While the evidence base for the efficacy of medical cannabis remains comparatively low, a large number of athletes and former athletes have begun to advocate for the use of cannabinoid-based products for the management of several conditions related to sports performance and recovery. With an aim to understand how cannabinoids may work for some of these conditions, a group of researchers recently set out to review the current evidence.
Cannabis and Sport
Cannabis Sativa L. plants produce over 100 compounds known as cannabinoids. The most prevalent, and therefore, most studied, of these compounds are cannabidiol (CBD) and (−)-trans-Δ⁹-tetrahydrocannabinol (THC). Cannabinoids interact with our bodies through the endocannabinoid system (ECS), which has been found to play a significant role in a number of cognitive and physiological responses including mood regulation, sleep, and pain perception.
Many athletes – including some famous names – have become increasingly vocal in recent years about their use of cannabinoid products. While cannabis use is restricted in most sports – due to its psychoactive properties – CBD was recently removed from the World Anti-Doping Agency’s list of banned substances. CBD has also been gaining significant attention from athletes for its potential benefits. Among the benefits that some athletes claim of CBD are pain and anxiety relief and as a recovery aid.
But what is the evidence for the use of cannabinoids to manage these ailments?
The body of evidence for the efficacy of cannabinoids in the management of acute pain remains limited. The authors of this evidence review identified only two randomised double-blinded crossover trials on this subject. In addition, the patient base was small in both studies.
The first of these studies found a dose-dependent response to pain perception in a capsaicin-induced intradermal pain model. Fifteen participants were given cannabis with varying levels of THC present. The study found a significant decrease in reported pain scores from participants with moderate THC doses. However, pain scores were seen to increase with high doses of THC.
The second study assessed 18 healthy female volunteers with sunburn-induced and intradermal capsaicin pain models. Participants were given an oral preparation of cannabis extract capsules. This study concluded that there was no effect on acute pain.
Advocates for the use of cannabinoids for sport-related ailments often quote their ability to improve recovery time and decrease muscle soreness. While there may be anecdotal evidence, no studies included in this review specifically focused on these areas. However, the authors found a number of studies that assessed the potential of cannabinoids for related symptoms, including inflammation and sleep.
These studies revealed that intake of CBD is linked to a decrease in the inflammatory marker IL-6, which is potentially linked to the accentuation of muscle soreness. In addition, sufficient sleep helps to improve muscle recovery, with many athletes associating good sleep with faster recovery.
In fact, a recent narrative review, in collaboration with the National Collegiate Athletic Association (NCAA) Inter-association Task Force on Sleep and Wellness, recommended that collegiate athletes focus on sleep for the improvement of overall health and athletic performance. Furthermore, a number of studies have linked higher doses of CBD consumption to improvements in sleep quality.
As more countries continue to embrace the medical potential of cannabis, chronic pain is among the most common conditions for research and prescription. Currently, there exists a robust collection of studies that demonstrate the benefits of cannabinoids for chronic pain as well as a potential opioid-sparing effect.
The authors of this review identified a large number of these studies, with researchers concluding that, in comparison to placebo, a greater number of participants reported better pain management with cannabinoid-based treatments. In addition, a panel formed by the National Academies of Sciences, Engineering and Medicine found that there is conclusive or substantial evidence that cannabis and/or cannabinoids are effective in the treatment of chronic pain.
The authors of this review concluded by urging clinicians to remain curious about the potential of cannabinoids for the treatment of conditions related to sports, including chronic pain. In particular, the authors find that there increased research into the cannabinoids and the endocannabinoids system for related conditions, and symptoms are warranted.