Can CBD Help with Back Pain?

A marijuana leaf laying on CBD cream A marijuana leaf laying on CBD cream

Over 30 million Americans experience back pain at any given time. And half of all Americans admit to having back pain at least once a year. It affects people of all ages, and costs Americans at least $50 billion in health care costs each year.

If you’re one of the millions of Americans who suffer with back pain, you’ve probably tried a number of treatments to alleviate the discomfort. You may have tried creams, over-the-counter pain relievers, yoga, meditation, acupuncture, physical therapy, or even surgery. 

You’ve also probably heard about CBD. A recent Harris Poll that surveyed more than 2,000 people found that more than 85% of Americans have heard of CBD, and of those, at least one in five had actually tried it.

It’s being hailed as a miracle cure for everything from anxiety to acne to glaucoma. And if your back pain persists, you may have been tempted to try it. After all, CBD already seems to be everywhere: The cannabis industry in the U.S. is expected to reach $80 billion by 2030

In this blog, we’ll investigate whether CBD can help with back pain, and the current research that exists on CBD products and its effects. 

Can CBD Help with Back Pain?

The short answer is maybe. Cannabidiol, commonly referred to as CBD, has shown promise in relieving inflammation, which is often a cause of common back pain. But it’s still an understudied treatment, and it’s too still too early to tell whether CBD is an effective treatment for back pain. Until it’s further researched, it should be used with caution, and you should keep your expectations realistic.

What is CBD?

A cannabis plant contains two main components known as phytocannabinoids: CBD and THC (tetrahydrocannabinol). Both marijuana and hemp, two products that come from the cannabis plant, have THC and CBD in them. However, marijuana typically contains much more THC than hemp while hemp contains more CBD.

CBD is the non-psychoactive part of of cannabis, which means that it does not cause the "high" that is typically associated with the drug.

As a matter of fact, most of the CBD products available today do not contain THC, the chemical that causes most of marijuana's psychological effects.

CBD is typically dissolved in an edible oil and does not have any psychogenic effects if it doesn’t also contain THC. It is also available as creams, gels, pills, and even sodas, coffee and candy.

One London restaurant included a CBD-infused brew in its afternoon tea offerings – a move that garnered a good deal of buzz in the British press.

Cannabidiol – A Definition

Cannabidiol, the full name for CBD, which is a molecule that is synthesized from the hemp plant.

IS CBD FOR BACK PAIN LEGAL?

Purchasing CBD is legal in most states as long as it doesn't contain more than 0.3 percent THC. If you want to purchase a CBD product that contains higher amounts of THC, you’ll need a doctor’s prescription.

But some states, like Virginia, have restrictions on buying any CBD product, and you can only buy these products with a prescription.

It’s important to note that the FDA doesn't regulate CBD, and many products have been found to be more or less potent than marked. Some products labeled as not containing THC have actually been found to contain some THC.

So, if you’re going to purchase CBD, make sure it’s legal in your state and make sure you’re buying from a reputable seller, like a pharmacy.

HOW DOES CBD WORK?

In a recent survey, 55% of people said they had tried CBD for relaxation, and 50% said they had tried it for stress relief. Forty-four percent tried it for muscle pain.

CBD’s physiological activity relates to “binding and activating several nervous receptors in the body.” CBD targets more than 65 molecular targets in the body, without having an intoxicating effect.

Throughout the body there are nervous system receptors that act as signals for how the body responds to stimuli. When a person consumes CBD, it interacts with the receptors related to the brain, tissues, glands, cells and other parts of the body.

The main areas of CBD focus have been on pain perception, anxiety, stress, and inflammatory responses. CBD acts on these receptors, moderating the signals sent to the brain.

Is CBD Medically Approved?

The only FDA-approved CBD medication is Epidiolex, which was approved last year to treat certain types of epilepsy. CBD has NOT been FDA-approved for chronic pain, anxiety or any other medical issue.

CBD AND BACK PAIN: THE RESEARCH

Whether or not CBD is effective for treating chronic pain is unclear. CBD has been cited anecdotally as alleviating back pain in three ways:

  1. Reducing inflammation;
  2. Combating anxiety associated with back pain; and
  3. Improving sleep.

But there’s still a lack of research-backed evidence to substantiate these claims. It’s possible that CBD can create a placebo effect, influencing how an individual perceives pain.

There are two main types of pain: musculoskeletal and nerve. Preliminary research shows that CBD may influence both kinds of pain by targeting both tissue and nerve receptors.

A 2013 study found that “phytocannabinoids in combination, especially cannabidiol and β-caryophyllene, delivered by the oral route appear to be promising candidates for the treatment of chronic pain due to their high safety and low adverse effects profiles.”

