Medical Cannabis and Back Pain

Back pain is a broad term that includes pain originating from muscles, nerves, bones, joints, or other structures in the back and spine.  It usually described based on the area affected, such as lower back pain, middle back pain, or upper back pain.  Back pain may radiate to other areas, for example, “low back pain with sciatica.”

Symptoms of back pain include muscle ache, shooting or stabbing pain, radiating pain, inability to stand straight, and limited flexibility or range of motion.

Back pain is a very common problem.  According to the Centers for Disease Control (CDC), at any point in time, 28% of U.S. adults will have experienced severe low back pain and 15% of U.S. adults will have experienced severe neck pain with the last 3 months.  80% of Americans will be affected by back pain at some time in their lives.  Back pain is one of the most common reasons why people go to the doctor or miss work.

Causes of Back Pain

  • Bulging disc
  • Herniated disc
  • Sciatica
  • Spinal stenosis
  • Arthritis
  • Scoliosis and other skeletal irregularities
  • Strained muscles and ligaments

Factors that increase the risk of developing back pain include smoking, obesity, older age, being female, physically strenuous work, sedentary work, stressful job, anxiety, and depression.

A Data Profile on Chronic Back Pain published by the Georgetown University Center on an Aging Society estimates that health care costs and indirect costs due to back pain are over $12 billion per year.  The Profile also notes that:

  • Back pain is a leading cause of work-loss days
  • One in four adults with back pain is in fair to poor physical health
  • Downhearted feelings are common among adults with back pain
  • Back pain affects adults of all ages and incomes
  • Adults with back pain are less active
  • Older adults with back pain are less satisfied with their retirement
  • Earnings are lower for workers with back pain

Conventional Treatments

Most back pain resolves on its own with rest, self-care, and OTC pain relievers.  A short period of bed rest may be helpful, but more than a day or two may do more harm than good.  If home treatments are ineffective, stronger medications or other therapies may be necessary.

A variety of pharmaceutical medications may be used to treat back pain including pain relievers such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin) or naproxen (Aleve).  Muscle relaxants such as cyclobenzaprine (Flexeril) may also be utilized.  As back pain becomes more severe, pharmaceutical treatment often escalates to include narcotics such as codeine or hydrocodone.  As back pain becomes more chronic, long-acting narcotic pain medications such as oxycodone (Oxycontin) or methadone (Dolophine) are often prescribed.  Anti-depressants, anti-anxiety medications and sleeping pills are also often added to the pharmaceutical cocktail.

These medications are commonly associated with a number of serious side effects including constipation and gastrointestinal disturbance, drowsiness, reduced coordination, problems with balance and memory, headaches, and addiction.  Many patients report that they “feel like a zombie.”  Taken in very high doses, some of these medications may even be fatal.

Common conventional treatments for back pain include physical therapy and exercise, injections (e.g., cortisone), and surgery (discectomy, microdiscectomy, laminectomy, spinal fusion, etc.).

Complementary and Alternative Medicine

There are a number of complementary and alternative treatments that may be effective in treating back pain.  These include:

  • Chiropractic care
  • Acupuncture
  • Massage therapy
  • Mind-body techniques (e.g., cognitive behavioral therapy, progressive relaxation)
  • Yoga

Herbal supplements with anti-inflammatory properties may also help to ease back pain.  Studies suggest that the following herbs may be effective:

  • Willow bark (taken orally)
  • Devil’s claw (taken orally)
  • Capsicum (applied as a plaster)

Medical Cannabis

Many patients also report that medical cannabis is very effective in treating their back pain and other associated symptoms.  Patients commonly say that medical cannabis provides relief of their symptoms better than pharmaceutical medications with significantly fewer side effects.  Medical cannabis may also effective in treating associated symptoms of muscle spasms, anxiety, depression, and insomnia.

