3rd August 2021
By Emily Ledger

Cannabis has been used medicinally in the treatment of numerous conditions and ailments for thousands of years. Even today, the plant is once again becoming increasingly recognised for its diverse potential in a wide variety of indications. One of the most common reasons reported for medical cannabis use in countries with a legal framework is for pain management.

Research shows that low back pain presentations in primary care varies between 6.8% and 28.4% in high-income countries, making it a significant health problem. While the causes of low back pain can vary, it is widely associated with both physical and psychological stressors, making it difficult to establish effective treatment options.  

Current Treatment Options for Low Back Pain 

Due to the complex nature of conditions such as low back pain, interdisciplinary action is often called for. This can include the use of drugs, including opioids and non-steroidal anti-inflammatory drugs (NSAIDs), in combination with behavioural/talking therapies. However, the long-term efficacy of these treatment options is often unreliable, making research into alternative treatment options a key area of research. 

Medical Cannabis and Low Back Pain 

While whole plant medical cannabis has been found to have some promising potential for the treatment of some pain conditions, the psychoactive properties of the product mean that it is often considered as a last resort, or in many countries, disregarded completely.  

On the other hand, cannabidiol (CBD) – the second-most prevalent cannabinoid produced by the cannabis plant – may be a product of interest thanks to its ability to interact with our body through numerous routes, and safety profile. The World Health Organisation recommends that CBD is safe and well-tolerated in both adults and children alike.  

A recent scientific rationale aimed to understand who these mechanism and interactions may make CBD a product of interest for the treatment of low back pain.  

Findings of the Study 

To understand the potential of cannabidiol for low back pain, researchers assessed the current evidence of the compound’s analgesic, anti-inflammatory, and fear reduction abilities.  

Endocannabinoid receptors (CB1 and CB2) by which CBD has been found to act, may play a role in key pain mediation processes and neuro-inflammatory modulation. CBD may also affect certain central dopaminergic neuronal pain circuits and be involved in serotonin and vanilloid receptor (TRPV1) activation – a complex mechanism that is likely responsible for descending pain control and, perhaps, for the placebo effect (via fear reduction). 

Furthermore, previous studies appear to demonstrate favourable interactions between endocannabinoids and inflammatory joint diseases. The authors of this review suggest that these interactions could make CBD “a potential three-in-one solution in chronic pain management and improvement in quality of life”.  

Anecdotal evidence also suggests that “CBD can reduce acute fear, impair the consolidation of anxiety inducing memories and facilitate the extinction of previously attained fear-related imprints.” These qualities make the compound a promising substance for the treatment of anxiety, fear and pain-related conditions.  

Conclusions 

Collectively, current research shows that patients report beneficial effects on chronic pain using CBD treatments, which the researchers suggest are likely due to the improvement to insomnia, anxiety, cognition, and/or mood. While preliminary evidence yielded from in-vitro and animal studies imply that CBD may well be a key area of research in the future of low back pain treatment, more clinical evidence is needed to produce a clearer picture of the potential of the compound.  

The researchers recommend that future interventional trials assessing the potential of CBD in comparison to opioids and NSAIDs, should consider assessing multiple modalities of low back pain in comparison to only one outcome.  

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