CBD for back pain

Last updated on 13 July 2021

Introduction

Pain is a global problem. And back pain is the most common health concern for men, women, and sometimes children too. Occupation, obesity, faulty lifestyle, stress, and many other causes could lead to back ache.

This article aims to share some insight into the use of CBD for back pain. We are quite familiar with the anti-inflammatory properties of CBD and that it is known for its analgesic properties. But, does CBD provide a permanent solution for pain management? Or does it merely suppress for a short time? To answer these questions, let us deep dive into understanding the nature and type of pain. Let us discuss this in this article.

Understanding types of pain

A patient needs to understand the pain he/she is experiencing for the simple reason to precisely communicate to the physician and receive appropriate treatment. 

A study¹ says that men and women process pain differently. 

Also, back pain may present itself in a mixed pattern. It may trigger discomfort in other areas of the body apart from the origin of the pain, leading to disability in carrying out everyday functions. 

Therefore let us first understand the different types of pain.

A study² points out four main types of pain:

Nociceptive:

It is the most common type of pain that most of us experience. Have you experienced a sharp shooting pain when your little toe got stubbed? Or the reflex action when you accidentally touched something hot or cold?

Inflammation, chemical contact or physical events trigger nociceptive fibers. Therefore nociceptors are specialized nerve cells that respond to a specific situation. In short, nociceptive pain serves as a protective function.

Inflammatory:

This type of condition is an inappropriate response by the body’s immune system that causes abnormal inflammation. 

Inflammatory pain is a spontaneous hypersensitivity to pain that originates in response to inflammation and tissue damage.

Examples of such conditions are injury from accidents, arthritis pain, post-surgical pain, etc.

Functional:

Hypersensitivity to pain resulting from no recognizable reason, it could be called functional pain. 

Studies³ have shown that functional pain is loosely defined. 

Most of us can relate to this kind of pain when we experience symptoms and disability without a specific reason. Or confusion to pinpoint the origin of the pain. 

Examples of such conditions are Fibromyalgia, irritable bowel syndrome. 

Neuropathic:

Pain conditions that include symptoms such as burning and shooting sensations coupled with tingling and numbness. 

A dysfunction in the nervous system can cause neuropathic pain. They may originate from peripheral nerves, spinal cord, brain. Moreover, the disturbance is caused by several nerves, making it difficult to gauge the source of neuropathic pain. Studies report hundreds of diseases connected to this kind of pain. Also, 30% of neuropathy pain is due to diabetes. 

Several reasons could trigger this type of pain. For example, Nerve irritation, alcoholism, Shingles, radiation therapy, chemotherapy drugs, Diabetes, Spinal nerve compression, radicular pain, trigeminal neuralgia, and many more.

Understanding back pain

Back pain is a too simple term given for a complicated pain that is often difficult to diagnose and treat. That is why we briefly discussed the different types of pain that could probably help us understand backache a little easier. 

From the references used in this article, it seems that back pain predominantly branches out from neuropathic pain. And takes shape into more varieties of pain. It may also represent itself as a combination of nociceptive, functional, and neuropathic pain. Therefore, treatments vary from case to case. 

A report on spine health discusses three common classifications of back pain. They are:

Axial pain: 

Study⁴ explains axial low back pain as a syndrome with both nociceptive and neuropathic pain. In a cross-sectional survey conducted among 1083 patients with low back pain, it was found that 37% showed a predominant neuropathic pain component. Therefore, Axial pain in most cases is associated with low back pain. 

Referred pain: 

Reference from a 2016 study⁵ describes that referred pain is caused by injured or irritated tissues in muscle, facet joints or periosteum. 

For example, cardiac pain in the left shoulder and arm, pain in the right shoulder, pain in the gallbladder, back pain, neck or shoulder pain that spreads to the upper arm, pain in the muscle, joints, ligaments, tendons.   

From a 2011 study⁶ it is clear that Referred pain is felt in regions away from the source of pain. It could spread to the shoulder region and the upper extremity. 

