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Cannabidiol (CBD) in addition to current treatment for pain reduction in canine osteoarthritis 

Clinical Scenario

Alfie is an elderly Golden Retriever who has been your patient since he was a puppy. He developed osteoarthritis several years ago which has been managed with non-steroidal anti-inflammatory medication (NSAIDs). You have tried additional gabapentin then tramadol, but neither have had much impact on his pain behaviour. Alfie's owner is keen to explore additional supplements or treatments that can be added in with his NSAIDs. She has read online about other owners using cannabidiol (CBD) oil and asks if you think treatment with CBD in addition to his current medication would reduce Alfie's pain......

3-Part Question (PICO)

In [dogs with osteoarthritis] does [cannabidiol (CBD) in combination with current treatment compared to placebo plus current treatment] [reduce pain]?

Search Strategy and Summary of Evidence

Search Strategy

MEDLINE(R) In-Process & Other Non-Indexed Citations and MEDLINE(R) 1946 to Present using the OVID interface

(dog.mp. OR dogs.mp. OR canine.mp. OR canines.mp. OR canis.mp. OR exp Dogs/)

AND

(osteoarthritis.mp. OR osteoarthritic.mp. OR joint disease.mp. OR joint diseases.mp. OR DJD.mp. OR OA.mp. OR arthritis.mp. OR arthritic.mp. OR exp Osteoarthritis/)

AND

(cannabidiol.mp. OR CBD.mp. OR CBD oil.mp. OR cannabis sativa.mp. OR phytocannabinoids.mp. OR cannabinoid.mp. OR cannabinoids.mp. OR endocannabinoid.mp. OR tetrahydrocannabinol.mp. OR THC.mp. OR cannabis.mp. OR Sativex.mp. OR Epidiolex.mp. OR Epidyolex.mp. OR exp cannabidiol/ OR exp Cannabis sativa/)

CAB Abstracts 1910 to Present using the OVID interface

(dog.mp. OR dogs.mp. OR canine.mp. OR canines.mp. OR canis.mp. OR exp Dogs/)

AND

(osteoarthritis.mp. OR osteoarthritic.mp. OR joint disease.mp. OR joint diseases.mp. OR DJD.mp. OR OA.mp. OR arthritis.mp. OR arthritic.mp. OR exp Osteoarthritis/)

AND

(cannabidiol.mp. OR CBD.mp. OR CBD oil.mp. OR cannabis sativa.mp. OR phytocannabinoids.mp. OR cannabinoid.mp. OR cannabinoids.mp. OR endocannabinoid.mp. OR tetrahydrocannabinol.mp. OR THC.mp. OR cannabis.mp. OR Sativex.mp. OR Epidiolex.mp. OR Epidyolex.mp. OR exp cannabidiol/ OR exp Cannabis sativa/)

Search Outcome

MEDLINE

  • 4 papers found in MEDLINE search
  • 3 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 0 papers excluded as they are review articles/in vitro research/conference proceedings
  • 1 total relevant papers from MEDLINE

CAB Abstracts

  • 8 papers found in CAB search
  • 6 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 1 papers excluded as they are review articles/in vitro research/conference proceedings
  • 1 total relevant papers from CAB

Total relevant papers

1 relevant papers from both MEDLINE and CAB Abstracts

Summary of Evidence

Gamble et al. 2018, USA

Title:

Pharmacokinetics, Safety, and Clinical Efficacy of Cannabidiol Treatment in Osteoarthritic Dogs

Patient group:

16 dogs with clinically (signs of pain and lameness) and radiographically- confirmed osteoarthritis

Study Type:

