Tremors are caused by conditions, such as neurodegenerative diseases, anxiety, and brain injury. Can CBD help with tremors, if so, how? Does CBD help with tremors? What kind of abrupt movements can CBD oil reduce — and what’s the secret behind its therapeutic versatility? This article breaks down the benefits of CBD for tremors. Essential Tremor Research Program: Cannabidiol Anti-Tremor Action and Mechanisms “People tend to think of medical marijuana as a single substance; a substance that may have beneficial effects but
Best CBD Oil for Tremors – August 2022
Tremors are caused by conditions, such as neurodegenerative diseases, anxiety, and brain injury.
Scientific studies have yet to determine how cannabidiol ( CBD ) may affect tremors. However, scientists are now investigating its capability to reduce symptoms of the movement disorder .
In January 2019, the University of California, San Diego , called for volunteers for a double-blind study on how medical cannabis may affect essential tremors (ET) (6) .
Dr. Nahab explained that there are currently no pharmacological agents developed for ET. For years, epilepsy medications have been used as off-label treatment.
Also, modern treatment for severe ET involves deep brain stimulation ( DBS ) surgery. DBS is an invasive procedure where a device is implanted into the brain.
The researchers, led by neurologist Dr. Fatta Nahab , are expected to share their findings in December 2020 (7) .
In a clinical trial conducted on Parkinson’s disease patients by the University of Colorado, the authors examined CBD ’s efficacy and tolerability (8) . The study measured appropriate CBD dosing and its ability to reduce tremors.
A positive outcome from ongoing CBD studies may lead to a natural solution to treating tremors.
Although CBD ’s efficacy on tremors is yet to be seen, many studies attributed its positive effects on several brain conditions, such as neurodegenerative diseases, stroke, brain injury, and anxiety (9) .
CBD vs. Neurodegenerative Disease-Related Tremors
Parkinson’s disease (PD) is a non-reversible disorder of the central nervous system . Symptoms of PD may include hand tremors , rigid muscles, impaired posture, uncontrolled muscle movements , and many more.
Neurotherapeutics released a study in 2015 that discussed how individuals who were experiencing severe PD-related pain and tremors showed significant improvements after medical cannabis treatment (10) .
Furthermore, patients from the Prague Movement Disorder Centre also reported tremor improvements after using cannabis (11) .
Medical cannabis ( medical marijuana ) does not guarantee the same amount of compounds as one would get from a full-spectrum CBD oil .
However, the two main subspecies of cannabis (Cannabis indica and Cannabis sativa) are abundant with CBD (12) .
The US federal law prohibits CBD products from containing more than 0.3% tetrahydrocannabinol ( THC ), the cannabinoid that causes psychoactive effects. Meanwhile, medical cannabis may contain THC levels higher than 0.3%.
More comprehensive studies are essential to determine how CBD , as a monotherapy, may affect rigidity and tremors among individuals with PD.
However, some researchers acknowledge that CBD may have neuroprotective properties that can help with PD.
A study posted in the British Pharmacological Society mentioned that CBD might be able to modulate neurotransmission and improve neurogenesis (formation of new neurons) (13) .
The study added that CBD , as a monotherapy, or if used in conjunction with other phytocannabinoids, had demonstrated significant effects among individuals with Parkinson’s disease , Huntington’s disease, and multiple sclerosis (14) .
The authors continued that CBD was able to activate the G-protein receptors, leading to an increase of adenosine (a building block for DNA and RNA) concentrations. This response resulted in the reduction of inflammatory cells in the brain (15) .
According to another study, systemic inflammation in the brain can lead to an exaggerated synthesis of proinflammatory cytokines, a protein released by the immune system (16) .
The release of these proinflammatory proteins can lead to both acute and chronic neurodegeneration. Long-term studies are needed to confirm any potential benefits of CBD for neurodegenerative or other disorders besides certain childhood seizures.
CBD vs. Anxiety-Related Tremors
A recent study posted by the Journal of Psychopharmacology has shown how CBD reduced anxiety and tremor amplitude among PD patients (17) .
The study specified that a 300mg/d (milligrams per day) CBD dose produced significant differences in blood pressure , heart rate, and frequency of tremors among the participants.
The study also saw a reduction in anxiety-related tremors during a simulated public speaking test.
