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.
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 :
- 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?
- Does the manufacturer report adverse events tied to its products?
- Is the product certified organic?
- 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.
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.
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.
CBD oil and back pain
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- Research overview
- The studies
Recognized as the leading cause of disability worldwide, back pain is a common condition that can cause extreme discomfort – not to mention a few missed days of work or physical activity. Evidence suggests that 50% to 80% of adults will experience at least one episode of back pain at some point in their lives.
Back pain can occur for any number of reasons and range in severity, whether it be a simple muscle strain, bad posture, a ruptured disc, arthritis, or even a sign of more serious medical conditions, such as a kidney infection or blood clot.
As research into the benefits of cannabis continues, cannabidiol (CBD) has emerged as a potentially viable treatment for pain relief. CBD is a non-intoxicating cannabinoid found in the cannabis plant, second in abundance only to THC, and is widely perceived to help reduce pain.
Therefore, it stands to reason that someone experiencing back pain might be wondering whether they can effectively use CBD oil for back pain.
CBD is a non-intoxicating cannabinoid found in the cannabis plant and is widely perceived to help reduce pain. Photo by: Gina Coleman/Weedmaps
More peer-reviewed research is needed, focused specifically on CBD treatment for back pain relief, but numerous studies have already demonstrated the anti-inflammatory and analgesic properties of this cannabinoid.
When CBD interacts with the endocannabinoid system (ECS), which is an internal system that regulates our bodies, it enhances the signaling of anandamide, a pain-regulating compound found in the brain that is linked to feelings of well-being and happiness. By preventing the absorption of this molecule, CBD pushes excess quantities into the bloodstream, reducing pain throughout the body.
CBD pushes excess quantities into the bloodstream, reducing pain throughout the body. Photo by: Gina Coleman/Weedmaps
CBD has also demonstrated the ability to reduce pain through the body’s TRPV1 receptors, responsible for control functions such as inflammation and the awareness of pain.
One study, published in the September 2015 edition of the journal Neurotoxicology, found that CBD also inhibits glutamate levels in the brain and spinal cord, which is associated with increased sensations of pain and transmission. Past research also suggests that CBD could be an effective treatment for some of the most detrimental conditions that cause chronic pain, such as neuropathic pain in multiple sclerosis (MS) and intractable cancer pain.
In a 2012 study, also conducted on lab mice, researchers found that CBD targets alpha-3 glycine receptors to suppress chronic inflammatory and neuropathic pain associated with dysfunctional glycine receptors, an important target for pain processing by the spine, without causing any noticeable analgesic tolerance.
There’s no definitive answer yet, but a 2016 animal study published in European Journal of Pain found that topical application may be more effective than the sublingual method. The research team discovered that while CBD had poor oral bioavailability in lab rats, topical CBD application provided more constant plasma levels, bypassing gastrointestinal administration and first-pass metabolism, which is a phenomenon where the concentration of a drug is reduced before it reaches circulation.
There is evidence that CBD could reduce pain associated with osteoarthritis, a multifunctional joint disease that causes joint degeneration and inflammation. A 2017 study in the journal Pain found that local application of CBD reduced joint inflammation and prevented pain, suggesting that CBD would be an effective treatment for pain associated with arthritis.
In a 2014 review in the European Journal of Neuroscience that summarized past research on CBD and osteoarthritis, researchers concluded that while clinical evidence is limited, existing studies on CBD use for arthritis treatment have shown promising results.
CBD has also been examined as a treatment for other conditions that cause intense bouts with back pain. For instance, a 2014 study demonstrated that CBD reduced the severity of damage caused by disc degeneration in the vertebrae. After inflicting lab rates with a spinal injury, the research team injected them with various concentrations of CBD, and concluded that higher doses of CBD provided an anti-degenerative effect and “attenuated the effects of disc injury.”
For some, chronic back pain may make it difficult to get a proper night of sleep, but a growing faction of research points to CBD as an effective sleep aid as well. One study, published in the Permanente Journal in January 2019, found that CBD alleviated short-term sleep issues and reduced anxiety in a majority of patients.
Chronic back pain may make it difficult to get a proper night of sleep, but research points to CBD as an effective sleep aid as well. Photo by: Gina Coleman/Weedmaps
While the initial evidence supports that notion that CBD is a viable treatment for chronic pain, it’s important to note that more clinical research is needed to gain a better understanding of the anti-inflammatory and analgesic properties of this non-intoxicating cannabinoid.
CBD oil and back pain Copy article link to clipboard. Link copied to clipboard. Contents Research overview The studies Recognized as the leading cause of disability