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Cannabis and CBD for Back and Neck Pain Q&A

For people who have struggled with chronic back or neck pain, the list of treatments tried is likely long. Some traditional therapies for pain, namely opioid medication, pose significant risks. Seeking safer alternatives, people are increasingly using cannabis, hemp, and cannabinoid products (such as cannabidiol, or CBD) to manage spine pain. But because marijuana-related pain management is legally conflicted in the United States and a relative newcomer to mainstream medicine, questions remain about its safety and efficacy.

the word cannabis in bold type in copy Use of cannabis, hemp and cannabinoid products for many different medical conditions, including back pain, is gaining popularity. Photo Source: iStock.com.

This Q&A guide can help clarify the confusion about cannabis-related pain management, so you can better understand the risks and benefits of this potential chronic pain treatment.

What are the key definitions I need to understand regarding medical marijuana?

The terms surrounding medical marijuana can be confusing. Below are some basic definitions.

  • Cannabis sativa: The plant that produces both marijuana and hemp. 1
  • Cannabinoid: One of the more than 100 compounds that exists in cannabis. 2
  • Tetrahydrocannabinol (THC): A cannabinoid known for producing an intoxicating “high,” 2
  • Cannabidiol (CBD): A cannabinoid known for its non-intoxicating, nonpsychoactive medicinal effects. 1

How and why might some people use cannabis for medical purposes?

Although cannabis has recently exploded onto the mainstream medicine scene, evidence suggests that people have used cannabis for medical purposes for more than 5,000 years. 3 Common uses for medical marijuana include treatment of epilepsy, sleep disorders, anxiety disorders, and pain (including back, neck, and chronic pain). More recently, people have sought out cannabis and CBD products as alternatives to opioids, which have been linked to addiction and death.

Is it legal to use marijuana for back and neck pain?

State and federal laws differ regarding marijuana, but it largely depends on where you live.

  • On the state level, more U.S. states are legalizing both medical and recreational use of marijuana. As of January 2020, in the United States, legalized medical marijuana programs are in 33 U.S. states, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands. An additional 13 U.S. states have enacted programs legalizing the use of low-THC, high-CBD products to treat specific conditions. 2
  • On the federal level, cannabis and its related products that contain more than 0.3% of THC are considered Schedule 1 controlled substances—making them federally illegal. However, industrial hemp, which is cannabis containing very low amounts of THC, was made federally legal in 2018. 2

What does the evidence say about cannabis’ effect on spinal pain?

Overall, more high-quality, human studies are needed to confirm whether cannabis, CBD, and hemp are safe and effective therapeutic options for chronic back and neck pain. However, evidence is mounting that shows CBD and hemp may play a greater role in managing chronic spine pain and curbing opioid-related risks.

A 2018 study found that CBD reduced nerve-related and inflammatory pain in animals, supporting a promising future for CBD as a mainstream pain relief option. Evidence has also found that CBD is a safe effective addiction therapy, leading CBD to rise in popularity for it’s potential to treat opioid abuse and prevent it as a viable chronic pain-relieving alternative. 1

Will I get “high” if I use CBD or hemp products to manage my back pain?

No, CBD and hemp do not cause any intoxicating effects. The “high” resulting from marijuana use is caused by THC, which is just one of the many cannabinoids in cannabis. CBD is also a cannabinoid in cannabis, but it doesn’t cause any “high.” CBD and hemp products may contain trace amount of THC, but the levels are too low to cause any psychoactive effects.

How do people use cannabis and CBD?

Products containing cannabis, hemp, and CBD are exploding. Some people prefer to smoke cannabis, but manufacturers are getting creative when it comes to producing products containing cannabis and its related compounds. Food, beverages, dietary supplements, oils, topicals (like creams and salves), and bath soaks are just a few of the applications consumers can use.

Is vaping a safe way to use cannabis for pain relief?

No. Vaping, or e-cigarette use, grew in popularity as a more discrete alternative to smoking. However, the subsequent rise of lung-related disease directly connected to vaping sickened thousands and even led to the death of dozens of Americans. The Centers for Disease Control and Prevention has encouraged people to stop vaping entirely.

What is known about the safety of CBD products?

The FDA admits research about the safety of CBD products is quite limited. To date, Epidiolex (cannabidiol) is the only FDA-approved prescription drug, and this medication is only indicated for treatment of 2 rare types of epilepsy. Bear in mind that just because a product is FDA-approved doesn’t mean it’s completely safe without potential side effects that could be serious. 4

The FDA warns consumers about illegal CBD marketing strategies and product promises. They also suggest the potential for liver damage, serious side effects when combined with other medications, such as central nervous system depressants (eg, tranquilizers). While CBD products can cause side effects (eg, drowsiness, mood changes), these symptoms may go away when use is stopped. The FDA raises many unanswered questions about the effects on infants and children, not only adults. 4

How can people find a high-quality CBD or hemp product?

Because mass-marketed CBD and hemp oils and other products are not approved or regulated by the FDA, it can be challenging to know whether a product is safe or actually contains the ingredients promised on the label. Products containing synthetic cannabinoids (eg, “spice”) are especially concerning, as they have been linked to serious complications.

To narrow the field, researchers recommend you ask the following questions before buying 1 :

  1. Does it meet quality standards outlined by a credible certification body, such as Current Good Manufacturing Practices (CGMP), European Union (EU), or Science Foundation (NSF) International?
  2. Does the manufacturer report adverse events tied to its products?
  3. Is the product certified organic?
  4. Does the product undergo laboratory testing to confirm THC levels?