Other studies have mentioned how CBD might have therapeutic benefits for individuals with anxiety and other neuropsychiatric conditions (18) .
CBD vs. Brain Injury and Stroke Tremors
An animal study from Pharmaceuticals addressed how CBD may positively affect brain injury and ischemic stroke (stroke caused by lack of blood blow) (19) .
The study found that cannabinoids might facilitate neuroprotection and neuro repair response in the brain.
A dose of 3mg/kg (milligrams per kilogram) CBD administered to mice models with cerebral ischemia improved the neurological scores and motor coordination (20) .
The study concluded that more research is needed to evaluate CBD ’s clinical value on brain injury and stroke.
CBD vs. Other Movement Disorders
A study mentioned that basal ganglia dysfunction is responsible for causing movement disorders , like tremors and chorea (21) .
The British Journal of Pharmacology released a study that supported cannabinoid ’s affinity in activating receptors in the basal ganglia (22) .
The authors added that the activation might have therapeutic potential in treating Huntington’s disease (HD) and Parkinson’s disease (PD) symptoms.
A 2018 study released in Neurochem evaluated how CBD and other cannabinoids might have neuroprotective effects in an HD cell culture model (23) .
In the study, CBD , tetrahydrocannabinol ( THC ), and cannabinol (CBN) showed 51-84% protection against Huntington-induced cell death.
Moreover, a review from Neurology mentioned that CBD might have reduced chorea among patients with HD. A dose of 300mg/d (milligrams per day) CBD was administered to patients orally for three weeks.
Mild improvements in choreic movements (5 to 15%) were reported in the first week. In the second week, further improvements (20 to 40%) were reported (24) .
Chorea, like tremors, is a movement disorder . However, a tremor is classified for its rhythmicity and predictability, while chorea has more random and untimely movements (25) .
Meanwhile, a contrasting study was released by Pharmaceuticals, where a controlled clinical trial showed no significant improvements among 15 patients with HD.
In the study, patients were treated with 700mg/d for six weeks. The study did acknowledge that high doses of oral CBD (150-600 milligrams per day) might hold a therapeutic effect on social anxiety, insomnia, and epilepsy (26) .
Also, CBD is a medically-accepted therapy for epileptic spasms. In 2018, the FDA approved Epidiolex as a pharmaceutical drug for rare child epilepsies. The main active ingredient in the drug is CBD (27) .
Although there are no studies that have used Epidiolex as off-label medication for tremors, another antiepileptic drug, Primidone , is a medically-accepted off-label treatment.
How CBD Oil Works to Help With Tremors
The human endocannabinoid system (ECS) is a complex system made of G-protein-coupled receptors, cannabinoid receptor 1 (CB1) and cannabinoid receptor 2 (CB2).
These receptors are located throughout the human body. Most are present in the central nervous system (CNS) and peripheral nervous system (28) .
Many researchers have discussed how modulating the ECS might result in many therapeutic promises in a wide range of pathological conditions and diseases (29) .
Researchers also learned that there is a high density of cannabinoid receptors in the cerebellum and basal ganglia (areas that control motor function).
These receptors have caused many researchers to examine how tremors caused by CNS-related diseases can be alleviated.
A study published in the British Journal of Pharmacology explained how cannabinoids , such as THC and CBD , may have the ability to interact with CB1 and CB2 receptors (30) .
The authors mentioned that CBD displays high potency in modulating CB1 and CB2 receptors.
Another study hypothesized that alterations to the ECS might be beneficial to Parkinsonian tremors. The study also called on researchers to consider testing the range of individual cannabinoids for their therapeutic potential in managing tremors (31) .
The Pros and Cons of CBD Oil for Tremors
- CBD might be able to modulate neurotransmission and improve neurogenesis (formation of new neurons) (32) .
- CBD has demonstrated significant effects among individuals with neurological disorders, such as Parkinson’s disease , Huntington’s disease, and multiple sclerosis (33) .
- CBD might help reduce inflammatory cells in the brain (34) .
- CBD has been reported to have reduced movement disorder symptoms among patients with Huntington’s disease (HD) (35) .
- CBD has been acknowledged as well-tolerated and safe for daily use (36) .
- CBD has been found to improve motor functions in animal models with induced ischemia (37) .
- There is a lack of evidence if CBD , as a monotherapy, can help improve essential tremors or treat any disorder other than certain childhood seizures.f
- CBD is poorly regulated. Individuals are encouraged to do extensive research before choosing a CBD brand.
