CBD for Back Pain

Introduction

Cannabis sativa, or more commonly known simply as cannabis, has been used for medical treatment for a long time now owing to some of its natural healing properties it grants to the body. Cannabis has several chemicals that exist naturally in it, the chemicals which have a potent effect on the natural healing system of the nervous structure of our body. Among these chemicals, tetrahydrocannabinol (THC) is the substance that gets you the characteristic ‘high’ when marijuana is consumed. However, cannabidiol (CBD) is a chemical that helps our body get rid of stress and anxiety along with some other medical benefits without giving the ‘high’ effect of marijuana. CBD is not psychoactive, which means that it does not get a person high but grants an equal amount of cure against anxiety and nervousness. Contrary to the conventional use of the cannabis plant to make marijuana for smoking, some of the natural chemicals found in this plant such as cannabidiol (CBD) have been investigated to use them for medical purposes. As a result, the usefulness of using cannabis plant extracts to treat ailments related to the brain have particularly been so much highlighted in the past decade or so. Having found the sweet spot between the characteristic ‘high’ of the marijuana due to THC and the positive brain effects of marijuana due to the existence of cannabidiol (CBD), the therapeutic uses of marijuana are certainly increasing day by day.

CBD as a Treatment

CBD is emerging largely as a full body treatment nowadays. The effects of CBD are not only limited to treating localized pain and anxiety, but it also has found a vast range of uses in other medically related conditions such as inflammation, cancer and nervous conditions such as Alzheimer’s disease, Parkinsonism and multiple sclerosis. Owing to the neuroprotective and anti-psychotic effects of cannabidiol, this compound has found itself being used for many pharmaceutical purposes. The main advantage of using CBD is that it is not psychoactive as is the case of THC. THC leads to a deranged state of mind for the user, where the user experiences euphoric thoughts without having the control over his or her thoughts. The difference between CBD and THC lies in the site of action of both chemicals in the central nervous system. CBD has a largely opposite effect as compared to that of THC in the areas of brain such as the striatum, hippocampus, and prefrontal cortex. This fact has been established after years of research that CBD is finally safe for medical use, as is the case for ‘medical marijuana’’. Many studies conducted by laboratories around the world, along with controlled clinical trials, have confirmed that CBD can be adopted as a well-tolerated, safe, and effective drug for antipsychotic purposes. The THC has an impairing effect on the body, while all the effects of CBD are non-impairing. But, CBD in cannabis has some effects on the body where it serves to release overall stress on the body. These effects are different from the euphoric or ‘high’ sensations induced in our bodies due to THC, and serve to alleviate the stress and anxiety. This makes CBD as the best alternate to marijuana to seek an escape from pain and anxiety.  23 states and the District of Columbia have legalized marijuana to be used for a variety of medical conditions. 15 other states have also formed laws that are intended to allow access to CBD oil and strains of marijuana containing high CBD to THC ratio.

Back Pain and its Causes

Back pain is one of the most common pain disorders people have to endure in their lives. Almost everyone of us has endured it in some form, and almost 8 out of 10 people in the whole world have to suffer from this pain in their old age. The extent of back pain may go through the whole length of our spine, or may be a localized one due to some disorder. The pain sensation is usually radiating, shooting acute pain that often radiates to the back of the leg and into the neck in some cases. The pain may be so severe that it can cause complete immobilization sometimes in the victim.

The causes of back pain in people are very diverse. Most commonly, back pain is caused due to degenerative causes such as arthritis or osteoporosis in people. However, there might be some other underlying causes such as having lumbar, thoracic or cervical disc herniation, or may be due to muscle or ligament strain that hold the vertebrae together. However, osteoarthritis is probably the most common cause of back pain in people. Osteoarthritis results due to inflammation and degeneration of the tissue supporting the ligaments and tendons in our body. This degeneration may be due to various causes, including aging, malnourishment or excessive strain on the ligaments which support the muscles on the back.   

