Cannabis works against back pain, new studies show: Shots

Should I try cannabis for my back pain?

It’s a question that spine surgeon Richard Price says patients who come to his clinic ask him at least several times a day.

When Price finally looked at the evidence several years ago, he found that there weren’t many high-quality studies, even though chronic pain is one of the most common reasons people turn to medical marijuana.

“Anecdotally, [people] “It’s the only thing that helps them sleep at night, the only thing that gives them relief.”

That’s why the results of two major clinical trials in Europe evaluating cannabis for lower back pain — the leading cause of disability worldwide — have caught the attention of Price and others who are studying the plant’s potential in pain management.

The first, published in the journal Natural medicineshowed that a mixture of cannabis oil containing the psychoactive compound THC, along with CBD and other natural compounds from the plant, outperformed a placebo.

The other compared this same proprietary cannabis tincture to opioids. Here, patients were much less likely to have gastrointestinal side effects like constipation, and cannabis provided better relief over 6 months than their painkillers.

Price believes the new studies are “groundbreaking” and will form the “cornerstone” of the growing evidence base on cannabis and chronic pain.

Because cannabis remains a Schedule 1 drug – a category reserved for substances with no accepted medical use – and is heavily regulated, this type of large-scale clinical trial is difficult to conduct in the United States.

Vertanical, the German company that funded the trials, hopes to obtain approval to market its full-spectrum cannabis oil, called VER-01, to patients in several European countries within months.

Meanwhile, the Food and Drug Administration requires the company to replicate this research in the United States, meaning it could be years before the drug has a chance of being approved here.

“If politicians or the FDA want to speed up the process, we are ready,” says Dr. Clemens Fischer, founder of Vertanical.

The FDA would not comment on the future of VER-01, but a spokesperson told NPR in a statement that it supports “rigorous, scientific research to evaluate these products.”

An alternative to relieve pain

The European trial results are “remarkable,” particularly that cannabis outperformed opioids in terms of pain relief and sleep, said Kevin Boehnke, a cannabis expert. assistant professor of anesthesiology at the University of Michigan who studies cannabis and chronic pain.

The opioid trial had nearly 400 participants – about half the size of the other study comparing cannabis and a placebo – and patients knew which drug they were receiving.

While these are limitations, Boehnke says the study was also more “reflective” of the real world and validates previous research indicating that “many people deliberately use cannabis in place of opioids” because they find it more effective and doesn’t cause the same side effects.

Although Vertanical’s cannabis tincture won’t be available in the United States anytime soon, Boehnke says that for people seeking treatment for lower back pain, the study suggests it might be worth trying a similar cannabis product instead of opioids.

“It may not be exactly the same thing,” he says. “But I think it provides a lot of useful evidence for patients.”

Other players in the field, however, are more circumspect.

This is the kind of rigorous study that is badly needed, says Simon Haroutounian, who has decades of experience in this area and leads the research at the Washington University Pain Center in St. Louis.

But he believes the results are specific to this particular compound that was tested.

In the trial, people in the cannabis group saw, on average, a reduction in pain of around 30% after 12 weeks compared to their baseline level. Meanwhile, those who took the placebo saw a reduction of around 20%.

Haroutounian says it’s likely that the real effect of the treatment is the difference between the two.

Another way to assess effectiveness is that the number of people who need to take the drug for one person to get clinically significant pain relief is about seven.

“Most of the medications we have to treat chronic pain fall into this range,” says Haroutounian. “So it’s not a panacea, it’s not a compound that’s going to treat all chronic pain.”

Proponents of medical cannabis are quick to point out that the drug’s safety profile is a clear advantage. Unlike opioids, it doesn’t raise the same concerns about overdose and addiction.

Vertanical’s Fischer notes that there were no signs of addiction or withdrawal. In fact, he says participants generally didn’t feel well, especially if they had taken the drug for a longer period of time.

“You’re not high,” he said. “They go to work, drive cars, use machines, all this is possible and legal in Europe.”

In the study, however, those who took opioids and cannabis experienced about the same rate of side effects, and about 13% ultimately quit.

Over the years, Haroutounian, a clinical pharmacist, has experienced successes and failures with his own patients.

A patient had suffered a horrific motorcycle injury and eventually stopped taking opioids with the help of cannabis. On the other hand, he recalls the case of an older woman who tried cannabis for knee pain.

“From the first dose, she felt dizzy. She fell and broke her hip,” he says. “She spent the next six months in hospital.”

Pain patients want cannabis options

Currently, there is only one cannabis-derived drug approved by the FDA, the seizure treatment Epidiolex, and it does not contain THC.

Although it’s not entirely clear, experts like Boehnke say THC appears to be one of the “primary” compounds responsible for reducing pain and improving sleep.

“There is no silver bullet for chronic pain, for pretty much anything,” he says. “We often say, ‘oh, I had a little profit here and a little there,’ you’re kind of putting the puzzle together.”

Although most Americans live in a state where marijuana is legal, whether for recreational or medical use, there are well-documented concerns about the quality and consistency of these products.

Ellen Lenox Smith, who works for the US Pain Foundation, says FDA approval of a cannabis product would not only make it available in all states, but also give chronic pain patients confidence in what they are using.

“I wish it was our country publishing this right now,” she says.

As a patient advocate, she is frustrated at not being able to direct others toward better research.

“It’s unfortunate because a lot of people are on their own,” says Lenox Smith, who has used medical marijuana for nearly two decades to treat his own pain.

His condition, known as Ehlers-Danlos syndrome, led to more than two dozen surgeries, including on his neck and spine. However, a spoonful of her homemade cannabis oil gives her relief and helps her sleep through the night.

UC Davis surgeon Richard Price thinks it’s a reasonable option for his non-surgery patients, although he would like to see European findings replicated in the United States, before promoting cannabis more widely.

“It’s really hard to say to someone, ‘I know you’re hurting, but there’s nothing I can do for you, and a lot of patients don’t want to take opioids,'” he says.