- CBD may cause side effects , such as dry mouth, diarrhea, and loss of appetite (38) .
- According to the US Food and Drug Administration ( FDA ), CBD may cause liver injury if consumed in extremely high doses (39) .
How CBD Oil Compares to Alternative Treatments for Tremors
There are no recommended alternative treatments for tremors except for off-label use of other pharmaceutical drugs and compounds (40) .
- Propranolol – contraindicated in pulmonary disease or heart block
- Primidone – may cause sedation and cognitive side effects
- Allopregnanolone – used for postpartum depression
- Octanol – fatty alcohol used in perfumes and flavoring
- TPA023 – anti-anxiety drug
- OnabotulinumtoxinA (Botox) – injected into the larynx (voice box) for voice tremors and face muscles for face tremors (41) .
Researchers list the following recommendations as emerging treatments for tremors due to their anxiolytic, anticonvulsant, and sedative properties.
Meanwhile, studies have acknowledged CBD for its anxiolytic, anticonvulsant, and sedative properties (42) .
How to Choose the Best CBD Oil for Tremors
For individuals who want to improve tremor symptoms, it may be appropriate to use full-spectrum CBD oil .
Full-spectrum CBD oil contains all the cannabinoids present in hemp plants, such as CBD , cannabigerol (CBG), cannabinol (CBN), and THC .
The previous studies mentioned in this article mostly used cannabis as a trial treatment.
Most full-spectrum CBD products contain all the phytocannabinoids one can find in a cannabis plant (43) . However, the product may not contain more than 0.3% THC due to the United States ’ federal law .
The broad-spectrum CBD oil is another product that contains all the cannabinoids with 0% THC . Broad-spectrum oil is recommended for individuals who do not want THC in their system.
Moreover, individuals who cannot tolerate other cannabinoids may opt for CBD isolates, which contain only pure CBD .
CBD Dosage for Tremors
The recommended dosage for individuals who want to take CBD for brain- or CNS-related conditions is less than 1 milligram to 50 milligrams per day (44) . The dosage can be increased when the body gets used to CBD .
A high CBD dosage is not recommended due to lack of information on how CBD may affect symptoms of essential tremors .
How to Take CBD Oil for Tremors
When taking CBD oil for tremors, the fastest delivery method is through vaping. A study had mentioned that the lungs are a very efficient mechanism for drug delivery.
The authors continued that CBD inhaled through aerosols or vaporizations can deliver plasma concentrations that can be felt within 10 minutes or less (45) .
Vaping is also recommended for its accessibility. Individuals who are looking to find a quick relief can vape CBD at home or while traveling.
However, there had been several reports that vaping can potentially cause harm, such as chemical irritation, allergic reactions, shortness of breath, and chest pains (46) .
Individuals may also opt for oral or sublingual (under the tongue) delivery, such as CBD capsules or CBD tinctures . The oral administration allows for optimal absorption (47) .
Some CBD tinctures may have an earthy taste and smell due to terpenes and flavonoids added into the concentration. Individuals who do not care for this distinct flavor can opt for CBD capsules.
Individuals must discuss their treatment options with a licensed physician before using CBD for their medical conditions .
Reports on CBD ‘s therapeutic potential in improving PD’s primary motor symptoms have resulted in scientists pursuing the mechanism behind its efficacy (48) .
A positive outcome of these studies could significantly impact individuals who suffer from tremors.
Nevertheless, tremor sufferers may also adjust their lifestyle to naturally improve their quality of life, such as trying meditation, avoiding caffeine, and reducing alcohol (49) .
Experts also advise a few modifications, such as using the hand with less tremor more often, utilizing voice-activated commands on smartphones, and speech-recognition on computers.
Always seek qualified professional medical advice for any personal health concerns and before taking CBD for any reason.
Does CBD Oil Help with Essential Tremors?
Tremors can be caused by various factors, from neurodegenerative diseases to anxiety, brain damage, aging, and withdrawal symptoms from addiction.
Scientists have been examining the health benefits of CBD for quite some time now, with great effort being fueled into research on how CBD may affect tremors.
The endocannabinoid system (ECS) controls an array of essential physiological processes, including motor functions and movement. Since tremors are muscle movements that involve back and forth rhythmic swaying, they perfectly fall into that bracket.
