 - Follow-up One Visit, Day 44 - Baseline Two Visit, and Day 74 - Follow-up Two Visit
The investigators will measure adherence with study medication by weighing the study medication bottles at study visits to determine the number of dosage units used from the bottle during medication periods. This weighing method has been used to assess adherence in other topical medication trials. Please note this is crossover clinical trial and there are 2 Baseline Visits (One and Two). Bottle weighing to measure adherence with study medication will be assessed at the Baseline One Visit (Day 1), Follow-up One Visit (Day 30), Baseline Two Visit (Day 44), and Follow-up Two Visit (Day 74). The number of dose units used from the Baseline One Visit to the the Follow-up One Visit will be assessed and the number of dose units used from the Baseline Two Visit to the the Follow-up Two Visit will be assessed.
Time frame: From enrollment at Day 1 to the end of treatment at Day 74
The investigators will also assess adherence with study medication by self-report via text message during medication use weeks up to 60 times between the Baseline One Visit (Day 1) and Follow-up Two Visit (Day 74). The investigators will use a simple question to ask the participant whether the study oil was placed on the Right Knee (Yes/No) and the Left Knee (Yes/No) today. This measure will be used to encourage compliance with the Study Intervention.
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