Therefore, this type of pain is deep and diffuses itself and could sometimes lack objective physical pain signs. This makes it difficult to locate it precisely, leading to complexity in diagnosis and treatment. 

Radicular pain:

A 2020 study⁷ defines radicular pain as a diffuse disease process that affects more than one nerve root. Leading to pain, loss of sensation, and difficulty in carrying out daily activities. Of course, depending on severity, pain and other symptoms may vary.

The most common symptom in radicular pain is paresthesia, again a neurological disease affecting the central nervous system, a clear signal of traumatic nerve damage. In some cases, back pain could radiate into the foot. 

The most common cause is a herniated disc leading to compression of the nerve root.

Summing up from what has been discussed so far, we now know that back pain in most cases could be generally related to neurological pain type. But it could present itself in a mixed pain syndrome in which patients’ pain perceptions could be a combination of nociceptive and neuropathic mechanisms. 

Causes

A 2013 study⁸ asserts that back pain is caused by a complex interaction of biological, psychological and social factors. 

Beyond theoretical descriptions, experiencing back pain is much complicated. The anatomical structure of the back is interconnected with large muscles supporting the spine, spinal nerves that reach the legs, facet joints connecting the vertebrate, and Intervertebral discs.

With this complex structure, we perform various day to day activities. Some general causes and conditions of back pain can be summarized as:

• Muscle or ligament strain due to hurried lifestyle, bad posture, prolonged sitting oriented jobs, twisting, excessive driving, over-exercise, or even wrong footwear could trigger acute back pain. 
• Degenerative causes such as arthritis or osteoporosis. 
• Inflammation of tissue and ligaments -Osteoarthritis 
• Fractured disk
• Increased coughing due to smoking could lead to strain on the disc.

According to the NIH study, other general causes of back pain could also be due to:

• Age
• Weight
• Genetics
• Nature of occupation
• Psychological factors

Symptoms

Below are some general symptoms that one could experience in conditions of back pain. However, case-to-case variations apply. Describing your pain correctly to your medical advisor could go a long way in helping your doctor to diagnose your type of back pain and guide you for appropriate treatment. Reports highlight that millions get the wrong treatment for back pain. 

• According to the 2013 study⁹ constant aching pain in the back, shooting pain attacks, pressure in the back during conditions of nociceptive pain. 
• Burning and tingling sensations are typical symptoms of Neuropathic pain. 
• Back pain that radiates to other areas, during straight leg raising, walking, or while getting up from a chair, or lifting an object.
• It may or may not be a localized pain or could radiate through the whole length of the spine sometimes until the neck. Depending on the condition, the pain could be acute or chronic. 
• Excruciating back pain causing immobility 
• Depression and anxiety are some commonly associated mental health issues that accompany back pain.

Role of CBD in back pain

Hemp-derived CBD or cannabidiol is known for its anti-inflammatory and analgesic properties and its potential to trigger the endocannabinoid system. The various non-psychoactive phytocannabinoids that are derived from Cannabis are being extensively researched for their applicability in treating chronic pain and inflammatory-related conditions. For example, THCA, CBDA 

And, CBD has been showing promising capabilities as a naturally effective alternative to opioids and NSAIDs. Hemppedia has compiled several useful articles on the applicability of CBD in various conditions. 

• It is good to recall that CBD interacts with the body through the endocannabinoid receptors CB1 and CB2. And these play a significant role in pain, anxiety, neuroinflammation, immune function, metabolic regulation, bone growth, etc. 

• According to a 2007 study¹⁰ CB1 receptors are present in multiple locations in the peripheral and central nervous systems and CB2 receptors are located primarily on inflammatory cells and immunity-related cells. 

• The focal point of a 2008 study¹¹ is on cannabinoids in the management of difficult to treat pain. The report asserts CBD’s endocannabinoid modulating effects and CB1 receptor antagonist for treating central neuropathic pain and intractable cancer pain. More importantly, the safety and efficacy of Cannabis in treating central and peripheral neuropathic pain have been indicated by several randomized clinical trials. 

• A recent study¹² points out preliminary evidence in the rat model of CBD’s interaction with glycine receptors to reduce inflammation and hyperalgesia in neuropathic pain conditions.

