If you’re living with ankylosing spondylitis (AS) — a severe subtype of axial spondyloarthritis — you may be considering different types of complementary and alternative medicine (CAM) to help manage symptoms like lower back pain. Some members of MySpondylitisTeam, the online support network for people with spondylitis, have asked about cannabidiol (CBD) products for spondylitis, usually as a complement to their medical treatments.

One MySpondylitisTeam member posed the question, “Seeing a chiropractor and feeling better. Also, I’m going to try CBD oil. Any thoughts on CBD oil?”

CBD is a compound derived from the cannabis plant (commonly referred to as marijuana) that can be used to improve sleep quality and reduce nausea, anxiety, and pain. According to a 2023 study published in JAMA Network Open, an estimated 21 percent of U.S. adults reported using CBD products in the past year, reflecting a 50 percent increase since 2019. However, CBD is not currently approved by the U.S. Food and Drug Administration (FDA) to treat AS.

You may be curious about exploring CBD products to complement your current treatment for spondylitis. Here, we describe the safety, effectiveness, and legality of CBD for AS.

What Is CBD?

CBD is becoming an increasingly popular treatment for ailments like pain, sleeping problems, and anxiety. Cannabis plants contain hundreds of compounds, with two of the best-known compounds being CBD and tetrahydrocannabinol (THC). Among their differences, CBD doesn’t induce a “high” the way THC does.

People have long used these two compounds for recreational purposes and to self-medicate for various ailments. Following years of research studies on animals and humans, some healthcare providers are now recommending these compounds as medical agents.

Importantly for people living with AS and other inflammatory pain disorders, CBD has been shown to have anti-inflammatory, antidepressant, and antioxidant abilities.

MySpondylitisTeam members often discuss using CBD, as well as other medical marijuana products. CBD comes in many forms, brands, and formulations, so learning more before using this substance is essential.

Is CBD Legal?

CBD is legal in most states, but regulations vary. As of early 2025, 17 states and Washington, D.C., have fully legalized both medicinal and recreational cannabis, making CBD legal for adult use. Twenty states allow CBD with restrictions, such as for medical use only or with strict THC limits. Meanwhile, six states (Idaho, Kansas, Nebraska, North Carolina, South Carolina, and Wyoming) prohibit CBD entirely.

Because state laws differ — some only permit CBD for specific medical conditions or with low THC levels — it’s important to check local regulations before purchasing or using CBD products.

As of 2020, the FDA started actively evaluating CBD’s safety, effectiveness, and market regulation, emphasizing that most CBD products — aside from the epilepsy drug Epidiolex — have not been approved for medical use. The agency raised concerns about potential risks, including liver damage, drug interactions, and unknown effects on vulnerable populations. It also warned against misleading health claims, product contaminants, and inaccurate labeling.

To address these gaps, the FDA expanded research efforts, encouraged industry data sharing, and continues monitoring the market for public health risks.

Advocacy groups for people living with AS and other types of arthritis have come out in support of expanded research and clearer regulations around CBD and medical cannabis as potential pain management options. These groups include the Arthritis Foundation and the Spondylitis Association of America.

Forms of CBD Oil for Ankylosing Spondylitis

You can take CBD in many forms. It can be taken orally as an oil, a capsule, an edible, a beverage, or a liquid. CBD products that are eaten are absorbed through the digestive tract, and they generally start working in one to three hours. Capsules offer a consistent dose but may require adjustments for effectiveness. Edibles, such as gummies or cookies, provide an alternative method but come with inconsistent dosing and added sugars, which may not be ideal for health.

CBD oil can also be taken sublingually (under the tongue) via tinctures or sprays for faster absorption into the bloodstream (effects may start within 15 to 45 minutes). However, the taste can be unpleasant, and if swallowed, sprays or tinctures behave similarly to capsules or edibles.

CBD can also be applied topically (to the skin) as a cream, balm, or ointment. This strategy can be used to target joint and back pain due to spondylitis. The topical form is absorbed directly through skin receptors (specialized nerve endings). Topical CBD products are often combined with ingredients such as menthol, which may enhance anti-inflammatory, analgesic (pain-relieving) effects.

You can also inhale CBD-specific liquid using a vaporizer (vape). However, the FDA and the Centers for Disease Control and Prevention (CDC) caution against vaping of any kind, due to concerns about lung health and harmful additives, especially in unregulated products.

Choosing a CBD Product

Since most CBD products are not FDA-regulated, finding a safe, high-quality option can be challenging. Some products have been found to contain contaminants such as pesticides, heavy metals, or unlisted THC, and others have mislabeled CBD content​​.

Here are some tips to consider when choosing a product with CBD:

• Verify third-party testing — Reliable manufacturers provide certificates of analysis from independent labs, confirming CBD content and absence of contaminants.
• Check the label for transparency — High-quality products should clearly list CBD content per dose, total amount, and all additional ingredients.
• Be wary of medical claims — Avoid products that claim to cure or treat diseases, as this is not FDA-approved and often signals misleading marketing​.
• Buy from trusted sources — Purchase from pharmacies, state-regulated dispensaries, or reputable manufacturers.

When in doubt, consult a healthcare professional to ensure a CBD product is safe and appropriate for your needs, especially if you take medications​.

Safety of CBD for Ankylosing Spondylitis

Like any complementary and alternative medicine, CBD carries some risks of side effects and potential drug interactions. Although researchers have not identified serious safety concerns, common mild to moderate side effects may include:

• Drowsiness or fatigue (persistent exhaustion that doesn’t improve with rest)
• Decreased appetite
• Diarrhea or vomiting
• Sleep disturbances (insomnia or excessive sleepiness)
• Increased liver enzymes (especially at high doses)

These align with side effects reported for Epidiolex, the only FDA-approved CBD-based medication, which is used to treat epilepsy. Epidiolex has also been linked to rash, fever, infections, and rare but serious risks such as liver problems and suicidal thoughts.

