CBD Oil for Back Pain

CBD oil

CBD_for_back_pain_relief

Figure 1.https://www.marijuanabreak.com/cbd-for-instant-back-pain-relief

CBD oil for chronic back pain

What is CBD?

CBD stands for cannabidiol.  It is the decarboxylated form of CBD-A or cannabidiol carboxylic acid.  When heated, this acid becomes CBD.  CBDA occurs naturally in cannabis Sativa, cannabis Indica, and cannabis Ruderalis (hemp with low thc).  CBD is the second most abundant cannabinoid in pot, second only to THC.  Though similar to THC in structure, it does not produce a high.  Instead, it helps moderate the stimulant effect of THC.  It has also been found to work as an antipsychotic, reducing the psychotic effects of THC in marijuana and reducing psychosis in research patients when used without THC and other cannabinoids.  In the US, it can be found in the form of a Rx pharmaceutical named Epidiolex for seizures in children.  During research for this product and from anecdotal reports, researchers were motivated to re-examine the compound and discovered anti-pain effects.

What is CBD Oil?

CBD oil is made by using a solvent to extract CBD and evaporating to concentrate the CBD which will be suspended in the hemp oil.  CBD oil can be taken orally or applied topically.  CBD oil is not something most people will want to smoke.

Usual Back Pain treatment

What is back pain?

What_is_back_pain

Back pain is pain in the upper dorsal region of the body, including the neck, upper back, lower back, and tailbone.  Low back pain is most frequently experienced by sufferers.  Back pain may be experienced as a sharp, stabbing pain or burning pain.  It can be acute or chronic and spread to the arms, hands, legs, and feet.  This pain can come from muscles or joints, and less frequently from organs like the kidneys. 

  • Back pain is the top cause of disability worldwide.2
  • Back pain is a leading cause of missing work.
  • Half of the adult population in the US has back at some point each year.3
  • 264 million work days are missed by Americans every year due to back pain.4
  • 80% of people will have back pain at some point.5
  • Back pain can happen at any age.5
  • 3rd leading cause of doctor visits.6
  • Back pain usually has a mild cause rather than being caused by serious disease.7
  • Incidence of back pain appears to be increasing.7
  • $50 billion annually in health care costs.  Double that if including lost productivity.9

Causes of back pain

Back pain can have a variety of causes, however, 85% of the time, the cause is unknown.  Other times, causes can range from autoimmune diseases such as arthritis, to osteoporosis, a disease of the bones.

More rare causes of back pain include:

  • Anterior ligaments of the intervertebral disc damaged
  • Arthritis
  • Compression of vertebral column
  • Damage to blood vessels
  • Fracture
  • Infection
  • Internal organ damage
  • Kidney damage or damage to other organs
  • Nerve root damage
  • Osteoporosis
  • Spinal cord damage
  • Vertebral column damage
  • Vertebral muscle myopathy
  • Whiplash

Very rare

Conventional back pain treatment

Conventional treating of symptoms for back pain begins with non-medical attempts to relieve the pain.  Sufferers may get some relief from massage and acupuncture.  Some hard scientists claim chiropractic adjustment is also not truly a medical treatment but will provide relief to some sufferers.  Heat therapy, exercise, stretching, and physical therapy may be tried before medication.

Conventional back pain treatments

Non-pharmacological

  1. Acupuncture
  2. Exercise
  3. Heat therapy
  4. Massage
  5. Physical therapy
  6. Posture correction
  7. Stretching

Pharmacological

  1. Ibuprofen and other NSAIDS
  2. Acetaminophen
  3. Opioids like Oxycontin
  4. Antidepressants
  5. Antibiotics for infections

Surgery

  1. Discectomy
  2. Foraminectomy
  3. Foraminotomy
  4. Laminectomy
  5. Spinal Fusion

Medication

Medication treatment of back pain include NSAIDS like ibuprofen, and non-NSAID medications like acetaminophen initially. 

Chronic back pain may be treated with opioid medication.  Opioids can produce tolerance and dependence and also produce a risk of addiction and overdose fatalities.  The use of antidepressants to treat back brain point to a neuropathic aspect.  Antibiotics are used if the source of the pain is infection.

