CBD Oil For Back Pain Mayo Clinic

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People with arthritis may consider CBD products for pain relief. Learn what science and experts say about CBD’s benefits, risks, different ways the product can be used and how to be a smart shopper. Cannabidiol, or CBD, is a new medical treatment that may be effective for back pain. It has relatively few side effects and does not come with the high associated with marijuana. Clinicians’ Guide to Cannabidiol and Hemp Oils Cannabidiol (CBD) oils are low tetrahydrocannabinol products derived from Cannabis sativa that have become very popular over the past few years.

CBD Oil For Back Pain Mayo Clinic

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CBD for Arthritis Pain: What You Should Know

Learn what the science says about the risks and benefits of CBD use for arthritis and what to shop for.

What is CBD? CBD, short for cannabidiol, is an active compound found in the cannabis plant. CBD is not intoxicating but may cause some drowsiness. The CBD in most products is extracted from hemp, a variety of cannabis that has only traces (up to 0.3%) of THC, the active compound that gets people high.

Does CBD work for arthritis? Animal studies have suggested that CBD has pain-relieving and anti-inflammatory properties, but these effects have not been validated in quality studies in humans. Anecdotally, some people with arthritis who have tried CBD, but not all, report noticeable pain relief, sleep improvement and/or anxiety reduction.

Is CBD safe to use? Research evaluating the safety of CBD is underway. At this point very little is known. So far, no serious safety concerns have been associated with moderate doses. CBD is thought to have the potential to interact with some drugs commonly taken by people with arthritis. Talk to your doctor before trying CBD if you take any of the following: corticosteroids (such as prednisone), tofacitinib (Xeljanz), naproxen (Aleve), celecoxib (Celebrex), tramadol (Ultram), certain antidepressants, including amitriptyline (Elavil), citalopram (Celexa), fluoxetine (Prozac), mirtazapine (Remeron), paroxetine (Paxil), sertraline (Zoloft), and certain medications for fibromyalgia, including gabapentin (Neurontin) and pregabalin (Lyrica).

Are CBD products legal? CBD products derived from hemp are no longer considered Schedule I drugs under the federal Controlled Substances Act, but they still remain in a legal gray zone. There are changes underway on federal and state levels that will ultimately clarify the laws and regulations related to CBD-based products and sales. Despite that, they’re widely available in nearly every state and online. People who want to use CBD should check their state laws.

Taking the First Step

Should I give CBD a try? Without quality clinical studies on CBD and arthritis, doctors have not been able to say who might benefit from CBD, at what dose and in which form, who likely won’t benefit and who should avoid it. Still, there is agreement on several points:

  • CBD is not a substitute for disease-modifying treatment for inflammatory arthritis.
  • Patients who are interested in trying CBD should first talk to the health care provider who treats their arthritis before trying CBD. Together, they can review what has worked or not worked in the past, whether there are other options to try first, how to do a trial run, what to watch for and when to return for a follow-up visit to evaluate the results. Keep a symptom and dose diary to track effects.
  • Quality CBD products can be expensive, especially when used for prolonged periods. To avoid wasting money, be completely sure that the product is truly having a positive effect on symptoms.

What type of product should I consider? CBD-based products can be taken orally, applied to the skin or inhaled. There are pros and cons for each.

By mouth. CBD that is swallowed, whether in capsules, food or liquid, is absorbed through the digestive tract. Absorption is slow and dosing is tricky due to the delayed onset of effect (one to two hours), unknown effects of stomach acids, recent meals and other factors.

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Capsules can work for daily use after a safe, effective capsule dose has been established. Experts discourage taking CBD via edibles, like gummies and cookies, because dosing is unreliable, and they are appealing to children but do not come in childproof containers. Like any medicine, edibles should be secured out of sight and reach of children.

CBD can also be absorbed directly into the bloodstream by holding liquid from a spray or tincture (a liquid dosed by a dropper) under the tongue (sublingual) for 60 to 120 seconds. The taste may not be pleasant. Effects may be felt within 15 to 45 minutes.

On the skin. Topical products, like lotions and balms, are applied to the skin over a painful joint. Whether these products deliver CBD below the skin is unknown. Topical products may also include common over-the-counter ingredients such as menthol, capsaicin or camphor, making it difficult to determine if a positive effect is due to the CBD or another ingredient.

Inhaled. CBD can be inhaled via a vaporizing, or vape, pen. However, inhalation of vapor oils and chemical byproducts carry unknown risks, particularly for people with inflammatory arthritis. For this reason and because the Centers for Disease Control and Prevention is investigating vaping in association with widespread hospitalizations and deaths from severe pulmonary disease, vaping is not recommended.