Scientifically, there is basis for the use of cannabis in the treatment of back pain.  Two of cannabis’ key medicinal ingredients, tetrahydrocannabinol (THC) and cannabidiol (CBD), haves been well documented to have pain relieving and anti-inflammatory properties.  Medical cannabis has also been shown to have anti-anxiety, anti-spasm, and sedating effects that may be beneficial in the treatment of back pain.  In particular, cannabinoids may have particular use in the treatment of neuropathic (nerve injury) pain.

Highlights from the Scientific Literature

Manzanares J, Carrascosa A (2006). Role of the Cannabinoid System in Pain Control and Therapeutic Implications for the Management of Acute and Chronic Pain Episodes.

  • Conclusions:  Clinical trials seem to indicate that either extracts of the Cannabis sativa plant containing known amounts of the active compounds (mainly THC and CBD) or diverse synthetic derivatives of THC are promising treatments for painful conditions that do not respond to available treatments, such as neuropathic, inflammatory and oncologic pain.
  • Specifically, cannabis extracts have shown effectiveness to relief some symptoms of the patients with multiple sclerosis, mainly for pain and spasticity.

Ashton JC, Milligan ED (2008). Cannabinoids for the treatment of neuropathic pain: clinical evidence.

Conclusions:  Data from large, well-controlled studies show that cannabinoids are moderately effective in reducing chronic pain and that side effects are comparable to existing treatments, suggesting that cannabinoids can play a useful role in the management of chronic pain.

Burns TL, Ineck JR (2006, Creighton University Medical Center, Omaha, NE). Cannabinoid analgesia as a potential new therapeutic option in the treatment of chronic pain.

  • Conclusions:  Cannabinoids provide a potential approach to pain management with a novel therapeutic target and mechanism. Chronic pain often requires a polypharmaceutical approach to management, and cannabinoids are a potential addition to the arsenal of treatment options.

Medical Marijuana Patient Information

Besides smoking, delivery methods for the use of medical cannabis include vaporization, tinctures, teas, and edible products.  Most commonly reported side effects from the use of medical cannabis include dry mouth, red eyes, increased appetite, and tiredness.   There has never been a death attributable to a medical cannabis overdose.  Medical cannabis should be used in consultation with a physician who specializes in cannabinoid medicine.

Prevention

With back pain, prevention is key!

The staff at the Mayo Clinic has the following preventive tips to help keep your back healthy and strong:

  • Exercise
  • Build muscle strength and flexibility
  • Quit smoking
  • Maintain a healthy weight
  • Use proper body mechanics (stand smart, sit smart, lift smart)

References and Resources

Ashton JC, Milligan ED (2008). Cannabinoids for the treatment of neuropathic pain: clinical evidence. Current Opinion in Investigational Drugs. 2008; 9(1):65-75.  http://www.ncbi.nlm.nih.gov/pubmed/18183533

Burns TL, Ineck JR. Cannabinoid analgesia as a potential new therapeutic option in the treatment of chronic pain. Annals of Pharmacotherapy. 2006; 40(2):251-260. http://www.ncbi.nlm.nih.gov/pubmed/16449552

Data Profile. Chronic Back Pain. Center on Aging. Georgetown University.  http://ihcrp.georgetown.edu/agingsociety/pdfs/backpain.pdf

Health, United States, 2010. U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. National Center for Health Statistics.  http://www.cdc.gov/nchs/data/hus/hus10.pdf

Manzanares J, Carrascosa A. Role of the Cannabinoid System in Pain Control and Therapeutic Implications for the Management of Acute and Chronic Pain Episodes. Current Neuropharmacology. 2006; 4(3): 239-257. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2430692/

Mayo Clinic Health Information. Back pain.  http://www.mayoclinic.com/health/back-pain/DS00171

WebMD. Back Pain Health Center.  http://www.webmd.com/back-pain/default.htm

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About markrabe

Mark L. Rabe, MD, ABIHM Integrative Holistic Medicine Centric Wellness 2308 6th Avenue San Diego, CA 92101 Telephone: (619) 546-0420 Fax: (619) 615-2346 E-Mail: info@CentricWellness.com

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