CBD for Low Back Pain: Discover its Benefits

Low back pain, commonly known as lumbago or back pain, is a debilitating condition that affects millions of people around the world and negatively impacts well-being, hindering mobility, productivity and quality of life for those who suffer from it. Although there are various treatment options, low back pain can be resistant to conventional therapies and can be difficult to treat. The potential of cannabidiol (CBD) as a therapeutic agent to treat low back pain presents new treatment possibilities.

In today’s Cannactiva article, we review research on the use of CBD for the treatment of back pain, based on Cannabiscientia’s Handbook of Clinical Cannabinology, written by Viola Brugnatelli and Dr. Fabio Turco.

What is low back pain?

Low back pain is localized pain in the lumbar region of the back, the area from the lower part of the ribs to the gluteal region. In 2020 alone, some 619 million people worldwide were affected by low back pain, a number that is expected to increase significantly over the years, underscoring the urgent need for effective treatment strategies. (1)

The causes of this type of pain can be various, including postural factors, repetitive strain injuries and poor sleep habits. However, approximately 90% of cases are nonspecific in origin, with no clear underlying cause.

In addition, there are different factors that can increase the risk of low back pain, some of which we can control, such as a sedentary lifestyle, smoking, obesity and work stress. Other factors include underlying diseases, injuries and referred pain from other systems that manifest in back pain.

Low back pain varies from acute episodes to chronic conditions, significantly impacting daily life.

Regardless of its temporary manifestation, low back pain can have profound implications for emotional well-being and quality of life. It impairs mobility, disrupts daily activities and can precipitate social isolation and psychological distress.

Although it can appear at any age, it is most common between the ages of 50 and 55 and affects women much more often than men. Symptoms vary from a dull or mild ache, to a sharp pain to a more intense, throbbing and radiating pain.
In some cases, acute episodes of low back pain resolve spontaneously, while in others they progress to a state of chronic pain, requiring comprehensive treatment strategies.

Conventional treatment of back pain

Effective treatment of low back pain requires a personalized, multidisciplinary approach that addresses the underlying cause and promotes overall well-being. Treatment strategies vary depending on whether the pain is specific or nonspecific, with interventions aimed at relieving symptoms and restoring function. (3)

In the case of specific low back pain, treatments are directed at the underlying cause through surgical interventions, medications, or specialized interventions to promote healing.

In contrast, treatment of non-specific low back pain focuses on symptom relief and functional restoration through physical therapies, psychological support and lifestyle modifications.

Medications can be used to alleviate symptoms, but they should complement other treatments and should be used judiciously. Comprehensive clinical assessments, encompassing both physical and psychosocial evaluations, are essential to tailor care to individual needs and optimize treatment outcomes. Analgesics, in particular, should be used judiciously, and elderly people and those with comorbidities should consult health personnel before taking medications.

CBD in Low Back Pain Relief

Since conventional treatments are sometimes not sufficient to provide relief from low back pain, cannabinoids, in particular cannabidiol (CBD), are emerging as a potential intervention worthy of study.

What is CBD?

Cannabidiol (CBD) is a non-psychoactive compound derived from the cannabis plant, which has caught the attention of researchers, physicians and patients. The potential of CBD as a therapeutic agent to treat low back pain represents a shift in pain management strategies, and offers a new therapeutic possibility for pain relief.

CBD has attracted attention for its potential therapeutic effects, especially in modulating pain and inflammation.

Unlike tetrahydrocannabinol (THC), the intoxicating compound in marijuana, CBD is non-psychoactive, offering potential therapeutic benefits without inducing intoxication, making it a viable option for people seeking pain relief without psychoactive effects.

Mechanism of action

CBD interacts with the body’s endocannabinoid system to regulate various physiological processes, such as pain perception and immune response. By modulating receptor activity and influencing the release of neurotransmitters and endocannabinoids, CBD can attenuate pain signals and mitigate inflammatory responses associated with low back pain.

Furthermore, in the complex phenomenon of low back pain, the perception of pain involves a variety of factors, including biological, psychological and social elements. Unlike analgesics such as NSAIDs, CBD can influence multiple modalities, potentially reducing both the pain and fear associated with low back pain.

Potential Benefits of CBD for the Treatment of Low Back Pain

The therapeutic potential of CBD in the treatment of back pain goes beyond symptom relief to encompass broader benefits, such as:

• Improved sleep quality
• Improved mood
• Reduced dependence on conventional analgesics

CBD’s multifaceted mechanism of action, coupled with its favorable safety profile, positions it as a promising complementary or stand-alone treatment for people with chronic low back pain.

Scientific Studies on CBD for Back Pain

Research on the efficacy of cannabinoids in acute low back pain is limited. The CANBACK study, a rigorously designed trial, compared 400 mg of CBD to placebo in 100 participants with acute back pain. (4) After two hours, pain levels and ED stays were similar between the CBD and placebo groups. However, this study has limitations, such as the subjective assessment of pain and the lack of information on the use of medication prior to emergencies.