Randomised controlled trial

Outcomes:
  • Owner-assesed pain via the Canine Brief Pain Inventory (CPBI)
  • Owner-assessed activity via CPBI and Hudson activity scores
  • Veterinarian-assessed pain, lameness and weight-bearing
  • Blood biochemistry and CBC
Key Results:
  • Owners reported a significant decrease in pain using the CBPI scale, and increased activity scores using the CBPI and Hudson scales in the CBD group at weeks 2 and 4 compared to baseline. No other significant differences were reported in owner-assessed outcome measures.
  • Veterinarian-assessed pain on palpation scores significantly decreased in the CBD group at weeks 2 and 4 compared to baseline. Week 2 CBD oil pain assessment was significantly lower than placebo at baseline and lower than placebo at week 4. 
  • No changes were detectable in vet assessed lameness scores and vet assessed weight-bearing scores in either CBD oil or placebo groups at any of the measured times.
  • Vet assessed pain scores decreased from baseline in dogs on NSAIDs. Lameness assessed by vets increased from baseline with age of animal and if on NSAIDs, the lameness scores decreased from baseline.
Study Weaknesses:
  • Sample size is small.
  • Some dogs were on NSAID treatment during the study although the dosing was not changed. from 4 weeks prior to the end of the study so presumably its effect remained constant.
  • There is no reporting of whether any of the subjects were on fish oil or glucosamine/chondroitin sulfate, although it is mentioned in the methods that they would have been allowed to receive these supplements.
  • A wide range of severity and location of OA in the dogs included in the study could lead to variable response to treatment.
  • Measurements were made only over a short treatment period  - baseline, 2 and 4 weeks after starting treatment.
  • Relatively subjective outcome measures were used for the veterinarian scoring scheme.
  • Washout period (2 weeks) may not have been long enough.
  • Unclear if vets were blinded to whether the dog was also on NSAID treatment - this could have biaised their assessments.
  • Veterinary pain assessments are reported to be significantly different, but this difference is not clearly visible in Table 3, possibly due to weakness of the scoring system.
  • It is difficult to unpick the data in relation to the change in dogs already receiving NSAIDs versus those receiving only the CBD product.
  • More detail is needed in order to adequately appraise results from the mixed modelling especially given the small sample size.
  • Results are only applicable to this product at the dose used as there is no standaridsed product composition or defined dose rate.
Attachment:
Evidence appraisalEvidence appraisal

Comments

In the UK, CBD is considered to be a veterinary medicinal product, but there are currently no soley CBD products authorised for animals or for humans. Veterinary surgeons are advised to follow the prescribing cascade.

In addition, CBD products marketed as supplements are unregulated and not standardised so there is likely to be wide variation in active ingredient concentration. This study tested a very specific product and it is not known whether or how these results can be extrapolated to other products since they may contain different compounds in different concentrations.

Further studies using the same double blind randomised controlled cross-over design with a larger number of dogs, with more comparable OA location and severity, over a longer time period, and using validated and objective outcome measures would greatly improve understanding of the efficacy of CBD oil in the treatment of OA. It would also be informative to further study CBD use as a sole agent as well as in addition to NSAID therapy.

Bottom line

The single study appraised suggests that adding a specific CBD oil to current treatment may reduce owner-assessed pain in canine osteoarthritis. No changes were detectable in veterinarian assessed pain. Better quality evidence is required to definitively answer this question.

Disclaimer

The BETs on this website are a summary of the evidence found on a topic and are not clinical guidelines. It is the responsibility of the individual veterinary surgeon to ensure appropriate decisions are made based on the specific circumstances of patients under their care, taking into account other factors such as local licensing regulations. Read small print

References

Gamble LJ, Boesch LM, Frye CW, Schwark WS, Mann S, Wolfe L, Brown H, Berthelsen ES, Wakshlag JJ, (2018). Pharmacokinetics, Safety, and Clinical Efficacy of Cannabidiol Treatment in Osteoarthritic Dogs. Frontiers in Veterinary Science 5: 1-9.

About this BET

First author:
Lisa Morrow
Second author:
Zoe Belshaw
Institution:

Centre for Evidence-based Veterinary Medicine, University of Nottingham

Search last performed:
2020-03-06 16:41:47
Original publication date:
2020-03-10 16:41:47
Last updated:
2020-03-10 16:41:47
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