Written by Renata Filiaci, MSHW

Last week I pulled my back like I never have before. When I was getting ready for work, I turned slightly while brushing my teeth and felt the most excruciating, electrocuting pain shoot up my lower back and down into my right thigh. I fell to the ground, toothpaste spewing from my mouth as I FaceTimed my boyfriend to run into the bathroom for help. I was on my hands and knees with no sudden movement waiting for the right time to move into my bed. It took me 5-10 minutes before I was able to hobble over to the bed with the strength of my boyfriend and I had to lay in there all day with constant help.

Luckily, I work in the cannabis industry. I have done more cannabis this past week than I have in a very long time. Granted I take CBD pretty much every day, I had to add in THC for the full body anti-inflammatory experience. My cocktail of medicinal cannabis included: CBD balm/Tiger Balm on my back in the morning, CBG/CBD tincture in the morning and afternoon, and 5-10mgs of THC gummy at night to knock me and the pain out. Now it has been exactly a week since throwing my back out and I have to say I am about 80% back to normal; I equate this to my increased use of cannabis.

The potential use of cannabis and cannabinoid products for the treatment of low-back pain is an important area for investigation. As one of the leading reasons to visit a primary care provider, low-back pain results in a significant burden of disease in both the United States’ economic and health care systems. Given the current opioid epidemic, it is important to seek novel analgesics and understand their efficacy for myriad pain conditions, including low-back pain.

Based on current evidence, it is concluded that cannabis has demonstrated to be effective in chronic pain, and has the potential to reduce opioid consumption. Currently, there are very few options for the treatment of chronic pain. Any of the currently approved drugs have a very modest effect (approximately 30% pain reduction) in only a subpopulation of chronic pain patients (approximately 50%) with or without improvements in function. In addition, pain drugs produce multiple side effects that limit clinical use. Chronic pain affects approximately 100 million adults, and costs $560–$635 billion in the United States. Opioids are recommended as an option for the treatment of chronic pain, despite their lack of superiority to nonopioid options and high potential for dependence: 1 day of therapy has a 6% probability of resulting in long-term opioid use (1 yr, indicative of dependence), 8 or more days of therapy has a 13.5% probability, and 31 or more days of therapy has a 29.9% probability of long-term opioid use. In comparison, the probability of dependence on cannabis after 10 years of use is 5.9% (ever users), and the lifetime probability is 8.9% (ever users). Even though in past-year daily or weekly users the risk of dependence is approximately twice as high, 17–18.8%,45 this risk is considerably lower than that of opioids, nicotine (46–50%), or cocaine (50%).

In a Systematic Review, researchers evaluated the efficacy of cannabis as an analgesic for surgical and non-surgical back pain. Overall, the studies were well-performed. No studies demonstrated excessive or outright bias. A total of 110 participants were involved in the four studies. In three out of four studies, there was a statistically significant reduction in pain reported in the cannabinoid group when compared to the control group.

Another study conducted at Rothman Orthopedic Institute in Philadelphia, Dr. Ilyas and his colleagues recruited 186 patients with chronic back pain and 40 patients with chronic arthritis pain. Between February 2018 and July 2019, doctors certified the patients to purchase medical marijuana in the state of Pennsylvania. The patients were allowed to use pot as they chose — some vaped or smoked, while others used edibles.

Doctors then tracked the patients’ opioid painkiller use for six months using a state-run prescription drug monitoring database, and using an opioid measurement called morphine milligram equivalents (MME). Average daily opioid prescriptions for arthritis patients declined during the study period, falling from 18.2 to 9.8 MME. Back pain patients also experience a reduction in their average daily opioid prescriptions, from 15.1 to 11 MME. About 37% of arthritis patients and 38% of back pain patients quit opioid painkillers altogether. Patients in both groups experienced a reduction in their pain symptoms and an improvement in their physical health.

Cannabis has been shown to have a potentially positive-impact in treating back pain and chronic pain. Medical marijuana has become a pivotal tool in pain management, allowing patients to experience relief while moving away from addictive opiates. Medical cannabis can both relieve pain and reduce inflammation, a key component of chronic back pain. Patients who experience back pain and treat it with medical marijuana have reported less pain, less reliance on addictive pain relievers, improvement in mood, decrease in depression, improvements in insomnia and anxiety derived from chronic pain, and overall, a much better quality of life.