In one clinical case, a 40-year-old man with an L3 compression fracture experienced a significant reduction in pain after applying CBD cream topically (400 mg of CBD per two ounces, where one ounce equals approximately 28.35 grams). Despite the failure of conservative treatment, the CBD cream relieved his pain for about 10 hours. (5)

The efficacy of CBD in the treatment of chronic low back pain is also poorly investigated, and few randomized controlled trials are available. Most studies evaluate cannabinoid preparations containing both CBD and THC, making it difficult to isolate the specific effects of CBD. In addition, the variability of the doses of the preparations and the heterogeneity of low back pain conditions in the different studies pose difficulties in evaluating the efficacy of the treatment. (6)

Despite these limitations, CBD shows promise as a potential therapeutic option for chronic low back pain, and further high-quality research is warranted to elucidate the role of CBD in the treatment of low back pain and address gaps in current knowledge.

Administration and Dosage of CBD for Back Pain

CBD Products

CBD is available in various formulations, such as oils, capsules, topical creams and edibles, allowing for customized treatment approaches based on individual preferences and therapeutic goals.

Topical CBD creams offer localized relief by targeting specific areas of discomfort, while oral formulations provide systemic effects for comprehensive pain management. The choice of route of administration depends on factors such as the severity of symptoms, patient preferences and the presence of comorbidities, and should be advised by the specialist physician.

CBD dosage

In the case of low back pain, CBD administration may vary depending on the product used and clinical experience. Previous studies have shown significant heterogeneity in CBD dosing.

No specific dosing regimen is recommended, due to the paucity of data, but it appears that a dose of 0.1-12.5 mg/kg CBD twice daily can be safely administered in adults (7). Studies suggest starting therapy with the lowest dose that shows clinically documented effects -0.5-1 mg/kg/day- and adjusting the dose according to the patient’s needs.

Type of cannabis extract

Most studies on CBD for pain have focused on products containing different amounts of THC.

The composition of cannabis can be classified into 3 types: high THC, balanced THC:CBD, and high CBD and low THC.

Studies have shown that elevated THC levels can negatively affect the efficacy of CBD. (7) For example, when THC levels are too high, CBD can have an antagonistic effect to the action of CBD.

Both pure CBD and full-spectrum CBD have been used in the studies reviewed, and both have shown encouraging results in the management of low back pain. The use of CBD-only products has shown beneficial effects on chronic pain, possibly due to improvements in insomnia, anxiety, cognition and/or mood. However, research on high-CBD products, such as Epidiolex® (99% CBD, 100 mg/ml), is limited as to their efficacy in back pain.

A 2018 study observed that full-spectrum CBD is more effective in relieving pain compared to CBD isolate (8). The increased efficacy of full-spectrum CBD is attributed to the synergistic effects of CBD along with trace amounts of THC present in full-spectrum CBD products. As is often the case with cannabis extracts, full-spectrum or broad-spectrum products contain a wide range of cannabis-derived compounds, including different types of cannabinoids, terpenes and flavonoids, the combination of which appears to have a superior effect compared to single molecules. This increased efficacy is attributed to the entourage effect, in which these various constituents of cannabis work synergistically to produce therapeutic benefits.

Side effects of CBD

CBD is generally well tolerated, although it can produce adverse effects such as fatigue, gastrointestinal disturbances and changes in appetite, requiring careful monitoring by the medical specialist and adjustment of treatment plans as necessary.

Conclusion

CBD holds promise as a therapeutic option for treating low back pain, as it offers a holistic approach to treating symptoms and improving the quality of life of affected individuals.

If you are a professional and want to delve deeper into the use of medical cannabis, we recommend reading the Handbook of Principles of Clinical Cannabinology, a comprehensive resource for healthcare professionals and amateurs seeking evidence-based information on the therapeutic applications of cannabinoids. Developed by Cannabiscientia, this handbook is a valuable guide that provides information on the science, regulations, medicine and the various products offered in the changing landscape of medical cannabis.

Note: This is an informational article and is not intended to prevent, diagnose or treat any disease. Its contents may complement, but should never replace, any diagnosis or treatment of any disease or symptom. Cannactiva products are not medicines and are intended for external use. The authors and Cannactiva are not responsible for any misuse of this information. Please note that new scientific evidence may become available since the date of publication. Therefore, consult your doctor before using CBD or if you have any doubts about it.

References

1. GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 2023: 5: e316-29.
2. J D Bartleson. Low Back Pain. Curr Treat Options Neurol. 2001 Mar;3(2):159-168.
3. Crystian B Oliveira, Chris G Maher, Rafael Z Pinto, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018 Nov;27(11):2791-2803.
4. Bebee B, Taylor DM, Bourke E, et al. The CANBACK trial: a randomised, controlled clinical trial of oral cannabidiol for people presenting to the emergency department with acute low back pain. Med J Aust.2021;214(8):370-375.
5. Eskander JP, Spall J, Spall A, et al. Cannabidiol (CBD) as a treatment of acute and chronic back pain: A case series and literature review. J OpioidManag. 2020;16(3):215-218.
6. Kim Teddy E, Townsend Robert K, Branch Charles L, et al. Cannabinoids in the Treatment of Back Pain. Neurosurgery, (2020), nyz573.
7. Gabor Xantus, Laszlo Zavori, Candice Matheson, et al. Cannabidiol in low back pain: scientific rationale for clinical trials in low back pain. Expert Review of Clinical Pharmacology (2021)
8. Vučković S, Srebro D, Vujović KS, Vučetić Č, Prostran M. Cannabinoids and Pain: New Insights From Old Molecules. Front Pharmacol. 2018 Nov 13;9:1259. doi: 10.3389/fphar.2018.01259. PMID: 30542280; PMCID: PMC6277878.