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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.

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.

What are the best cannabis strains for chronic pain?

Medical marijuana is an increasingly popular alternative to traditional pain-relieving medications, including opioids. Marijuana may ease certain types of chronic pain, including pain resulting from nerve damage and inflammation.

Today, chronic pain affects more people than cancer, heart disease, and diabetes combined. Chronic pain is the most common cause of long-term disability in the United States.

Most marijuana-based products do not have approval from the United States Food and Drug Administration (FDA), and more evidence is necessary to confirm their safety and effectiveness.

However, anecdotal evidence suggests that marijuana or its compounds may help relieve some types of pain.

There are distinct types or strains of marijuana available, and each may have slightly different effects on the user.

In this article, we look at the best marijuana strains for chronic pain relief.

Share on Pinterest Marijuana may help relieve certain types of chronic pain.

The different types of marijuana plants include the following:

  • Cannabis indica
  • Cannabis sativa
  • hybrids

There is limited research available on the use of specific marijuana strains for pain and other symptoms. As a result, strain-specific recommendations are not medically proven.

The results of an online survey, comprising 95 participants, featured in the Journal of Alternative and Complementary Medicine in 2014.

The researchers found that participants preferred indica strains for pain management, sedation, and sleep while they would opt for sativa strains to improve energy and mood.

Regarding pain management, participants reported a statistically significant effect when using indica for:

  • non-migraine headaches
  • neuropathy
  • spasticity
  • joint pain

It is, however, important to note that this study had several limitations. It was small in scale, anonymous, and asked people to self-report on their symptoms. Respondents did not use the marijuana in a controlled setting, potentially resulting in differences in drug composition, dosage, and potency.

Another study examined the use of organically grown sativa and indica strains in the treatment of several medical conditions. Just over half of the participants were using marijuana to treat HIV.

The study followed participants for 3 years and asked them about the effects of the drug on their condition during this time. The results indicated that indica strains are more likely to improve energy and appetite, while both sativa and indica strains can alleviate nausea to a similar degree.

Marijuana, or cannabis, contains compounds that may relieve pain, nausea, and other symptoms. The components of marijuana that most studies focus on for pain relief are cannabidiol (CBD) and tetrahydrocannabinol (THC).

THC vs. CBD

THC resembles the cannabinoid chemicals that occur naturally in the body. When people ingest or inhale THC, it stimulates the brain’s cannabinoid receptors.

This activates the brain’s reward system and reduces pain levels. THC is a psychoactive compound as it binds to cannabinoid receptors and produces an elevated state of mind, known as a high.

CBD does not cause a high, although it does interact with pain receptors in the brain to exert pain-relieving and anti-inflammatory effects.

What the research says

In recent years, many studies have looked at the effects of marijuana for chronic pain. Some studies used parts of the marijuana plant and some have used the entire plant so more research is needed. Using parts of the marijuana plant (like CBD oil) helps study specific actions of that ingredient, but when the whole plant is used there is what is called an entourage effect, where the parts work together to have more effect.

A 2015 review of research on the use of marijuana and cannabinoids for various chronic pain conditions reports that several trials had positive results. The researchers suggest that marijuana or cannabinoids may be effective for treating some types of chronic pain including neuropathy (nerve pain).

A research paper from 2016 found that marijuana use for cancer pain led to a 64-percent reduction in opioid use, improved quality of life, and caused fewer medication side effects. It also led to participants using fewer medications.

Smaller studies have reported benefits for other types of chronic pain. For example:

  • Of about 17,000 people with cancer, 70 percent reportedly experienced an improvement in pain and general well-being after marijuana use.
  • People with chronic migraines experienced a decrease in migraine episodes after using the drug.

However, there is still a need for more research into the area of marijuana use for chronic pain, especially into the use of different strains, dosages, and methods of delivery.

An Australian study, published in July 2018, concluded that marijuana use did not reduce the symptoms of pain or the need to use opioid medications. However, the findings were mostly based on reports from people who used the drug recreationally.

Using marijuana specifically for medicinal purposes might yield different results.

Many different medications are available to treat chronic pain. One natural alternative treatment option is marijuana, or cannabis, which has a range of pain-relieving properties. There are different strains of marijuana. The most effective one depends on the type of pain. Learn more about marijuana for pain here. ]]>