How much CBD should I use? While there are no established clinical guidelines, the medical experts consulted by the Arthritis Foundation recommend the following for adults:

  • When preparing to take a liquid form, be aware that the CBD extract is mixed with a carrier oil, so there are two measures to know: the amount of the liquid product to take (the dose) and the amount of CBD in each dose.
  • Go low and slow. Start with just a few milligrams of CBD in sublingual form twice a day. If relief is inadequate after one week, increase the dose by that same amount. If needed, go up in small increments over several weeks. If you find relief, continue taking that dose twice daily to maintain a stable level of CBD in the blood.
  • If CBD alone doesn’t work and you are in a state where medical or recreational marijuana is legal, talk to your doctor about taking CBD with a very low-dose THC product. Be aware that THC, even at low levels, may get you high, creating cognitive, motor and balance issues. Try THC-containing products at home or at night first, so you can sleep off any unwanted effects.
  • After several weeks, if you don’t find relief with CBD alone or with a combination of CBD and very low THC, CBD may not be right for you.
  • If you experience any unwanted side effects when using a CBD product, immediately discontinue use and inform your doctor.

What to Look for When Shopping

There is good reason to be a cautious shopper. CBD products are largely unregulated in the U.S. market. Independent testing has shown mislabeling and lack of quality control. The biggest issues are strength of CBD (significantly more or less than the label says), the presence of undeclared THC, and contamination with pesticides, metals and solvents. Here’s what to look for:

  • Find products manufactured in the U.S. with ingredients grown domestically.
  • Choose products made by companies that follow good manufacturing practices established by the FDA for pharmaceuticals or dietary supplements (a voluntary quality standard because CBD products are not federally regulated under either category) or required by the state where they are manufactured.
  • Buy from companies that test each batch and provide a certificate of analysis from an independent lab that uses validated standardized testing methods approved by the American Herbal Pharmacopoeia (AHP), the U.S. Pharmacopeia (USP), or the Association of Official Agricultural Chemists (AOAC).
  • Avoid companies that claim their products have disease benefits.
  • Be aware that marketers and people behind retail counters are not health professionals; they are salespeople. That’s why your doctor is your best source for guidance and monitoring when using an unregulated product.
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Our gratitude to the following experts for their guidance and review:

Kevin Boehnke, PhD, a researcher at the Chronic Pain and Fatigue Research Center at the University of Michigan, focuses on medical cannabis as an analgesic and opioid substitute in chronic pain.

Daniel Clauw, MD, a professor of anesthesiology, rheumatology and psychiatry at the University of Michigan and director of the Chronic Pain and Fatigue Research Center, leads research on arthritis pain and fibromyalgia, and the effects of cannabis, particularly CBD, in pain.

Mary-Ann Fitzcharles, MD, an associate professor of medicine in the Division of Rheumatology at McGill University in Montreal, Quebec, conducts research on pain and rheumatic diseases. She is the lead author of the 2019 Canadian Rheumatology Association (CRA) position statement for medical cannabis.

During Pain Awareness Month in September and all year long, we’ve got you covered with unique pain management tools and resources you won’t find anywhere else.

Understanding CBD (Cannabidiol) for Back Pain

Cannabidiol, commonly referred to as CBD, is a new and relatively understudied treatment for pain, including back pain. Studies suggest it may help relieve inflammation, which is often a factor in chronic back pain. 1

CBD is available in many forms; topical creams and gels have shown promising results for inflammation and neuropathy, which may make them a good option for back and neck pain. 2

CBD requires more research in order to prove and explain its effectiveness as well as to better understand potential side effects (especially long-term) and potential drug interactions.

What Is CBD?

CBD oil is derived from a plant called cannabis sativa. The plant has over 100 chemical compounds, called cannabinoids, that have a range of effects, including anti-inflammatory and analgesic (pain relieving) qualities.

The cannabis sativa plant has two main varieties that are grown for specific purposes:

  • THC content. THC is the compound associated with the “high” feeling of marijuana use.
  • Industrial (non-drug) uses. This form of the plant contains trace amounts of THC (less than .03%) and can be used to make paper, clothing, and some building material. This variation of the cannabis plant is called hemp.

While CBD is present in both varieties, many of the CBD products available to consumers are from the hemp plant. CBD does not come with the high or psychogenic effects of marijuana.