• CBD produces analgesic and anti-inflammatory effects via interaction with spinal cord receptors. 

• Anxiety relieving and sleep-enhancing properties- The same study also reports that on CBD treatment, patients reported quality of life and sleep

Recommended reading: Basics of CBD

CBD for back pain: oil, Cream, or Vape which is best?

Different routes of drug delivery have gained more focus because of providing patient-specific treatments. 

The different forms of CBD including oil, topical creams have their own benefits while using it for back pain. We cannot say, which form is best as the condition and severity of back pain could vary from person to person. 

• CBD oil could deliver overall relaxation and pain relief without targeting back pain specifically.
• CBD topical or creams on the other hand could provide more localized effects for pain relief. 

A 2010 Study¹³ reports that topical application of preparations has potential to block nociceptive and neuropathic pain. 

• Finally, when it comes to vape, there is no supporting evidence to prove its efficacy in back pain specifically. But a study¹⁴ identifies that compared to oral routes inhalation route provides quick delivery. 

Also, since we stated that smoking is one of the causes of back pain, CBD vape could be a better alternative for smokers. It could help smokers to fulfill the habit of holding something at the same time, and help overcome tobacco addiction. 

Read about how CBD could help quit smoking.

Therefore, it is important to understand that the pharmacokinetics of CBD is still a work in progress, although it is widely being used. There is a need for more robust scientific data to prove the effectiveness of various forms of CBD and its efficacy in treating specific conditions.

How often can you take CBD oil for back pain?

We discussed above that CBD oil or hemp-derived cbd products could provide an overall effect in treating different pain and inflammatory conditions. That implies that if you just ingest CBD oil or other CBD products when you are experiencing pain and expect to get rid of it? may not be a great idea! In case you did, it may be an individual experience. 

CBD oil could supplement your health and you could include it as a part of your diet. 

Generally, you could consume CBD oil once or twice a day depending on some of the following considerations:

• Your medical condition
• Severity
• Other medications that you are taking 
• Sensitivity to plant-based preparations and your response to CBD oil or CBD products
• Metabolism

If you are a beginner, start with a microdose. That is 0.5 mg to 20mg of CBD oil per dose could be recommended.

Recommended reading: CBD dosage, How much CBD should I take?

Potential risks and side effects of CBD

Cannabidiol (CBD) is non-psychoactive. Thus, there is no fear of high risk such as emergency hospitalization for overdose on CBD products. However, some side effects of CBD products could be:

• Drowsiness
• Dizziness
• Dry mouth
• Low blood pressure
• Vomiting / Nausea
• Diarrhea

How to handle back pain?

From what we have discussed so far, we have understood the importance of understanding back pain. We also grasped that neck pain could radiate to the lower back and could trigger pain. Also, acute pain if not addressed on time, could aggravate chronic pain that could become difficult to treat. Hence, seeking medical advice at the right time could go a long way in handling back pain.

Also, one common advice that most doctors recommend is adapting lifestyle changes as a first step to treat any condition. Later comes prescription and medications. 

What makes a good lifestyle mix?

• A good diet
• Good sleep
• Fitness and exercise
• Quit smoking 
• Good mental health

Although all of the above seems quite simple, inculcating them every day as a part of life does involve effort and will.

Conclusion

A 2018 study¹⁵ asserts that the current treatments for neuropathic pain are often inadequate and produce severe side effects. 

For example, gabapentin, pregabalin, serotonin, etc are some of the prescription drugs that are strongly recommended for pain. But, clinical trials from 2015 report that the reduction in pain from the use of these drugs is only relatively modest.  

Also, treatment for back pain in chronic conditions includes surgery, spinal cord stimulation, physical and psychological therapies, and a variety of other interventions.

There is scope for enhanced understanding of the molecular basis of neuropathic pain, which could lead to the development of novel therapies. 

 A 2008 study¹⁶ contends that cannabinoids medicines are a new hope to many. Despite stringent laws and political controversies, Cannabinoids offer a novel approach to the issue of chronic pain management.

References

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