Interested in using cannabis for back pain? Before you pop over to your doctor or dispensary, make sure you know what the science actually says about using medical marijuana to manage pain! Here, our resident nutritional anthropologist and traditional medicine expert helps you do just that!
Many people see the idea of using cannabis for back pain and other illnesses as very “new age-y”. From the perspective of medical and nutritional anthropology, however, we know that cultures have used plants as medicine for centuries.
For example, in India, people have used aloe, turmeric, and lemongrass for thousands of years to treat inflammatory diseases in Ayurvedic medicine. And in traditional Chinese medicine, ginseng is used to treat conditions like palpitations and insomnia.
And, believe it or not, cannabis, specifically, has a long history of use for medicinal purposes, as well.
So, while in much of the Western world today, marijuana is best known as a recreational drug that is smoked or eaten whole in foods to “get high”, some researchers argue that cannabis is, first-and-foremost, a medicine.
This perspective on marijuana has led to an increasing interest in researching the potential use of marijuana for medicinal purposes.
Over the past two decades or so, scientists have published mountains of research on the medicinal effects of medical marijuana. Marijuana can potentially treat nausea from chemotherapy cancer treatments, multiple sclerosis, appetite loss caused by HIV, seizure disorders, Crohn’s disease, and, yes, even chronic back pain.
This article provides an overview of the most up-to-date research on the use of marijuana for chronic back pain.
- What Can Cause Chronic Back Pain?
- When Should I Go to Urgent Care for Back Pain?
- The Politics of Pot
- Changing Laws Regarding Medical Marijuana
- What Do We Know Cannabis Does for Pain?
- Which Strains of Marijuana are Best for Chronic Back Pain?
- Evidence for Benefits of Cannabis for Back Pain
- Potential Risks of Medical Marijuana
- Take Home Message
What Can Cause Chronic Back Pain?
To understand how cannabis could useful for easing chronic back pain, it’s important to understand how chronic back pain develops.
“Back pain” describes discomfort felt between the costal margin and the gluteal fold. (The costal margin is about one-third of the way down the spine. The gluteal fold is at the bottom of the buttocks.)
For the pain to be diagnosed as “chronic”, it must continue for longer than three months.
Mechanical Causes of Back Pain
The majority of chronic back pain cases have purely mechanical causes.
Typically, they originate in the mid- to lower-back and may extend down to the buttocks.
Back pain that is mechanical in nature has four main causes, as summarized by the anesthetic specialists, Dr. Jackson and Dr. Simpson:
Discogenic pain: Discogenic pain accounts for about 40% of cases of chronic back pain. Discogenic pain is pain which originates in the discs that separate the vertebrae in your back. It most likely results from the leakage of inner disc material into outer layer disc material.
Sacroiliac joint pain: Sacroiliac joint pain accounts for about 20% of cases of chronic back pain. The sacroiliac joints are the largest joints in the body, and they connect the spine to the pelvis. Pain in this area can be caused by a change in weight, like that which accompanies pregnancy.
Lumbar facet joint pain: Lumbar facet joint pain accounts for 10-15% of mechanical back pain in young adults and up to 40% in the elderly. The facet joint connects your vertebrae in a way that stabilizes the spine and limits rotation and shifting. Damage to any of these joints between your vertebrae can lead to back pain.
Muscular back pain: Strains or tears in ligaments and muscles that stabilize the spinal column can produce pain. These are often caused by injury.
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Nervous System Causes of Back Pain
Some back pain is not mechanical in nature but originates in the spinal column nerves themselves. Dr. Jackson and Dr. Simpson describe spinal root nerve pain as well-localized (as opposed to general) pain that often radiates down your leg(s) with bursts of sharp or electric-shock-like pains. In this type of pain, the shooting pains in your buttocks, legs, and feet often hurt worse than the pain in your back.
There are three main causes of nerve root pain: disc herniation, spinal stenosis, and epidural adhesions.
Disc herniation: Above, I mentioned that discs are the tissues between your vertebrae in your spinal column. A herniated disk occurs when the disc nucleus (center of the disc) pushes out of the outer layer. This causes the disc to press on your spinal nerves, often causing debilitating pain. The most vulnerable age for developing a herniated disc is 30-55 years old.