On the better side, fortunately, the back pain in people is very easily curable. The back pain can be treated by having proper bed rest and giving time to the body to heal the disorder causing the pain. If simple home remedies and rest does not cure the pain, it can be cured by having certain over the counter medications that reduce inflammation and increase the body threshold for sensing pain. Surgery is very rarely used to treat the back pain, as this disorder does not require that much invasive procedures for its treatment. 

Although back pain usually affects the people who are elderly, almost anyone can develop back pain in any age. The risk factors include malnutrition, which hampers the nourishment and strength-gaining ability of the connective tissue supporting the back. Other factors include excessive strain on the back muscles causing fatigue, which commonly goes away on its own without leaving any permanent damage. Lifestyle habits such as smoking, postural adjustments and improper lifting may also increase the risk of back pain. Smokers are at a greater risk due to their increased coughing frequency. The increased strain on the discs due to coughing increases the risk of disc herniation, which causes back pain later on. 

Role of CBD in Back Pain

Due to some healing properties, CBD has a great potential for acting like a pain reliever. CBD can be used to treat back pain due to these causes.

Back Pain Due to Inflammation

There are different types of back pain, one of them is mechanical back pain that is due to some type of back disorder such as disc herniation or ligament tear or strain. The other type is inflammatory back pain, which occurs due to severe inflammation in various areas of spine. Inflammatory back pain is very strongly linked with several inflammatory conditions that may have both effects, the axial body pain limited to central back or to the peripheral areas. Inflammatory back pain is pretty common. A study discovered that there is inflammatory back pain in approximately 5 to 6% in the United States in adults ranging from ages anywhere between 20 years and 69 years. This is not only restricted to the United States, but there are a large number of cases of back pain reported in other developed countries. For example, a study conducted in the United Kingdom noted that the incidence of back pain cases in their whole population is anywhere between 3 percent to 7 percent, depending upon the criterion of classifying the back pain. Another study conducted in Mexico found that approximately 3 percent of their population ranging in all age groups is affected by back pain. Studies show that back pain is more dependent on the racial status, that is, Inflammatory back pain is more common in non-Hispanic white people than others.  However, not enough research has been done to show the dependence of back pain on varying age groups.

Consequences of Unchecked Back Pain

Back pain due to inflammation is not benign. Majority of cases of back pain are reported to aggravate further, sometimes even resulting in deformations. We know that inflammation depends upon an immune response, where the cells of the immune system mediating inflammation attack necrotic tissue and other body parts. This process that takes place through the immune response of the body, thereby associated with inflammatory back pain, may also aggravate to an extent where it can affect the process of bone remodeling in the back region. If unchecked, the inflammatory back pain may lead to unbalanced bone remodeling, resulting in fusion of joints and ultimately, complete seizure of movement in the region. 

Another major consequence of unchecked back pain is ankylosing spondylosis. It is an inflammatory disease. In this disorder, various inflammatory phenomena lead to ultimate fusion of the small bones in the spine, which serve the purpose of supporting the spine in the case of movement. After their fusion, the patient is unable to carry out any movement in the lower back region, which is very drastic to the lifestyle of the patient. Moreover, in severe cases, the disorder may also affect the ribs, and cause interference in vital functions such as breathing. The patients suffering from ankylosing spondylitis are at a greater risk of experiencing critical spine problems such as disc herniation, vertebral fracture and joint fusion as compared the general population without the AS. The most common manifestation of AS can be seen in the cervical region, near the atlas and axis vertebrae. The incidence of spinal cord injury increases drastically in the case of inflammatory back pain, with the incidence of aggravation being 11 times more common than the general public. The patients with long-standing disease are at increased risk of cauda equine syndrome.  Inflammatory back pain may also lead to another impairing disease known as osteoporosis. In case of inflammatory back pain, this disorder can be diagnosed within the first 10 years after the inflammatory back pain affects the person. The most common manifestation of osteoporosis in the back region is seen in the form of spinal compression fracture. The pain due to this disorder is exponential, and may change with the changes in posture, as in walking or sitting.