In other words, the study suggested that CBD (a phytocannabinoid) seemed to have an effect at reducing chronic pain when it was delivered orally.

However, a 2018 study came to a somewhat different conclusion. After completing a comprehensive survey of studies examining cannabinoids and musculoskeletal pain, researchers declared that while some evidence indicated that “cannabis can be effective for managing arthritis pain, back pain, and trauma-related pain,” that evidence was of poor quality.

It urged the medical research community to investigate the question further through “high-quality Level I studies.”

Given this discrepancy, individuals suffering from back pain should use caution before jumping on the CBD-train. It might work well for managing other kinds of chronic pain or for tackling mental health challenges, but its impact on musculoskeletal pain is unclear at best.

When dealing with a structure has vital and sensitive as your spine, it's incredibly important to ensure that the techniques and chemicals you're using to reduce pain have been properly researched and approved by medical professionals.

Until further evidence emerges, it would be wise to consider other options. Just because something is trendy doesn’t mean it’s worth your time or the risks involved.

MEDICALLY-PROVEN ALTERNATIVES TO MANAGING BACK PAIN

So – what are other options for managing back pain? The short answer is, plenty, but none of them should be used without consulting your doctor. Because back pain can come from so many causes, it’s important to move slowly, considering all possible reasons for the pain before developing a treatment plan.

If over-the-counter solutions such as ibuprofen and naproxen haven’t proven helpful, your doctor may move you on to a muscle relaxant to loosen up tension. These drugs, while helpful for some, are not long-term solutions, as they tend to induce sleepiness and dizziness.

Some doctors will also use a cortisol injection to address back pain that also impacts the legs. The injection goes into what’s known as the “epidural space” – the same space around the spine where a woman in labor receives an epidural – to decrease inflammation. The effects of the injection don’t last longer than a few months, however, so it also doesn’t work well as a long-term solution.

Interestingly, doctors have also found antidepressants such as duloxetine and amitriptyline to work well for some patients. Because these drugs are not addictive, they are a safer long-term solution, regardless of whether or not the patient grapples with mental health conditions like depression or anxiety.

NON-MEDICAL ALTERNATIVES TO MANAGING BACK PAIN

Medication isn’t the only way to combat back pain, however. Physical therapy can help not only with pain-reduction, but also with retraining muscles to be stronger and more flexible so that, once pain is eliminated, it doesn’t come back.

Another approach is focusing on the mental components of pain through techniques like mindfulness-based stress reduction (MBSR) – a combination of yoga and meditation – and cognitive behavioral therapy (CBT). One study found that these two approaches were more effective than other treatments. Researchers directed 300 patients to continue with their usual care plan or to choose between CBT and MSBR and complete eight sessions a week.

After half a year, 45% of patients who focused on the mental components of their back pain via CBT and MSBR reported experiencing less back pain, whereas only 27% of those who continued with their usual care plan could say the same. Similarly, 60% of those who did CBT or MSBR could use their back better than they could before, while only 44% of those continuing their usual care plan could do so.

These are just a few of the options available to you. No matter the nature of your pain, there is a whole host of professionals out there who want to help you find a solution that works for you and your body.

If you determine that your back pain is due to a nerve problem, a neurologist can help alleviate pain; a rheumatologist is the best source if it’s a matter of extreme inflammation; and a neurosurgeon can address problems with a disc or the spinal column.

Back pain is complex and unique as the individuals who suffer it – which means that the one-size-fits-all promises of CBD may not live up to your expectations. And the good news is that they don’t have to.

CONCLUSION

There’s a reason that CBD has exploded in popularity: It allegedly helps ease anxiety, stress and (sometimes) physical pain without the addictive effects of opioids.

In other words, it makes perfect sense in an America where anxiety levels are on the rise, marijuana legalization is becoming more common, and opioid abuse is so prevalent that it’s been declared a national crisis.

But just because something makes perfect sense for our current national moment doesn’t mean it will work for you. Sufferers of chronic back pain are right to be cautious; if you allow yourself to get your hopes up with every faddish new solution, you set yourself up for disappointment that only compound the physical pain.

Until more research is done, a healthy dose of skepticism towards CBD is just what the doctor ordered.

In the meantime, speak with your doctor before trying anything new and focus on determining what techniques, medications and approaches are best suited to your individual needs.

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Atlantic Brain and Spine A graduate of both Yale and Stanford, Dr. Jae Lim is a board-certified spine surgeon who specializes in minimally invasive spine surgery and robotic spine surgery, significantly reducing surgical impact and recovery times. (703) 876-4270
8501 Arlington Blvd. Suite 330
Fairfax
Virgina
22031
United States
Jae Y. Lim Ben L. Nguyen