Surgery

Surgery is reserved for intractable cases, none-the-less, most of us know of someone who has had back surgery.  Long-term outcomes are not very good, but it may delay having to use a wheelchair so many people will make that trade off.  However, in the long-term, one will end up the same as someone who used less-invasive methods.  Surgery can help address congenital issues like cauda equina syndrome, a curved tail-bone causing pain and problems with nerve transmission.

For herniated, compressed, bulging, torn, or protruding vertebral issues, a laminectomy, discectomy, foraminotomy or foraminectomy may be ordered.  Spinal fusion surgery may be needed if a disc is totally replaced.

Can CBD Oil Be Used To Treat Back Pain?

How does CBD help ease back pain?

Research has revealed that CBD has many mechanisms of action to produce an analgesic effect.  The most obvious is that it should bind to cannabinoid receptors.  However, actual study reveal that binding affinity for CB1 and CB2 receptors is suprisingly pretty low.  CBD does bind to the GPR3 (inverse agonist), GPR6 (inverse agonist), GPR12 (inverse agonist), GPR55 (antagonist) receptors.  It is a serotonin 5-HT1A receptor partial agonist as well as an allosteric modulator of mu and sigma opioid receptors, a glitazone receptor agonist, and an inhibitor of fatty acid amide hydrolase, increasing levels of endogenous cannabinoids.

Mechanisms of action of CBD
  1. CB1 receptor agonist
  2. CB2 receptor agonist
  3. GPR3 (inverse agonist)
  4. GPR6 (inverse agonist)
  5. GPR12 (inverse agonist)
  6. GPR55 (antagonist) receptors
  7. Serotonin 5-HT1A receptor partial agonist
  8. Allosteric modulator of mu and sigma opioid receptors
  9. Glitazone receptor agonist
  10. Inhibitor of fatty acid amide hydrolase, increasing levels of endogenous cannabinoids

Dosage of CBD oil for chronic back pain

Dosage_of_CBD_oil_for_chronic_back_pain

Figure 2.https://www.marijuanapackaging.com/blog/cbd-dosage-calculation-is-a-process-but-you-can-start-here/

How much CBD oil you should take can vary widely.  Calculating the proper dosing includes considering your weight and the severity of your pain.  A small adult with mild pain might take 9 mg of CBD in oil while a large adult with severe pain might take 45 mg for pain.  CBD is not known to produce tolerance or overdose death therefore, it may be comparatively safe to experiment with dosages.  Using too much may lead to symptoms of memory loss and dry mouth.

CBD_oil

This screenshot from CBD Oil Review gives information about dosages which they claim to have gotten from Mayo Clinic.  You can see the highest dosage is for use as an antipsychotic at 1,280 mg.  The lowest is 2.5 mg with 2.7 mg of THC added, and mid-range is 300 mg for epilepsy.  A good approach is to simply start with 25 mg of CBD and titrate up until you find the right dose.

How to Use CBD Oil for Back Pain

There are various ways to use CBD for back pain.  The easiest way is to get a prescription for Epidiolex or Sativex and simply follow your doctor’s instructions.  These are nose sprays that deliver CBD or CBD/THC.  They have been found to be effective in a range of conditions.

Topical

Perhaps the safest way to use CBD oil for back pain is to apply it topically.  Simply rub the proper dosage onto the area of the back causing pain.  This means of application avoids putting a strain on the liver.  CBD has raised liver enzymes in some studies.  You might also have someone else massage it into your back for extra pain relief.  It is expected to absorb through the skin, have an anti-inflammatory effect right at the site of application, then also block pain as it enters the blood stream and affects the nervous system.

Sublingual

The second most safe way to consume CBD is to let it sit under the tongue for at least one minute.  This will allow it to absorb though the mucosa, again bypassing the liver as well as theoretically improving absorption.  Eating it has been shown to produce excessively low bioavailability, requiring higher dosages. 

Eat it

The next safest option is to eat your CBD.  This could cause a rise in liver enzymes which has not yet shown itself to be dangerous but is always a cause for monitoring.  Eating your CBD oil will provide a sustained release of CBD.  Availability of CBD from eating is fairly low and requires higher doses but provides a sustained release, giving relief over a longer period of time.  You can just put the oil on your tongue and swallow.  If you want to instead make it part of your diet, you can use our cannabis oil recipes and just replace THC oil with CBD oil: http://www.ncsm.nl/english/information-for-patients/make-weed-edibles  To learn to make CBD candies like gummies, see our site here: http://www.ncsm.nl/english/diy/weed-candy-recipes

Vape

Vaping CBD oil may provide relief and convenience to some users.  However, a study at Johns Hopkins recently found that metals from vape pens can leak into the oil with unknown long-term effects.  Also, the long-term effects of vaping is unknown.  There is a theoretical risk of popcorn lung.  So, use your CBD oil topically or sublingually for maximal safety and effect.