NSAIDs in Back Pain

Non-steroidal anti-inflammatory drugs, or better known as NSAIDS, is the treatment of choice for the inflammatory nature of the back pain. Due to the mechanism of inhibiting certain prostaglandin synthesis in the victims, this treatment has shown significant improvement in inflammatory back pain patients. These NSAIDS not only serve to reduce inflammation, but also serves to reduce the severe stiffness in the chest and back region due to the disorder. 

However, the nature of NSAIDS carries some cons due to its mechanism of action. Chronic use of non-steroidal anti-inflammatory drugs for patients with inflammatory back pain carry associations with a variety of possible complications. The anti inflammatory drugs such as NSAIDs are shown to have strong links to gastrointestinal disorders such as peptic ulcer disease, along with an increased risk of cardiovascular diseases in the susceptible groups of population and links with organ diseases such as airway obstruction and the renal failure in some persons.

CBD as a Potent Drug

However, due to certain advancements in research investigating the medical properties of marijuana, CBD has emerged as a potent drug for reducing the symptoms due to various inflammatory diseases such as arthritis and inflammatory back pain. Moreover, there is strong evidence in the favour of the fact that CBD changes the way in which the person perceives various types of pain. These properties of CBD has put it in competition with other treatments of choice for inflammatory diseases such as NSAIDS.

There is significant evidence due to recent researches conducted to investigate the role of CBD in its inflammation reducing properties. It is an established fact that inflammation is caused due to a certain immune response by our bodies. CBD can avert inflammation by tuning certain aspects of the nervous system that control the immune responses in our bodies. 

CBD as Immunosuppressant

The major mechanism of immunosuppression due to cannabinoids such as cannabidiol is cell death or apoptosis in immune cell populations which have a major role in mediating inflammation in various tissues. In non-inflammatory conditions, apoptosis, or better known as programmed cell death occurring through a controlled sequence of events, is required in order to maintain a balanced number of immune cells that mediate inflammation and it involves morphological changes as well as molecular changes  Cannabidiol is the non-psychoactive agent in cannabis, and is the second most abundant agent in cannabis after tetrahydrocannabinol (THC). Cannabidiol (CBD) was found to induce apoptosis in immune cell populations such as CD4+ and CD8+ T cells at medium concentrations through the production of radicals and increasing reactive oxygen species production. There was another mechanism through which CBD affected the cascade systems as well as caspase 3 and 8 activity. Another possible mechanism of averting inflammation through immune cell control by CBD during inflammation is the decrease of cytokine production by immune cells and disruption of the well-regulated immune response. Cytokines are important mediators of inflammation in our bodies, and serve to point out the site of inflammation in the body where it could happen. Furthermore, cannabinoids may change the nature of immune responses and how they are trigerred in our bodies.

Pain Relieving Properties

Of all the stimuli, pain is one of the most primitive senses ever known to organisms dwelling on the Earth. It is often defined as the warning system of our body to potentially disastrous, intense, and damaging stimuli. Pain has a separate nervous tract that goes all the way up to the brain. In the brain, there are specific areas to pinpoint the location of the localized pain one might be having. The area of the brain stimulated by the nervous signal depends on the area of the body where the pain stimulus is being produced.

Due to the specialized nature of pain in the brain areas, it is possible to use specific analgesics to increase the threshold of pain, thereby decreasing the pain itself.  No doubt, pain is the only way through which one comes to know that something is not right in his or her body and requires attention, but the issue of chronic pain in diseases such as liver inflammation, arthritis, nerve damage, etc. can result in a very unpleasant experience for the victim. Chronic pain not only degrades the overall lifestyle of the victim, but is also very exhaustive for the caregivers.  The chronic pain conditions interfere even with the sleep cycle and mess with the body mechanisms as a whole.  Effective therapeutic and pharmaceutical options for patients living with chronic pain due to malignant conditions are very limited. One might resort to traditional analgesics to relieve chronic pain, but the results yielded are not always satisfactory. In some cases, the pain is relieved but generally appears again due to unknown causes. 