Should you talk to your doctor if you use cannabis or cannabinoids?

Yes. To effectively treat your spinal pain, your doctor needs to understand all the medications, drugs, and supplements you’re taking—and that includes any cannabis, hemp, or CBD products. These products may interact with a drug you’re prescribed, so your doctor needs to know this information to keep you safe. As medicinal uses of marijuana become more commonplace, clinicians understand that more patients are curious about whether it will ease their pain. Don’t be hesitant to share your interest in CBD with your doctor, as he or she may help you choose a reputable product.

More Research Needed but Cannabis May Be a Promising Chronic Pain Therapy

With the rise of opioid-related addiction and death, people have sought out cannabis and cannabinoids (such as cannabidiol, or CBD) as pain-relieving alternatives. And if traditional treatments have failed to ease your back or neck pain, you may be curious to try cannabis or CBD products. As these therapies skyrocket in popularity and become more readily available, don’t forget to keep your doctor looped in. He or she needs to understand how you’re managing your pain to ensure your treatment regimen isn’t doing you more harm than good.

References
1. VanDolah HJ, Bauer BA, Mauck KF. Clinicians’ Guide to Cannabidiol and Hemp Oils. Mayo Clin Proc. September 2019;94(9):1840-1851. doi.org/10.1016/j.mayocp.2019.01.003. Accessed January 29, 2020.

2. Rubin R. Cannabidiol Products Are Everywhere, but Should People Be Using Them? JAMA. 2019;322(22):2156. https://jamanetwork.com/journals/jama/fullarticle/2756099. Accessed January 29, 2020.

3. Bridgeman MB, Abazia DT. Medicinal Cannabis: History, Pharmacology, And Implications for the Acute Care Setting. PT. 2017;42(3):180–188. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312634/. Accessed January 29, 2020.

4. US Food and Drug Administration (FDA). What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, including CBD. November 25, 2019. https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis. Accessed January 29, 2020.

Sources
Tyndall DS. CBD Oil, the new medical elixir. NWI Times. July 13, 2018. https://www.nwitimes.com/lifestyles/cbd-oil-the-new-medical-elixir/article_eb5fb3e3-862b-59f5-a859-70dbf5057193.html. Accessed January 29, 2020.

Harris-Taylor M. He Started Vaping THC To Cope With Chronic Pain. Then He Got Sick. NPR. December 11, 2019. https://www.npr.org/sections/health-shots/2019/12/11/776356212/he-started-vaping-thc-to-cope-with-chronic-pain-then-he-got-sick. Accessed January 29, 2020.

The Medical Letter on Drugs and Therapeutics. The Medical Letter, Inc. November 18, 2019;61(1585).

Cannabis, hemp, and cannabinoid products, such as CBD oil, are gaining public popularity to treat back pain. Spine doctor answers 10 key questions.

Understanding CBD (Cannabidiol) for Back Pain

Cannabidiol, commonly referred to as CBD, is a new and relatively understudied treatment for pain, including back pain. Studies suggest it may help relieve inflammation, which is often a factor in chronic back pain. 1

CBD is available in many forms; topical creams and gels have shown promising results for inflammation and neuropathy, which may make them a good option for back and neck pain. 2

CBD requires more research in order to prove and explain its effectiveness as well as to better understand potential side effects (especially long-term) and potential drug interactions.

What Is CBD?

CBD oil is derived from a plant called cannabis sativa. The plant has over 100 chemical compounds, called cannabinoids, that have a range of effects, including anti-inflammatory and analgesic (pain relieving) qualities.

The cannabis sativa plant has two main varieties that are grown for specific purposes:

  • THC content. THC is the compound associated with the “high” feeling of marijuana use.
  • Industrial (non-drug) uses. This form of the plant contains trace amounts of THC (less than .03%) and can be used to make paper, clothing, and some building material. This variation of the cannabis plant is called hemp.

While CBD is present in both varieties, many of the CBD products available to consumers are from the hemp plant. CBD does not come with the high or psychogenic effects of marijuana.

Ways CBD Treats Back Pain

Research indicates that CBD may reduce back pain by:

  • Reducing inflammation 3
  • Combating anxiety, often associated with long-lasting or chronic back pain 4
  • Helping with sleep and improving overall state of relaxation 5

Some studies suggest that CBD can have an effect on how an individual perceives pain, but more robust research is needed. CBD is generally considered a full-body treatment, which means that it does not target back pain specifically—except in the case of topical products—but contributes to an overall feeling of relaxation and pain relief.

Advocates of CBD believe it can be used to treat a range of conditions in addition to back pain, such as anxiety-related disorders. 5

Potential Risks and Side Effects of CBD

Cannabidiol, even in high amounts, is generally safe. Side effects from CBD may include:

  • Drowsiness
  • Dizziness
  • Dry mouth
  • Low blood pressure

More severe side effects, while rare, include:

  • Mental confusion
  • Nausea
  • Vomiting
  • Diarrhea

As with other natural products, there is potential for adverse reactions when taken with other medications, especially those that come with grapefruit warnings, such as certain blood thinners. These warnings indicate that certain medications should not be taken with products containing grapefruit.

CBD use prior to surgery

Before having surgery, all cannabis use, including CBD and marijuana, should be disclosed to the surgeon or anesthesiologist. A recent study suggests that cannabis use may have an effect on medications used to sedate patients. 6

Cannabidiol, or CBD, is a new medical treatment that may be effective for back pain. It has relatively few side effects and does not come with the high associated with marijuana.