Smoking

Smoking is the least safe way to use your CBD.  However, studies on the effects of marijuana on the lungs have so far been unable to identify any increased risk of lung cancer or emphysema.  However, this effect refers to whole leaf marijuana rather than CBD extracts.  On the positive side, smoking may deliver a superior bioavailable dose of CBD to the body.  The theoretical risk comes from the fact that inhaling any smoke whatsoever appears to cause lung ailments, whether it be coal, wood, metals, or plant matter.  The apparent exclusion of marijuana is explained by the fact that many substances in marijuana produce and entourage effect that reduces inflammation and cancer risk.  This may not extend to CBD alone especially in oil form which can be smoked in an oil rig.  Smoking and vaping also carry legal risk in states that only allow topical, edible, and sublingual CBD oil.

What the Research Says

There are few human studies of the effect of CBD on back pain.  However, there are some on the effects of CBD on pain indices in various similar conditions such as arthritis and neuropathic pain.  Back pain can be partly neuropathic, as sometimes there is no actual injury, or the pain is from a past injury which has long healed.

A 2010 study of Sativex published in the Journal of Pain and Symptom Management showed THC:CBD, 1 to 1, to be an effective treatment for cancer pain.

In 2013, the above study was replicated.  The Journal of Pain and Symptom Management reported Sativex successfully treated cancer pain which did not respond well to opioids.  It not only decreased pain but also reduced anxiety, insomnia, and tiredness.  It produced no noticeable tolerance, dependence, or withdrawal, and further, it prevented patients from requiring dose increases of their other pain medications (Johnson, Lossignol, Burnell-Nugent, & Fallon, 2013).

Research on Sativex, a half THC, half CBD prescription medication has indicated that it is very effective for pain in arthritis and neuropathy (Russo, 2008).  The same success was achieved in a 2015 study of the same formulation for neuropathic pain.  This medication, Sativex, is delivered in the form of a nasal spray (Hoggart, et al., 2015).

A 2014 study in the British Journal of Pharmacology of cannabidiol indicated successful treatment of neuropathic pain associated with chemotherapy by modulation of the serotonin 5ht2a receptor (Ward, et al., 2014).

A 2012 Study in the Journal of Experimental Medicine found that non-psychoactive cannabinoids including CBD produced reduced inflammation and produced analgesia in rats by potentiating glycine receptors.

Pros and cons

CBD oil versus Conventional Treatment for Back Pain
PROSCONS
  1. Cbd Oil is all natural
  2. Cannabis has been used for pain for at least hundreds of years
  3. CBD carries little risk of overdose
  4. CBD has little affect on behavior at higher doses
  5. CBD oil may be available OTC in some states
  6. Little risk of tolerance and addiction
  7. Can also improve mood
  8. No evidence of a withdrawal syndrome
  9. May reduce risk of diabetes which can reduce back pain symptoms from kidney damage and neuropathy
  10. May reduce risk of cardiovascular disease which may mimic back pain through angina pain experienced in the arms and back
  11. Produces no high
  1. Smoking or vaping can cause lung damage
  2. CBD can raise liver enzyme levels, indicating possible damage
  3. Opioids and synthetic treatments may offer stronger pain relief
  4. Opioids are highly controlled
  5. Opioids can produce severe addiction and withdrawal
  6. Surgery can have a painful recovery period and has not been shown to be more effective than other approaches in the long-term
  7. Smoking and vaping may produce currently unknown health risks
  8. Finding an effective dose and form can be difficult

Social Media Reviews

User Opinion on CBD Efficacy: Unhelpful

Social_Media_Reviews

Comment:  This user found no usefulness, and side effects of headache and ill feeling.  This could be from CBD itself or from adulterants.

User Opinion on CBD Efficacy: Excellent

Media_Reviews

Comment:  This user got relief from both CBD ointment and pills from back pain caused by arthritis.

User Opinion on CBD Efficacy: Excellent

Green_HeriZen

Comment: This user experienced benefit from sublingual, tincture, or edible use of CBD oil or tincture. 

