It’s no secret that cannabis has been medicinally for the management of pain for thousands of years. A number of ancient texts and records, originating from around the world, all describe the use of the plant as a treatment for various types of pain, from headaches to menstrual cramps to use as an anaesthetic. And this type of use has far from died out. In fact, pain is the most reported reason for medical cannabis use, globally and, with accessibility slowly expanding, many people with different types of pain may now be considering how cannabis could help them – including people with back pain.
While medical cannabis was effectively legalised in the UK in 2018 with the rescheduling of the drug, the National Institute of Health and Care Excellence (NICE) still recommends against the use of medical cannabis for chronic pain. To date, the only indications for which NICE does recommend medical cannabis treatment are intractable epilepsy, chemotherapy-induced nausea and vomiting, and spasticity. Nonetheless, a growing number of patients are now able to access cannabis-based medicines for back pain, and other types of pain, via private clinics.
But is there any evidence that medical cannabis can be useful for the treatment of back pain?
What is back pain?
To kick off, let’s start by explaining exactly what we mean when we say “back pain”. Sure, it might sound obvious, but a number of conditions/indications can fall under this umbrella. For example, back pain can be the result of an injury, such as a pulled muscle or strain. However, it can also be related to certain medical conditions like a slipped disc, sciatica (a trapped nerve) or ankylosing spondylitis. In less common cases, back pain may also be related to osteoporosis, fibromyalgia, endometriosis, and cancer.
Back pain can affect people of all ages and most people will experience back pain at some time in their lives. However, back pain can range in severity depending on the cause and area of the back affected. Acute back pain refers to pain that begins suddenly and lasts for between a few days and a few weeks; subacute back pain can also come on suddenly and typically lasts for 4-12 weeks. Finally, chronic back pain refers to pain that can either come on quickly or slowly but that lasts for longer than 12 weeks.
Treatment options for back pain largely depend on the cause and source of the pain; however, aside from addressing the cause of the pain, treatment will likely include medications such as over-the-counter painkillers (paracetamol, etc), anti-inflammatory drugs, muscle relaxants, and in cases of severe acute back pain, prescription painkillers.
Medical cannabis and back pain
As we mentioned earlier, medical cannabis may be considered in certain cases of back pain. However, these medications are currently only available for these indications in the UK via private clinics. Furthermore, to be considered for medical cannabis treatment, patients must have first tried at least two different conventional therapies.
It is important to note that clinical research into the efficacy of medical cannabis products for the treatment of back pain is limited. However, some recent studies have aimed to assess whether these medications could be a good option in this setting – with some interesting conclusions.
For example, one study aimed to determine a clinical rationale for future research into the use of CBD in low-back pain. The researchers assessed pharmaco-physiological papers published between 2000 and 2021 to collate relevant evidence in this area. They concluded that current observational evidence “reported good results with CBD in pain and fear reduction, which are both key factors in low-back pain.” While this is far from a clinical recommendation for the use of CBD for back pain, it does suggest that CBD the cannabinoid may have potential in this area.
A 2016 study assessed the effects of medical cannabis treatment in a cohort of 46 patients with chronic low back pain and/or sciatica. Participants were followed for a minimum of 12 months and were evaluated at baseline and 3 months, 6 months and 12 months after the initiation of smoked medical cannabis use. The data collected in this study indicated that medical cannabis treatment for low-back pain and sciatica was associated with reductions in pain and improvements in range of motion. The researchers concluded that “short-term usage of smoked medicinal cannabis appears to improve both physical and mental function while decreasing pain levels of chronic low back pain sufferers.”͘
Furthermore, another study conducted by researchers at Tel Aviv Medical Center in Israel assessed the potential of THC in radicular pain – a type of nerve pain that radiates from the spine into the legs (of which sciatica is a common form). They found that THC reduced pain when compared to baseline pain scores and placebo treatment pain scores. However, despite this promising outcome, the small sample size limits the significance of these findings. Further research into the potential of THC for back pain is therefore required in order to draw any solid conclusions.
If you would like to learn more about the process of obtaining a UK medical cannabis prescription for low back pain, either for you or a loved one, take a look at leafie’s extensive guide.