Note: If you or someone you know needs help, you can contact the 988 Suicide & Crisis Lifeline by calling or texting 988 or chatting online.

Compared to opioids and nonsteroidal anti-inflammatory drugs (NSAIDs), CBD appears relatively safe, with low risk of overdose or addiction. However, it can interact with medications by affecting liver enzymes that metabolize drugs — similar to how grapefruit interacts with certain prescriptions.

Potential CBD Drug Interactions

CBD may interfere with how the body metabolizes certain medications, increasing or decreasing their effects. Some drugs commonly used by people with arthritis that may interact with CBD include:

• Corticosteroids (such as prednisone)
• Janus kinase inhibitors such as tofacitinib (Xeljanz)
• NSAIDs like celecoxib (Celebrex), ibuprofen (Advil), and naproxen (such as Aleve)
• Certain antidepressants
• Fibromyalgia medications, such as gabapentin (Neurontin) and pregabalin (Lyrica)
• Blood thinners, such as warfarin

Although CBD has few risks, be sure to have a conversation with your healthcare provider before trying it. Your physician can help you determine whether CBD is safe for your particular condition and what dosage would be appropriate for you.

Effectiveness of CBD for Ankylosing Spondylitis

Does CBD reduce chronic inflammation? While some people with arthritis report pain relief from CBD, clinical research on its effectiveness for AS is still limited. However, emerging studies suggest CBD may help with pain, inflammation, and sleep quality in people living with arthritis.

A 2022 cross-sectional study of 428 people living with arthritis found that:

• Eighty-three percent reported reduced pain after using CBD, with an average 44 percent reduction in pain scores.
• Sixty-six percent reported improved physical function and sleep quality.
• Almost 61 percent reduced or discontinued other medications such as NSAIDs, acetaminophen, or opioids​.

While this study relied on self-reported experiences, was not specific to AS, and had a limited sample size, the findings suggest that CBD may help manage symptoms in inflammatory arthritis conditions, potentially including AS. However, more rigorous clinical trials are needed to confirm its effectiveness.

Some preclinical research has shown that CBD reduces inflammation by targeting synovial fibroblasts, a key driver of inflammation in rheumatoid arthritis (RA). Similar mechanisms may be relevant in AS, but more research is needed​.

Personal Accounts of CBD for Ankylosing Spondylitis

Because there’s a lack of research, we can look at the personal experiences of people living with AS and other inflammatory chronic pain diseases.

In its 2019 survey, the Arthritis Foundation found that 79 percent of respondents said that they were either using CBD, considering using it, or had used it in the past. In addition, 29 percent of respondents reported that they currently use CBD, and among them:

• Ninety-four percent said their primary reason for using CBD was to relieve pain.
• Seventy-seven percent reported a reduction in anxiety.
• Seventy-one percent said it helped them sleep better.
• Sixty-seven percent reported improved physical function.
• Forty-one percent said they have a general overall sense of well-being.
• More than 30 percent said it helped with morning stiffness and made it easier to get moving.
• More than 30 percent reported improvements in fatigue.

Importantly, this was a survey and not a controlled research study in which scientists could objectively measure the reported benefits against a control group.

What MySpondylitisTeam Members Say About CBD

MySpondylitisTeam members have reported a wide range of experiences with CBD, from significant pain relief to little or no benefit, and some have faced challenges with side effects and cost.

• Some members have found CBD highly effective in managing pain, inflammation, and sleep disturbances. “I have drastically reduced all of my pain by using CBD FECO powder with added terpenes,” one member shared. (FECO stands for “full extract cannabis oil.) Another wrote, “I do use CBD oil, and it helps with anxiety. The oil helps me sleep well too.”
• Some find CBD works best in combination with other treatments. “I use Celebrex, CBD high-dose brand, and a tincture from Desert Willow Botanicals called Inflammaid,” a member said. “The three seem to work well.”
• Other members have reported seeing no benefit from CBD. “I have tried CBD oil — three different strengths — and it never did anything,” one noted.
• Some struggle with side effects. “I’ve been using lots of CBD, and my blood pressure has shot up,” wrote a member who’s also being treated for blood pressure (BP). “I read that CBD may defeat my BP medication — not proven, but I’m quitting all CBD. Not sure it was doing my AS any good anyway.”
• For some, cost is a major barrier. “My husband and I both tried CBD and found it helpful, but due to not being covered by insurance, it’s not affordable on a regular basis,” said one member.

In general, CAM therapies will not help reduce the progression of AS, but they may help address your symptoms. That’s why it’s important to keep taking your prescribed spondylitis medication, such as disease-modifying therapy, while trying CAM.

If you choose to try CBD, do so alongside your normal medications and with the supervision of your rheumatologist (specialist in joint, muscle, and bone diseases). Start with small doses, and take careful note of how different products and brands make you feel. Slowly increase your dosage over time. If, after a few weeks, you find no relief from your spondylitis symptoms, you may decide that CBD is not effective for you.

Take-Home Message

CBD is considered a relatively safe and potentially effective CAM that some people living with AS use to manage symptoms. CBD should not be used in place of your prescribed spondylitis treatment regimen. Consult your doctor to determine if CBD could pose any risks to you, given your current treatment, history of medical conditions, and health status.

Talk With Others Who Understand

MySpondylitisTeam is the social network for people with ankylosing spondylitis and their loved ones. On MySpondylitisTeam, more than 99,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.

Have you used CBD to alleviate your inflammatory back pain? Have CBD products improved your quality of life with spondylitis? Share your experience in the comments below, start a conversation by posting to your Activities page, or connect with like-minded members in Groups.