Does CBD have any side effects?

CBD tends to have few side effects.  None-the-less, prescription CBD labels such as from Epidiolex and Sativex include the following possible side effects:

  • suicidal thoughts
  • sleep disturbance
  • rash
  • little appetite
  • infection
  • fatigue
  • elevated liver enzymes
  • drowsiness
  • diarrhea

Conclusion:  Is CBD Oil Good for Back Pain?

Our overall sense is that CBD Oil is most definitely worth a try for back pain due to some evidence of efficacy and a lot of evidence that topical forms are safe.

The legality of CBD oil

Thirty states have laws legalizing and protecting CBD and marijuana for restricted medical use.  Another 17 allow the use of low or no-THC CBD preparations.  Epidiolex, a prescription CBD product, is federally recognized as a Schedule V medication.  CBD itself, however, is still federally a controlled Schedule I substance.  Lawmakers have made promises to legalize CBD federally, but this has yet to go through.  CBD oil can be obtained in most states with minimal risk of prosecution.  See what the marijuana laws are in your state at our site here: http://www.ncsm.nl/english/business-law/medical-marijuana-card

CBD oil disclaimers (please read, this is important):
General Medical Disclaimer: NCSM and its employees and partners do not represent the medical establishment and our information is not a replacement for your doctor’s advice. 

FDA Disclaimer:  Use of CBD products with the exception of Epidiolex and Sativex have not been evaluated or approved by the FDA.

Drug Screening Disclaimer:  While most CBD products claim to have little to no THC, it is theoretically possible to fail a drug test for THC.  This can happen because some CBD products have been tested to have far more THC than represented on the label.  Also, CBD is similar in structure to THC.

Bibliography

Hoggart, B., Ratcliffe, S., Ehler, E., Simpson, K. H., Hovorka, J., Lejčko, J., . . . Serpell, M. (2015). A multicentre, open-label, follow-on study to assess the long-term maintenance of effect, tolerance and safety of THC/CBD oromucosal spray in the management of neuropathic pain. Journal of Neurology, 262(1), 27-40. Retrieved 10 26, 2018, from https://link.springer.com/article/10.1007/s00415-014-7502-9

Johnson, J. R., Lossignol, D., Burnell-Nugent, M., & Fallon, M. (2013). An open-label extension study to investigate the long-term safety and tolerability of THC/CBD oromucosal spray and oromucosal THC spray in patients with terminal cancer-related pain refractory to strong opioid analgesics. Journal of Pain and Symptom Management, 46(2), 207-218. Retrieved 10 26, 2018, from https://jpsmjournal.com/article/s0885-3924(12)00439-3/abstract?code=jps-site

Russo, E. B. (2008). Cannabinoids in the management of difficult to treat pain. Therapeutics and Clinical Risk Management, 4(1), 245-259. Retrieved 10 26, 2018, from https://ncbi.nlm.nih.gov/pmc/articles/pmc2503660

Ward, S. J., McAllister, S. D., Kawamura, R., Murase, R., Neelakantan, H., & Walker, E. A. (2014). Cannabidiol inhibits paclitaxel-induced neuropathic pain through 5-HT1A receptors without diminishing nervous system function or chemotherapy efficacy. British Journal of Pharmacology, 171(3), 636-645. Retrieved 10 26, 2018.

Footnote References:

  1. Hoy D, March L, Brooks P, et al The global burden of low back pain: estimates from the Global Burden of Disease 2010 study Annals of the Rheumatic Diseases Published Online First: 24 March 2014. doi: 10.1136/annrheumdis-2013-204428
  2. In Project Briefs: Back Pain Patient Outcomes Assessment Team (BOAT). In MEDTEP Update, Vol. 1 Issue 1, Agency for Health Care Policy and Research, Rockville, MD.
  3. Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences [review]. J Bone Joint Surg Am. 2006;88(suppl 2): 21-24.
  4. Rubin Dl. Epidemiology and Risk Factors for Spine Pain. Neurol Clin. 2007; May;25(2):353-71.
  5. Sauver, JL et al. Why patients visit their doctors: Assessing the most prevalent conditions in a defined American population. Mayo Clinic Proceedings, Volume 88, Issue 1, 56–67. 
  6. The Hidden Impact of Musculoskeletal Disorders on Americans, United State Bone and Joint Initiative, 2018.
  7. Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl1985; 11: 1-98.
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