Ways CBD Treats Back Pain

Research indicates that CBD may reduce back pain by:

  • Reducing inflammation 3
  • Combating anxiety, often associated with long-lasting or chronic back pain 4
  • Helping with sleep and improving overall state of relaxation 5

Some studies suggest that CBD can have an effect on how an individual perceives pain, but more robust research is needed. CBD is generally considered a full-body treatment, which means that it does not target back pain specifically—except in the case of topical products—but contributes to an overall feeling of relaxation and pain relief.

Advocates of CBD believe it can be used to treat a range of conditions in addition to back pain, such as anxiety-related disorders. 5

Potential Risks and Side Effects of CBD

Cannabidiol, even in high amounts, is generally safe. Side effects from CBD may include:

  • Drowsiness
  • Dizziness
  • Dry mouth
  • Low blood pressure

More severe side effects, while rare, include:

  • Mental confusion
  • Nausea
  • Vomiting
  • Diarrhea

As with other natural products, there is potential for adverse reactions when taken with other medications, especially those that come with grapefruit warnings, such as certain blood thinners. These warnings indicate that certain medications should not be taken with products containing grapefruit.

CBD use prior to surgery

Before having surgery, all cannabis use, including CBD and marijuana, should be disclosed to the surgeon or anesthesiologist. A recent study suggests that cannabis use may have an effect on medications used to sedate patients. 6

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Clinicians’ Guide to Cannabidiol and Hemp Oils

Cannabidiol (CBD) oils are low tetrahydrocannabinol products derived from Cannabis sativa that have become very popular over the past few years. Patients report relief for a variety of conditions, particularly pain, without the intoxicating adverse effects of medical marijuana. In June 2018, the first CBD-based drug, Epidiolex, was approved by the US Food and Drug Administration for treatment of rare, severe epilepsy, further putting the spotlight on CBD and hemp oils. There is a growing body of preclinical and clinical evidence to support use of CBD oils for many conditions, suggesting its potential role as another option for treating challenging chronic pain or opioid addiction. Care must be taken when directing patients toward CBD products because there is little regulation, and studies have found inaccurate labeling of CBD and tetrahydrocannabinol quantities. This article provides an overview of the scientific work on cannabinoids, CBD, and hemp oil and the distinction between marijuana, hemp, and the different components of CBD and hemp oil products. We summarize the current legal status of CBD and hemp oils in the United States and provide a guide to identifying higher-quality products so that clinicians can advise their patients on the safest and most evidence-based formulations. This review is based on a PubMed search using the terms CBD, cannabidiol, hemp oil, and medical marijuana. Articles were screened for relevance, and those with the most up-to-date information were selected for inclusion.

Abbreviations and Acronyms:

Cannabidiol (CBD) is a nonintoxicating compound extracted from Cannabis sativa plants that has gained popularity for medical uses ranging from epilepsy to pain control and addiction treatment because of its differing mechanism of action from marijuana and its safety profile.

Although important preclinical and pilot human studies have suggested a potential role for CBD in numerous clinical situations, thorough clinical studies have only been performed on intractable epilepsy syndromes for which Epidiolex, a CBD drug, was approved by the US Food and Drug Administration for use.

The legal landscape of CBD remains complex because of differing state and federal laws giving access to medical hemp and marijuana products.

The CBD and hemp oil product market remains a concerning one because of noted variability in CBD and tetrahydrocannabinol levels in products, as well as lack of regulation in production and distribution.

Although CBD and hemp oils remain an unproven therapeutic option, physicians should remain open to the possible future role these products may play in the management of a variety of difficult to treat diseases, in particular pain and addiction treatment in the context of the opioid crisis.

One of the biggest challenges facing health care today is combatting opioid abuse, with medical and nonmedical overuse of opioids exacting a huge toll on society in recent years.

  • Kolodny A.
  • Courtwright D.T.
  • Hwang C.S.
  • et al.

Although there has been a larger focus on reducing opioid prescriptions and preventing nonmedical use of opioids, there is an increasing interest in finding more treatment options for patients in pain,

  • Kroenke K.
  • Cheville A.
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  • Nahin R.L.
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  • Stussman B.J.
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Evidence-based evaluation of complementary health approaches for pain management in the United States.

One promising area has been use of the plant Cannabis sativa, both in medical marijuana as well as hemp and cannabidiol (CBD) oils, with some evidence that access to medical marijuana is correlated with a decrease in opioid use, although there has been controversy about the risks and benefits of encouraging poorly regulated medical use of a known substance of abuse.

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