Spinal stenosis: Spinal stenosis is a condition that occurs as a result of an enlargement of the bone and ligaments in your spinal cord, leading to a reduction in the diameter of the spinal canal. This change results in pressure on nerve roots. If you have spinal stenosis, you’ll find that you feel relief when your spine is curved and when you are walking or cycling uphill (as opposed to walking on flat terrain). The most vulnerable age for developing spinal stenosis is anything over 55 years old.
Epidural adhesions (spinal nerve root scarring): Epidural adhesion can occur after spinal surgery or in response to chronic inflammation due to disc leakage or joint damage.
When Should I Go to Urgent Care for Back Pain?
Most back pain does not require you to visit an emergency room. Typically, you can get your back pain under control with simple outpatient care (by making appointments with specialists).
However, there are a series of “red flag” markers that indicate you may have a serious spinal problem that should be examined by a physician as soon as possible.
In some cases, these “red flag” markers could indicate you have a very serious condition, such as a spinal tumor, a spinal infection, spinal trauma, an inflammatory/autoimmune disease, or cauda equina syndrome (a rare condition that affects a bundle of nerve roots at the end of the spinal cord).
If you experience any of these “red flag” markers, it is important to call your physician and visit urgent care as soon as possible.
- extreme back pain (in people under 20 or over 55)
- history of significant trauma
- constant progressive thoracic (upper back) pain
- sudden onset of back pain with a history of cancer, steroids, drug abuse, or HIV
- unexplained weight loss along with back pain
- generally feeling unwell with your back pain
- numbness in your groin, inner-thigh and/or buttocks
- changes in urination or bowel movements
- changes in the way you walk
- inability to bend forward (at your lower back) more than 5 cm
- changes the curve or shape of your back
- nerve pain (shooting, sharp, or electric-shock-like pains)
The Politics of Pot
Before I get into the details of how you might be able to use medical cannabis for your chronic back pain, it is useful to have a general understanding of the politics behind the legalization of medical marijuana, and why some people are still not convinced doctors should be allowed to prescribe it for pain.
The Drug Enforcement Administration (DEA), has a classification of drugs (drug scheduling) determined based upon the drug’s acceptable medical use and the potential for people to become dependent on it. This scheduling assigns drugs to one of five different categories.
Marijuana is categorized as a schedule 1 drug
According to the DEA’s website: “Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. Some examples of Schedule I drugs are: heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4-methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote.”
Groups in favor of promoting the legalization of medical marijuana, or people who are against the schedule 1 categorization of marijuana, have been fighting to remove marijuana from the schedule 1 list since the 1970s. Those efforts had been mostly unsuccessful until the last two years.
Many critics of the classification argue that the schedule 1 classification blocks potential research. This can keep researchers from finding the medical benefits that would allow the DEA to reschedule these drugs. Schedule 1 substances are very restricted, with strict bans on their growth/synthesis and purchase, even for scientific researchers.
In fact, before 2016, only a single producer of marijuana in Mississippi had a license to produce research-grade marijuana. This producer essentially had the monopoly over medical-grade marijuana produced in the US for over 50 years and anyone who wanted to research potential health benefits of marijuana had to buy from them, creating a serious bottleneck in the research process.
Changing Laws Regarding Medical Marijuana
Luckily, in 2016, after a significant rise in demand for medical-grade marijuana and extracts for research, the DEA decided to approve additional licenses to grow medical marijuana. This should help speed up medical marijuana scientific and clinical trials.
At the same time that the research community has been fighting for access to marijuana to be able to really put its benefits (and risks!) to the test, some economically and politically-motivated movements support the flat-out legalization of marijuana — medical benefits or not.
Legislators across the United States are pushing for this legalization (and regulation). It is estimated that legalization will result in important government revenue. And on this argument alone, they are gaining ground. As of early 2019, 10 states, plus Washington, D.C., had adopted laws that legalize marijuana for personal use in people over age 21.
Finally, both branches pushing for reclassification of cannabis also point to the DEA’s inconsistency in its treatment of cannabis as a whole plant versus individual components of cannabis as strong evidence for their side. In 2018, for example, the DEA placed lab-made THC (the primary active ingredient in marijuana) as a Schedule 3 drug. The DEA defines schedule 3 drugs as substances with moderate to low potential for physical and psychological dependence.
If the active ingredient in cannabis is safe for use, how can the whole plant be too dangerous to even do research on?
This is a political, social, and scientific debate that researchers, politicians and the public will soon have to find an answer to.
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What Do We Know Cannabis Does for Pain?