In turn, this suggests that the ECS can be a therapeutic target for people looking for effective tremor management.
CBD oil is the modulator of the ECS, but can it help with tremors?
This article explores how CBD affects tremors and what science says about its therapeutic potential in this subject.
Common Causes of Tremors
Tremors are involuntary movements of the body and can impact the hands, arms, head, face, legs, and voice. More often than not, tremors are caused by neurological disorders in the brain regions that control movement. Conditions that destroy or degrade the brain cells, like Alzheimer’s disease, Parkinson’s disease, or stroke, can trigger tremors.
However, they can also appear as a result of drug withdrawal or as the side effect of certain prescription medications. Tremors often appear during a stressful event when a person is going through anxiety.
So, while temporary tremors aren’t an alarming sign, chronic episodes may indicate a serious disease requiring medical attention.
Does CBD Help with Tremors?
Researchers have yet to find out how CBD affects tremors. CBD is widely studied for its ability to reduce the symptoms of movement disorders. So far, we know that CBD can reduce muscle spasms, convulsions, and tremors associated with conditions like epilepsy, Parkinson’s Disease (PD) , and Multiple Sclerosis (MS ). One study actually found that CBD reduced the intensity of tremors in patients with PD during their REM sleep stage.
The mechanism behind the potential positive effect of CBD on tremors isn’t well-known yet. However, scientists speculate that the ECS is the major therapeutic target in this relationship.
By indirectly acting on the cannabinoid receptors in the central and peripheral nervous system, CBD can ensure proper muscle movement and prevent tremors — at least hypothetically.
Let’s elaborate on that mechanism using the examples of different types of tremors.
Does CBD Oil Help with Hand Tremors?
As mentioned, CBD interacts with the ECS, which is a broad system of receptors and neurotransmitters that work to maintain homeostasis between essential bodily functions — including muscle movement.
When CBD regulates these receptors, it produces relaxing and antispasmodic effects; it can also block the release of pro-inflammatory proteins known to damage the nervous system.
Through these pathways, CBD can ease symptoms of tremors on top of effectively acting as a neuroprotectant.
One study on mice showed that CBD produced superior results in tremor relief without showing any life-threatening side effects or causing impairment. The authors also determine what receptors may be involved in these effects, suggesting that CBD engages with the 5-HT1A receptor to prevent tremors by activating the TRPV1 receptor .
Many of the prescription drugs that people usually take for tremors carry a risk of dangerous side effects. CBD, in turn, comes with anti-tremor properties and has a good safety profile with only minor side effects when overdosed.
CBD Oil Effects on Parkinson’s Disease Tremors
As mentioned earlier, tremors generally result from neurodegenerative diseases, such as Parkinson’s Disease (PD). This non-reversible disorder of the central nervous system causes people to experience impaired posture, uncontrolled muscle movements, rigid muscles, and hand tremors.
In 2015, Neurotherapeutics published a study that examined the efficacy of medical cannabis for PD symptoms, concluding that the majority of the subjects showed significant improvements at the end of the treatment .
Patients from the Prague Movement Disorder Centre also reported improved quality of life due to significant symptom relief after using cannabis .
That being said, medical cannabis isn’t the same as hemp-derived CBD oil. The former may contain higher amounts of THC on top of CBD and other cannabinoids, while the latter only comes with 0.3% of THC or less — meaning the effects of cannabis-derived CBD oil may not be replicated with hemp-derived extracts.
CBD Oil for Elderly Tremors
More studies are needed to determine if CBD can be used as monotherapy to manage tremors and other symptoms among the elderly and patients with PD.
However, some neuroscientists acknowledge that CBD may act as a neuroprotectant that helps with PD. A study published in the British Pharmacological Society mentioned that CBD could modulate neurotransmission and prompt neurogenesis (formation of new brain cells) .
These effects were tested as a monotherapy, and in conjunction with other cannabinoids, among patients with Huntington’s disease, multiple sclerosis, and Parkinson’s Disease.
Other Types of Tremors that CBD Oil Can Help With
Aging and neurodegenerative disorders are just two causes of tremors that CBD might help with. But can it also relieve tremors induced by stress or brain injuries?
