CBD has become popular due to its analgesic and anti-inflammatory effects. However, the marketing and sale of CBD has outpaced the scientific evidence of its effectiveness. So far, only one drug has been approved for the treatment of rare forms of epilepsy in children. In fact, the endocannabinoid system is involved in a variety of diseases ranging from neurodegenerative disorders to diabetes. As a result, CBD is marketed as a cure for every conceivable ailment. What is true and what is simply marketing is often indistinguishable for laypeople. We are therefore always on the lookout for new scientific publications on CBD to shed more light on its actual potential. Today, a study has caught our attention that asks patients with back pain about their CBD usage habits.
There is now scientific evidence that CBD can relieve inflammatory and neurogenic pain. This has prompted physicians to question whether CBD use can alleviate spinal conditions such as mechanical or neuropathic pain. An anonymous cross-sectional survey will provide insights into the CBD consumption habits and beliefs of patients with spinal pain. Patients in a spinal surgery hospital were asked whether they use CBD for pain relief.
Of the 214 spinal patients who completed the survey, 25% use CBD. The analysis of the consumption patterns of CBD users reveals the following:
Most (67%) patients state that they use CBD for back pain, 37% for neck pain. Around a quarter of patients also use CBD for possible improvements in sleep (26%). Of CBD users with a history of spinal surgery, 29% use CBD before their surgery, 18% before and after surgery, and 53% after surgery. Most patients use CBD either 2-5 (41%) or 6-10 (32%) times per week. Almost half of patients using CBD experience pain relief (46%), a third note an improvement in sleep (33%), a fifth report a reduction in anxiety (20%), and around a quarter note no positive effects (24%). Adverse effects were reported by 15% of CBD users, including restlessness (n = 1 patient), diarrhea (n = 2), fatigue (n = 4) and nausea (n = 2). Most users (63.0%) would recommend CBD to a friend for pain relief.
This study finds that the main reasons for the initial use of CBD are the potential relief of back and neck pain. Considering that back and neck pain are two symptoms that often do not respond to various forms of conservative and surgical treatments, it would be expected that patients with these symptoms would be keen to try a novel therapy for relief. The cause of chronic back and neck pain is multifactorial and consists of inflammatory, neuropathic and psychogenic components. From a pathophysiological perspective, there are several animal studies demonstrating the ability of CBD to alleviate both the inflammatory and neuropathic components of musculoskeletal pain. Several studies show promising initial results in orthopedic applications (2). One study compares pain behavior and inflammation of the knee joint after CBD administration in a rat osteoarthritis model and finds a dose-dependent response to CBD (3). Although there is limited data on spine patients, a non-controlled observational study of 11 patients with failed back surgery found that an oral CBD/THC combination preparation led to improvements in pain (4).
This study shows that CBD is a widespread alternative therapy that is used by many patients with spinal complaints.
1 Lovecchio F, Langhans MT, Bennett T, Steinhaus M, Premkumar A, Cunningham M, Farmer J, Albert T, Huang R, Katsuura Y, Qureshi S, Schwab F, Sandhu H, Kim HJ, Lafage V, Iyer S.; Prevalence of Cannabidiol Use in Patients With Spine Complaints: Results of an Anonymous Survey. Int J Spine Surg. 2021 Aug;15(4):663-668.
2 Philpott HT, O'Brien M, McDougall JJ; Attenuation of early phase inflammation by cannabidiol prevents pain and nerve damage in rat osteoarthritis. Pain. 2017;158(12):2442–2451.
3 Hammell D, Zhang L, Ma F, et al; Transdermal cannabidiol reduces inflammation and pain-related behaviors in a rat model of arthritis. Eur J Pain. 2016;20(6):936-948.
4 Mondello E, Quattrone D, Cardia L, et al; Cannabinoids and spinal cord stimulation for the treatment of failed back surgery syndrome refractory pain. J Pain Res. 2018;11:1761-1767