The most effective analgesics that are currently being used to treat chronic back pain in the patients include opioids and steroids. Non-steroidal anti-inflammatory drugs (NSAIDS) are used to treat the back pain which occurs due to inflammatory causes. For the back pain that occurs due to causes other than inflammation, such as mechanical pain, one needs an effective analgesic that not only relieves the pain, but also prevents it from coming back. In this case, cannabidiol (CBD) is a potential candidate to be used as a drug for relieving chronic pain.

Several research papers have been published after investigating the role of CBD in reliveing chronic pain symptoms in people. In this regard, a practical study was conducted in 2018 to examine whether there is any effect of CBD when it is used for treating chronic pain due to various causes. This review consisted of 47 studies, in which many different groups of people were studied who were using cannabidiol as an analgesic for chronic pains such as arthritis, mechanical injury pains, phantom limbs and back aches. This study excluded the pain due to various types of cancers. These studies examined various types of pain, including pain due to multiple sclerosis, fibromyalgia, rheumatoid arthritis, and visceral pain. The studies involved administering cannabidiol to people as an analgesic and also involved people who were administered placebos. The results were largely suggestive of the pain-relieving role of cannabidiol. It was noted that cannabinoids such as cannabidiol reduced the pain by 29.0 percent, as compared to 25.9 percent for the placebo. Moreover, because cannabidiol has no psychotic effects, there was no change observed in the psychological, emotional, or physical functioning of the subjects. As a result of a reduced sense of pain, the subjects also experienced improved quality of sleep as compared to the sleep they were having before taking cannabinoids. According to another research published in PubMed, 29 patients with symptomatic peripheral neuropathy were studied for the effects of CBD oil on their chronic pain. 14 people were randomized into the placebo group. The efficacy of topically used CBD oil for treating pain was studied for four weeks. All the participants had a mean age of 68 years. The purpose of the study was not only to examine the effectiveness of CBD in peripheral nueropathies, but also its role in preventing chronic pain symptoms in people. The Neuropathic Pain Scale (NPS) was administered two times a week to assess the average deviation from baseline to the end of the treatment period. After four weeks, it was found that the patients who were using CBD oil experienced a considerable deduction in sharp and excruciating pain due to the peripheral neuropathy as compared to the placebo group. This suggests that the CBD may be used to treat other chronic pains such as backaches, migraines and other kinds of chronic pain that affects people. No adverse events of physical, psychological, or emotional nature were reported in the subjects. This is in contrast to the use of NSAIDS for the eradication of chronic pain, which carry a number of side effects with them such as liver damage due to prolonged use, increased risk of cardiovascular problems and gastrointestinal disorders such as peptic ulcers.

CBD oil was provided a promising alternative with minimum side effects when compared to other therapies in the treatment regimen. The efficacy of cannabidiol (CBD) oil in the management of neuropathic pain was thereby proved from this study, and CBD was established as an efficient analgesic for those suffering from chronic pain due to malignancies such as cancer and neuropathies.

The National Center for Complementary and Integrative Health (NCCIH) based in the United States is funding new research into cannabinoids to examine their potential in pain management for chronic malignancies such as the chronic back pain. The trend of using cannabidiol for the symptomatic treatment of mechanical injuries is also rising gradually. This is because the symptomatic treatment of such injuries usually involves getting rid of sharp and excruciating pain that prevails for a prolonged period of time. According to this, about three million dollars’ worth of research will be conducted to produce nine papers that comprehensively explore the potential of using CBD oils as an analgesic.  

Anxiety Relieving and Sleep Enhancing Properties to Relieve Pain

Stress manifests itself in the human body in different forms, one of that forms is anxiety. Anxiety can be considered as the natural response of the body towards stress. Anxiety can be characterized as extensively fearful and nervous responses to otherwise trivial things. Triggers of anxiety may include traumas, or other major psychological events in one’s life. Anxiety vastly degrades the lifestyle of the patient by inducing insomnia in the victim. The resulting insomnia can further lead to aggravated diseases such as dementia, Parkinsonism, Alzheimer’s disease or other neurodegenerative disorders that emerge due to lack of sufficient rest.

