Understanding CBD (Cannabidiol) for Back Pain

Cannabidiol, commonly referred to as CBD, is a new and relatively understudied treatment for pain, including back pain. Studies suggest it may help relieve inflammation, which is often a factor in chronic back pain. ¹ Burstein S. Cannabidiol (CBD) and its analogs: a review of their effects on inflammation. Bioorg Med Chem. 2015 Apr 1;23(7):1377-85. doi: 10.1016/j.bmc.2015.01.059. Epub 2015 Feb 7. Review. PubMed PMID: 25703248.

CBD is available in many forms; topical creams and gels have shown promising results for inflammation and neuropathy, which may make them a good option for back and neck pain. ² Jorge LL, Feres CC, Teles VE. Topical preparations for pain relief: efficacy and patient adherence. J Pain Res. 2010;4:11-24. Published 2010 Dec 20.

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CBD requires more research in order to prove and explain its effectiveness as well as to better understand potential side effects (especially long-term) and potential drug interactions.

What Is CBD?

CBD oil is derived from a plant called cannabis sativa. The plant has over 100 chemical compounds, called cannabinoids, that have a range of effects, including anti-inflammatory and analgesic (pain relieving) qualities.

The cannabis sativa plant has two main varieties that are grown for specific purposes:

• THC content. THC is the compound associated with the “high” feeling of marijuana use.
• Industrial (non-drug) uses. This form of the plant contains trace amounts of THC (less than .03%) and can be used to make paper, clothing, and some building material. This variation of the cannabis plant is called hemp.

While CBD is present in both varieties, many of the CBD products available to consumers are from the hemp plant. CBD does not come with the high or psychogenic effects of marijuana.

Ways CBD Treats Back Pain

Research indicates that CBD may reduce back pain by:

• Reducing inflammation ³ Russo EB. Cannabinoids in the management of difficult to treat pain. Ther Clin Risk Manag. 2008;4(1):245–259. doi:10.2147/tcrm.s1928
• Combating anxiety, often associated with long-lasting or chronic back pain ⁴ Crippa, J. A. S., Derenusson, G. N., Ferrari, T. B., Wichert-Ana, L., Duran, F. L., Martin-Santos, R., ... & Filho, A. S. (2011). Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report. Journal of Psychopharmacology, 25(1), 121-130.
• Helping with sleep and improving overall state of relaxation ⁵ Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in Anxiety and Sleep: A Large Case Series. Perm J. 2019;23:18–041. doi:10.7812/TPP/18-041

Some studies suggest that CBD can have an effect on how an individual perceives pain, but more robust research is needed. CBD is generally considered a full-body treatment, which means that it does not target back pain specifically—except in the case of topical products—but contributes to an overall feeling of relaxation and pain relief.

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Advocates of CBD believe it can be used to treat a range of conditions in addition to back pain, such as anxiety-related disorders. ⁵ Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in Anxiety and Sleep: A Large Case Series. Perm J. 2019;23:18–041. doi:10.7812/TPP/18-041

Potential Risks and Side Effects of CBD

Cannabidiol, even in high amounts, is generally safe. Side effects from CBD may include:

• Drowsiness
• Dizziness
• Dry mouth
• Low blood pressure

More severe side effects, while rare, include:

• Mental confusion
• Nausea
• Vomiting
• Diarrhea

As with other natural products, there is potential for adverse reactions when taken with other medications, especially those that come with grapefruit warnings, such as certain blood thinners. These warnings indicate that certain medications should not be taken with products containing grapefruit.

CBD use prior to surgery

Before having surgery, all cannabis use, including CBD and marijuana, should be disclosed to the surgeon or anesthesiologist. A recent study suggests that cannabis use may have an effect on medications used to sedate patients. ⁶ Twardowski MA, Link MM, Twardowski NM. Effects of Cannabis Use on Sedation Requirements for Endoscopic Procedures. J Am Osteopath Assoc. 2019 Apr 15;. doi: 10.7556/jaoa.2019.052. [Epub ahead of print] PubMed PMID: 30985870.

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