Unfortunately, the political context and controversies surrounding cannabis use for different illnesses and conditions have made it difficult for scientists and doctors to point to definitive evidence for the use of medicinal cannabis. This is especially true for vulnerable populations like adolescents and pregnant women.
Like the National Academies of Sciences, Engineering, and Medicine states, “Unlike with substances such as alcohol or tobacco, no accepted standards exist to help guide individuals as they make choices regarding if, when, where, and how to use cannabis safely and, in regard to therapeutic uses, effectively.”
Even so, there are thousands of high-quality research articles that help to point towards benefits (and potential risks) as guidelines for cannabis use are being developed.
How Does Cannabis Work?
Cannabis has over 60 active compounds that scientists and industries can extract for various uses, with the right permissions.
The main compounds that have been studied for their therapeutic effects are tetrahydrocannabinol (THC), and cannabidiol (CBD).
THC and CBD act on your body by way of your cannabinoid receptors, which are found on your nerve cells (neurons) and the cells of your immune system.
Some researchers believe that activating your cannabinoid receptors on your nerve cells, in particular, are responsible for the medicinal effects of cannabis for pain. This activation is actually “inhibitory” for your nerves, “calming down” certain responses in your nerve cells, causing a relaxing effect and reducing pain sensations.
Interestingly, while THC provides medical benefits, it is also is the chemical responsible for the euphoric feeling of marijuana (its “high”). CBD, on the other hand, only provides medical benefits, without inducing a high. This suggests that opting for CBD-rich marijuana strains may offer a way to reap the medical benefits without experiencing psychological side effects.
Unfortunately, some research suggests that that medicines containing THC and CBD are the most effective for chronic, neuropathic pain. Because of this, avoiding THC may also reduce the medicinal effects of your marijuana. Future research will have to sort out exactly the best combination of THC and CBD for managing chronic back pain.
Which Strains of Marijuana are Best for Chronic Back Pain?
The two main strains of marijuana used for medicinal purposes are Cannabis indica and Cannabis sativa.
It is also possible to buy marijuana extracts which contain only CBD. This will allow you to avoid the euphoric effects of cannabis. But, as I mentioned above, it might be less effective for combating chronic pain than the whole plant, which contains both cannabinoids.
Evidence for Benefits of Cannabis for Back Pain
In efforts to fill the gap of conclusive recommendations for medical marijuana use, last year the National Academies put together a committee to draw up a comprehensive overview of the health effects of cannabis and cannabinoids identified, so far, in the medical literature.
The committee concluded that: “There is conclusive and substantial evidence that cannabis or cannabinoids are effective… for the treatment of chronic pain in adults.”
Unfortunately, the scientific community still has limited evidence that cannabis can help to reduce other types of chronic back pain. This includes back pain from muscle injuries, for example.
Another benefit of cannabis is that it may work together with opioids in patients with severe pain, allowing people to reduce their intake of highly-addictive opioid medications. A study in the Journal of Pain demonstrated that cannabis can help lower opioid use by up to 64%. The study found that it can also improve the quality of life of people with chronic pain.
Potential Risks of Medical Marijuana
An overview of systematic reviews looked at the tolerability and safety of cannabis-based medicines for chronic pain management. The study found that there are still inconsistent findings regarding the efficacy of cannabis for chronic pain from rheumatic diseases or cancer. If you are looking to the use of cannabis for back pain, few studies examine its effectiveness specifically for back-related conditions.
In other words, medical marijuana may not be effective for you.
We also cannot overlook that cannabis does have a direct effect on your brain (called psychoactive effects). The effects, in addition to including relaxation and stress relief, can also affect your thinking, potentially causing anxiety and paranoia.
Just like all recreational smoking, smoked marijuana may increase your risk for certain types of cancer, including testicular cancer and lung cancer. Researchers are still working on determining the relative risk of smoking marijuana compared to smoking tobacco.
Take Home Message
There is still a lot to learn about the medicinal effects of cannabis for back pain. However, most evidence on the therapeutic effects of cannabis concludes that it is effective for patients who participate in studies.
Medical cannabis has not yet been conclusively proved to be a safe drug. The following factors can determine the efficacy of medical cannabis for back pain:
- how often you use it
- duration of use
- age of use
- potency of the cannabis
- individual sensitivity
If you’re looking for a solution to your back pain, talk to your doctor about all the possible options, first. Consider potential side effects or other factors that could influence how well medical marijuana can help you manage your chronic back pain.
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