Another important trigger of anxiety includes chronic pain of any kind, that manifests anxious and nervous feelings in the victim. Getting rid of this anxiety is necessary, or it gives birth to insomnia that further aggravates to various nervous diseases in the victim. 

Humans have been using Cannabis to get rid of anxiety since centuries. Recently, the advances in the research field have pointed out the usefulness of CBD to get rid of anxiety and nervous symptoms in patients of insomnia and chronic pain. CBD is not psychoactive, which means that it can serve the purpose of getting rid of anxiety without the ‘high’ effects one gets by smoking marijuana. The main culprit behind that ‘high’ is tetrahydrocannabinol. CBD differs from THC in the way that it can grant equally good anxiety relieving effects, without impairing thoughts which is true in the case of THC by smoking raw marijuana.

The anxiety relieving properties of CBD have been studied extensively through research. Particularly, the results of using CBD to relieve anxious symptoms and nervousness due to impairing diseases are fascinating. In this regard, research was conducted in 2011, a study examined the effect of CBD given to patients with a control group which was given a placebo. The administration involved giving 400 milligrams (mg) of CBD or placebo to the subjects. Placebo was given to maintain a control group, the differences of which could then be compared to the subjects who were given CBD in the clinical trials. 

The results of the study were largely in favor of CBD treating anxiety. The subjects who were given CBD reported a considerable decrease in their anxiety levels. This study reports that administering CBD to patients reduces anxiety in SAD, particularly due to the effects of CBD on activity in limbic and paralimbic brain areas and related circuits involving the amygdala that control mood and emotions.

Studies also show that CBD appears to be promising in treating Post Traumatic Stress Disorder (PTSD). Post-traumatic stress disorder usually affects a person after an intensely traumatic event, be it physical or sexual abuse, an accident, or other natural causes. The major issue in post-traumatic stress disorder often includes intense, sharp pain that is often long term. The cause of this pain is often a mechanical injury, that affects the spine of the victim. 

Studies indicate that this disorder affects about 10 percent of the people at some point in their lives. Chronic pain due to PTSD  messes with the natural reflexes of the body, particularly with the natural response of the body towards an emergency also known as the ‘fight or flight’ response. This is because almost all the neuronal circuits of the body are preoccupied by the stimulus of the pain. The victims suffering from PTSD report heightened fear levels even when they are in suitable environments. Since the studies have reported the effect of the endocannabinoid system in emotions and memory processing related to those emotions, it is hypothesized that CBD can help with the elimination of traumatic memories and block their reconsolidation later at some point in life. CBD acts on 65 molecular targets involved in the reconsolidation of those memories, and thus helps the elimination of those traumatic memories. This ultimately helps the victims to attain a calm feeling, which helps treat PTSD. Among the brain areas that are affected by the effects of administered CBD, the amygdala is also particularly important, as it serves to be hyperactive in patients with PTSD. The hyperactivity of the amygdala and its role in controlling the mood and emotions of the patient is related to the severity of the symptoms in patients with PTSD. As CBD acts to decrease the activity of this brain part due to its therapeutic effects, it may be established that CBD is helpful against the symptoms caused by PTSD. Resultantly, it can also provide a calm state of mind to the patients suffering from PTSD which helps to improve the quality of sleep of those patients, thereby proving to help treat their insomnia. 

The potential of cannabidiol in treating insomnia due to various disorders is scientifically proven and is thus resulting in increased public awareness about its benefits. CBD is generally considered safe. However, it may have side effects such as diarrhea, fatigue, and changes in appetite in some people. CBD can also interact with some medications, so it is recommended to consult a doctor before using CBD. 

REFERENCES

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  3. Rahul Khare, MD. “Understanding CBD (Cannabidiol) For Back Pain”. Spine-Health, 2020, https://www.spine-health.com/treatment/alternative-care/understanding-cbd-cannabidiol-back-pain
  4. https://flic.kr/p/orug3o