CBD Oil for Anxiety Tremors
In a recent study published by the Journal of Psychopharmacology, the authors found that CBD reduced anxiety and tremor amplitude among PD patients. The research team used a dose of 300 mg CBD/day, which provided significant benefits for heart rate, blood pressure, and frequency of tremors among the subjects .
The scientists also noted a reduction in anxiety-related tremors during a simulated public speaking test.
Other studies implicate that CBD can have therapeutic benefits for people with anxiety disorders and neuropsychiatric conditions.
CBD Oil vs. Brain Damage Tremors
An animal study from Pharmaceuticals found that CBD may positively affect brain regeneration after an injury and ischemic stroke (one caused by the blockage of blood flow) .
The study found that CBD exerted neuroprotective actions and assisted in repairing communication between neurons in the brain. The researchers administered 3mg/kg of CBD per day to mice models with cerebral ischemia — reporting improved motor coordination and neurological scores.
The authors concluded that more research would help establish CBD’s clinical value on brain injury and stroke.
Best Type of CBD to Use for Tremors
There are three main types of CBD you can choose from: full-spectrum CBD, broad-spectrum CBD, and CBD isolate.
Full-spectrum CBD is made from the whole hemp plant, and as such, it contains all the cannabinoids present in hemps, such as CBD, CBN, CBG, CBC, and trace amounts of THC. It also contains a lot of terpenes, which are volatile molecules that modulate the activity of cannabinoids.
These compounds create a unique synergy known as the entourage effect. This concept was brought up in 1988 and further elaborated on in 2011 by E.B. Russo, an esteemed neuroscientist and cannabis expert. In the entourage effect, the sum of all active ingredients in the plant is more potent therapeutically than each compound in isolation.
Therefore, if you want to reap the most benefits of your CBD oil, opt for full-spectrum extracts.
Broad-spectrum CBD is very similar to its full-spectrum counterpart, but it doesn’t contain any THC. The intoxicating ingredient has been removed after initial extraction so that the user can benefit from some of the entourage effects without worrying about failing a drug test.
You can also choose CBD isolate, which is pure CBD that has been crystallized and infused into the same product formats as the other types of CBD. The advantage of CBD isolates over other types of CBD oils is the lack of flavor and aroma; that being said, there’s also an obvious downside — the lack of entourage effect.
Once you know your desired type of CBD, it’s time to consider the best form for your tremors. Here we’ll explore the two basic formats of CBD: oils and capsules.
CBD Oil vs. Capsules for Essential Tremors
Choosing between CBD oil and capsules for tremors boils down to mapping out your needs and knowing the pros and cons of both products.
CBD oil is administered under the tongue. From there, it absorbs through tiny blood vessels in the mouth, reaching the bloodstream. The effects of CBD oil are usually noticeable within 15-30 minutes after administration, lasting for up to 6 hours. The peak concentration levels of CBD oil are usually reached after 1.5 hours. The bioavailability of CBD oil is around 35%, meaning that slightly over one-third of the ingested content ends up in your system.
With CBD capsules , the route of administration causes a delay in effects. Since CBD needs to pass through the digestive system, the effects may need about 30 to 90 minutes to take hold, depending on your metabolism and whether you take CBD on a full or empty stomach. While CBD capsules offer lower bioavailability — up to 20% — they last longer than oils because CBD is released gradually from the liver.
If you’re looking for more pronounced and faster-acting effects, CBD oil is a better option. Capsules come in handy if you have your supplementation scheduled up and don’t mind the delay. CBD capsules also mask the earthy flavor of CBD oil because the extract is contained in a soft gel shell, which is another argument in their favor.
CBD Oil Dosage for Tremors
Dosing CBD depends on a range of individual factors, including your weight, metabolism, age, the severity of tremors, and unique body chemistry.
According to a review of studies evaluating the effects of different CBD doses in clinical populations, an effective dose can range from 1 to 50 milligrams per day. The dosage can be increased when you don’t feel any difference after, say, one week. From there, you can gradually adjust the amount of CBD to the point where it effectively reduces tremors.
When you use CBD for tremors, taking high doses may cause a few mild side effects , such as:
- Dry mouth
- Appetite fluctuation
CBD can also interact with many pharmaceutical substances , so consult your doctor before adding CBD to your daily routine if you take any medications.
Bottom Line: How Can You Use CBD to Help with Tremors?
