For centuries cannabis, also known as marijuana, has been used to manage a wide variety of health conditions, including chronic pain conditions like low back pain.
The medical use of marijuana has gained much attention in recent years with many states starting to legalize the use of this drug. As more states legalize the use of marijuana we are beginning to see a growing body of clinical evidence to suggest that cannabis may be an option for treating low back pain.
The Legalization Of Medical Marijuana
Up until 2012, marijuana was a Schedule 1 substance at the federal level which meant that there was no medical or legal justification for its use outside of clinical drug studies.
When Colorado and Washington legalized its use, the federal government took the position not to prosecute anyone involved in the state’s marijuana industry. Alaska and Oregon followed suit in 2014 to allow medical use of the drug, and 21 states, including Washington, D.C and Guam now also allow medical use of marijuana.
How Does Cannabis Work For Back Pain?
The active ingredients in cannabis, known as cannabinoids, have been found to have pain-relieving properties. The two main cannabinoids in cannabis are tetrahydrocannabinol (THC) and cannabidiol (CBD).
THC is the compound that is primarily responsible for the "high" associated with cannabis use, while CBD is non-psychoactive and has been found to have a wide range of therapeutic benefits, including pain relief.
Anti-Inflammatory Effects Of CBD
There are several ways in which cannabinoids can alleviate pain. For example, studies have found that cannabinoids can slow down the transmission of pain signals through the nervous system.
Cannabinoids also appear to have anti-inflammatory effects, which can help reduce the swelling and inflammation that often happens in conditions like low back pain. What’s more, cannabinoids have been found to increase the availability of natural pain-relieving compounds known as endocannabinoids, which are produced by the body.
What Are Cannabinoids? And What Is The Difference Between THC and CBD?
Cannabinoids are a group of substances found in the cannabis plant and two of the main cannabinoids are THC and cannabidiol (CBD).
THC:
THC (tetrahydrocannabinol) is one of the 113 cannabinoids found in cannabis and is the major psychoactive component.
When someone inhales or ingests THC it stimulates the body’s natural cannabinoid receptors that are located in the brain. This activates the brain’s reward system and causes a reduction in pain levels.
THC is the part of the plant that is responsible for the “high” that is associated with cannabis.
CBD:
CBD doesn’t contain THC and therefore doesn’t produce the “high” that THC does. Although it doesn’t cause an elevated state of mind, it does still interact with the pain receptors in the brain and it can also produce the pain-relieving and anti-inflammatory effects that THC produces.
How To Take Cannabis For Back Pain
When it comes to managing low back pain there are several different ways that you can take cannabis. Some of the most popular forms of cannabis are:
Oil (a great topical application to massage on to the lower back)
Lotions
Transdermal patches (typically stronger than lotions or oils)
Edibles (an easier way to take cannabis but the effects are more difficult to predict)
Sublingual drops (drops that you place under the tongue - the cannabis enters the bloodstream faster and works faster)
Risks Of Using Cannabis For Back Pain
Unfortunately, the use of cannabis for low back pain is not without risks. While there are definitely many benefits to taking cannabis for low back pain, studies are finding that there are some major risks that need to be considered before you decide to try this treatment. These risks are often divided into 2 groups: Acute or Chronic risks.
A range of acute and chronic health problems have been linked to the use of medical marijuana and cannabis. Some acute adverse effects include:
Hyperemesis syndrome (a condition where people have been using cannabis for a while experience severe nausea and vomiting and abdominal pain);
suicidal ideations
increased risk of motor vehicle crashes and fatal collisions.
Long Term Effects Of Cannabis Use
Impaired Cognitive Function
Along with impaired decision-making, impaired cognitive function can be particularly concerning for those who operate heavy machinery or drive. Cannabis use has also been linked to midlife cognitive problems.
A study, published in the American Journal Of Psychiatry followed almost 1,000 individuals living in New Zealand from the ages of 3 to 45 in order to see the impact of cannabis use on people’s brain function and cognitive capabilities over time. The researchers found that those who used cannabis long term and heavily (at least once a week for several years) had cognitive impairments in a range of areas.
Some of the issues they encountered were a 5.5 reduction in IQ points compared to their childhood, as well as deficits in “learning and processing speed”. The research participants also showed memory and attention problems. These results stuck even when the researchers considered other factors like other drug use or socioeconomic status.
Addiction
While the addiction rate of cannabis is lower compared to other substances like opioids, there is still strong evidence to suggest that long-term cannabis use often leads to dependence on the drug and addiction.
Marijuana use disorder has been found in around 30% of those who use the drug. People who start using marijuana before the age of 18 are more likely to develop a marijuana use disorder than adults who start using it.
Typically the addiction process starts with dependence where someone feels withdrawal symptoms when they are not using the drug. This can lead to feelings of irritability, sleep problems, cravings, moodiness, and decreased appetite.
Medication Interactions
An important consideration for cannabis use is that it can interact with other medications like anti-anxiety drugs and blood thinners.
Common types of drugs that can have dangerous interactions with marijuana include:
Sedatives — such as Ambien, Lunesta and Benadryl.
Anti-anxiety medications — such as Xanax, Valium and Librium.
Antidepressants — such as Zoloft, Prozac and Lexapro.
Pain medications — such as Codeine, Percocet and Vicodin.
If you are taking any type of medication for a chronic condition you should check with your healthcare provider before using cannabis for your low back pain.
Benefits of Using Cannabis For Low Back Pain
In 2022, a study was published in the Global Spine Journal that looked at the ‘Efficacy of Cannabis in Reducing Back Pain: A Systematic Review’ (R. Price MD, PhD, et al.). The study was a meta-analysis of 4 studies with 110 patients in total.
Each study found a clear “advantage of cannabis therapy for alleviating back pain” and no serious adverse events were reported. The authors did note that there is a need for more long-term follow up.
Other evidence exists to suggest that the use of cannabis was associated with significant pain reduction in individuals with chronic pain conditions, including low back pain and that cannabis-based medicine was effective in reducing chronic neuropathic pain.
It is important to note that the research on the effectiveness of cannabis for low back pain is still in its early stages, and more research is needed to understand its full effects.
The FDA have not yet approved the use of any cannabis drugs for pain relief but they have approved 2 medications for the use of controlling nausea in people undergoing cancer treatments and for the increase of appetite in people living with HIV.
Most cannabis-based products do not have approval from the US FDA and more evidence is needed to confirm their safety and effectiveness for pain management.
Conclusions
The use of cannabis for managing low back pain is a promising option, with many potential benefits. While it is not without risks, the use of cannabis under the supervision of a healthcare professional may be effective in reducing pain for individuals suffering from chronic low back pain.
As the legalization of marijuana has grown over the past decade, it is important for healthcare professionals to stay informed about the potential benefits and risks of cannabis for low back pain and for patients to have open conversations with their healthcare providers regarding their interest and concern about cannabis as a treatment option.