CBD’s potential in reducing different types of tremors is, without a doubt, promising. Several studies have already shown that it has the ability to improve primary motor symptoms of neurological conditions such as Parkinson’s Disease.
These positive results from the aforementioned studies shed new light on the therapeutic use of CBD for tremors. Products like CBD oil can significantly improve motor disorders without the dangerous side effects associated with pharmaceuticals.
Tremor sufferers can also adjust their lifestyle to naturally improve their lives, mainly by exercising, reducing alcohol, practicing meditation, and avoiding caffeine.
A consultation with a holistic or integrative neurologist should help you find the right set of remedies and adjustments to help you cope with tremors without frustration.
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Nina created CFAH.org following the birth of her second child. She was a science and math teacher for 6 years prior to becoming a parent — teaching in schools in White Plains, New York and later in Paterson, New Jersey.
Essential Tremor Research Program: Cannabidiol Anti-Tremor Action and Mechanisms
“People tend to think of medical marijuana as a single substance; a substance that may have beneficial effects but also causes mood- and mind-altering effects,” explains Dr. Adrian Handforth, Assistant Chief of Neurology at VA Greater Los Angeles Healthcare System in California, “But that is not the case at all. Actually, marijuana is made up of many related chemicals, called cannabinoids.”
Dr. Handforth is the lead researcher of an upcoming IETF funded study that will explore the effects of a particular cannabinoid known as “CBD” (cannabidiol) on essential tremor. Unlike the well-known cannabinoid “THC” (tetrahydrocannabinol), which has mind- and mood-altering effects, CBD does not alter the mind, the emotions, or one’s judgment. Although its long-term safety remains to be thoroughly studied, CBD has already shown some promising initial results in the treatment of epilepsy, pain, anxiety, and other disorders. Dr. Handforth and his team will try to find out whether CBD can suppress essential tremor in an animal model. And if it does, he will take the next step and try to understand how it works.
This is exactly why the IETF is so pleased to support Dr. Handforth and this cutting-edge research with a nearly $20,000 grant. “The significance of this work is two-fold,” says Dr. Handforth. “First, finding that CBD suppresses tremor in an animal model may provide justification for a clinical trial of CBD for essential tremor in humans. Second and more importantly, if we can understand how CBD stops the tremor, what mechanisms are at work, then an ET-specific medication could be developed that would be better-tolerated and more effective than what it available today.”
An ET-specific medication would impact millions of people around the world who have this life-altering condition but who don’t respond to the medications that are currently available. An ET-specific medication would be a life-changer for millions of men, women and children today and for generations to come.
Cannabidiol Anti-Tremor Action & Mechanisms – Conclusion
Principle Investigator: Adrian Handforth, MD
Cannabis, also known as marijuana, has been used for medicinal purposes for thousands of years. However, by federal law, the possession of cannabis is illegal in the United States, except within approved research settings; however, a growing number of states, territories, and the District of Columbia have enacted laws to legalize its medical use.
The U.S. Food and Drug Administration (FDA) has not approved cannabis as a treatment for any medical condition. However, the chemical components in cannabis are being studied. It is well known that certain chemicals in cannabis activate specific receptors throughout the body and these chemicals may be useful in treating neurological conditions, like ET. In this study, Dr. Handforth is looking at a specific chemical called Cannabidiol. Cannabidiol (CBD) is one of at least 113 active chemicals (also known as cannabinoids) identified in cannabis. However, CBD does not produce any intoxicating effects or alteration in mood. For years it was thought to be a benign and unimportant part of the plant. Now it is being investigated as a possible treatment option for ET.
In this study, Dr. Handforth aimed to show CBD can suppress tremor in animal models. If successful, it would offer justification for further study of CBD in humans. First, the study had to determine what effects CBD would have on mice impacted with harmaline–induced tremor. Then, if reduced, the team had to discover how CBD suppressed the tremor.
Testing a variety of doses, Dr. Handforth was able to note a robust suppression of tremor in the mice given CBD, without the animals showing any signs of impairment or sedation. Next, the team worked to discover what receptors in the brain might be involved in the noted effects. After looking at several options the information suggests that CBD activates the 5HT1a receptors to suppress tremor by activating the TRPV1 receptor.
Although the finding is clear with this model in mice, the extrapolation to human ET is tentative and would ultimately require validation in trials with the suggested therapies. So the findings are only suggestive at this time.