CBD Oil for Spinal Stenosis - April 2024

Why People Are Turning to CBD for Spinal Stenosis

Doctors prescribe over-the-counter pain relievers, such as ibuprofen, antidepressants (like amitriptyline), anti-seizure drugs, and opioids for spinal stenosis^[5]. However, these medications may have harmful side effects.

Antidepressants may cause dry mouth, difficulty urinating, constipation, blurred vision, and lowered blood pressure. It may also cause palpitations, weight gain, anorexia, dizziness, insomnia, headaches, and nervousness in some people^[6].

Meanwhile, anti-seizure medications may lead to the induction of suicidal thoughts or actions and the worsening of depression. Some of these drugs may also cause severe blood disorders and skin reactions, development of kidney stones, and liver injury^[7].

Opioids, the most potent pain-relieving medications, also come with several side effects, such as dizziness, constipation, drowsiness, and hallucinations. Some people may also experience lowered heart rate, decreased blood pressure, nausea, sexual dysfunction, and itching unrelated to allergies—not to mention, dependence and addiction^[8].

CBD may have properties useful in treating symptoms associated with spinal stenosis.

CBD for Back Pain

Back pain is one of the symptoms associated with spinal stenosis^[9].

A study archived in the Journal of Pain Research examined the effects of CBD and tetrahydrocannabinol (THC) on 11 patients with failed back surgery syndrome (FBSS)^[10].

The FBSS patients reported moderate to severe chronic pain and persistent low back pain.

The participants received spinal cord stimulation (SCS) treatment combined with CBD and THC for 12 months. The researchers observed that the test subjects’ pain perception decreased significantly.

The authors suggested that the cannabinoids CBD and THC might have analgesic effects. These properties might be useful in treating chronic refractory pain (hard-to-control pain) experienced by FBSS patients.

Cannabinoids are substances that help the endocannabinoid system (ECS) maintain natural harmony in the body^[11]. They may come from the body, made in laboratories, or extracted from the Cannabis sativa plant, such as CBD and THC.

Compared with THC, CBD does not have psychoactive effects.

A review in the journal Therapeutics and Clinical Risk Management outlined the analgesic effects of cannabinoids, such as CBD. The researchers discussed the ability of these cannabinoids to manage pain that is difficult to treat^[12].

The authors also noted that these cannabinoids demonstrated other benefits, like antiemetic (vomit-preventing), neuroprotective, antioxidant, and proapoptotic properties.

Proapoptotic substances promote apoptosis, the process of programmed cell death, which eliminates unwanted cells (i.e. cancer) in the body^[13].

CBD for Neuropathic Pain

Several spinal disorders, such as spinal stenosis, spinal cord injury, and radiculopathy (pinched nerve) due to herniated discs, are common causes of neuropathic pain^[14].

Research conducted in 2020 and documented in Current Pharmaceutical Biotechnology investigated the efficacy of CBD oil in managing neuropathic pain in 29 patients with peripheral neuropathy^[15].

The participants who received CBD reported that their severe pain and cold, itchy sensations reduced significantly. They also did not experience adverse effects.

The authors concluded that CBD oil’s transdermal application might help with significant improvement in pain and other disturbing sensations in peripheral neuropathy patients.

In multiple sclerosis, chronic neuropathic pain is a symptom detrimental to patients’ quality of life^[16].

Authors of a study in the journal Frontiers in Neurology reported that CBD might help improve the mobility of people with multiple sclerosis^[17]. 

They also added that CBD had properties that reduced spasticity (muscle tightening), pain, inflammation, depression, and fatigue in people with multiple sclerosis.

CBD for Anxiety and Depression

According to Harvard Medical School, chronic back pain is integrally connected to an individual’s state of mind. Limited movement may result in psychological distress, which can worsen lower back pain^[18].

Emotions, like anxiety, have a significant influence on chronic back pain. Emotional control may also become more difficult^[19].

A 2017 study documented in The Spine Journal found that chronic low back pain increases the risk of developing anxiety and depression symptoms^[20]. 

However, the authors could not determine whether these symptoms cause back pain or the pain-related condition causes anxiety and depression symptoms.

A 2014 review found in CNS and Neurological Disorders Drug Targets reported that CBD had anxiolytic (anxiety-reducing) and antidepressant effects on several animal models^[21]. 

The literature review revealed that these properties might be caused by the interaction between CBD and the 5-HT1A neurotransmitter, a serotonin receptor subtype.

Serotonin is a vital hormone that helps stabilize mood, happiness, and feelings of well-being. Low serotonin levels are associated with several behavioral and emotional disorders, such as depression and anxiety^[22].

A non-systematic literature review in the journal Frontiers in Immunology outlined CBD’s anxiolytic, neuroprotective, and antipsychotic properties^[23]. 

The researchers also concluded that CBD might be promising in treating depression, sleep disorders, post-traumatic stress, epilepsy, and substance abuse.

How CBD Oil Works to Alleviate Symptoms of Spinal Stenosis

CBD’s purported ability to target serotonin receptors may help with the pain and anxiolytic symptoms associated with spinal stenosis.

A 2014 study documented in the British Journal of Pharmacology stated that CBD inhibited chemotherapy medication-induced neuropathic pain^[24]. 

The researchers discovered that the substance produced analgesic and anti-inflammatory properties because of its interaction with the 5-HT1A (serotonin) receptor.

A 2019 study archived in the journal Pain showed that CBD decreased anxiety-like behavior and normalized 5-HT1A activity in a mouse model of neuropathic pain^[25]. 

The rodent test subjects were treated with CBD for one week. The authors also reported that CBD reduced mechanical allodynia. 

Mechanical allodynia is a nerve-related condition characterized by pain from supposedly non-painful stimuli, such as a light touch to the skin^[26].

The Pros and Cons of CBD Oil for Spinal Stenosis

The Pros 

• Previously cited research studies in humans and animals showed that CBD might be promising in alleviating spinal stenosis pain symptoms.
• Compared with conventional medications for spinal stenosis, CBD is well-tolerated and has an excellent safety profile, as found by the World Health Organization (WHO)^[27].
• According to the National Institute on Drug Abuse, CBD seems to be a safe drug with no addictive effects^[28]. 
• In states that allow CBD use, CBD products may be purchased without a prescription.

The Cons

• More clinical trials, animal research, and human studies should be conducted to assess CBD’s effects on spinal column conditions, such as spinal stenosis.
• CBD may still cause side effects, including nausea, fatigue, and irritability^[29]. 
• Spinal stenosis medications, such as antidepressants and antiepileptics, may have drug interactions with CBD that could potentially be adverse^[30]. Thus, CBD should not be combined with these medications. 
• The United States Food and Drug Administration (US FDA) does not support CBD use for medical conditions other than epilepsy^[31].

How CBD Oil Compares to Alternative Treatments for Spinal Stenosis

Individuals with spinal stenosis may explore alternative treatments for their health conditions.

A 2016 case study used massage therapy to relieve chronic low back pain in a patient with spinal stenosis, osteoarthritis, scoliosis, and disc degeneration-related disease^[32]. 

The 61-year-old male exhibited improvement in 9 out of 10 measurements of self-reported pain and activities of daily living. 

Dramatic differences were seen in the test subject’s post-massage therapy, such as improvements in the ability to walk and changes in degrees of pain.

According to the patient, he was able to decrease his pain medication. He was also able to ride his bicycle for the first time in years.

Researchers concluded that massage therapy is a promising treatment accessible and cost-efficient compared with other invasive therapies. They also recommend that this approach should be used as an adjunct therapy to regular medical care.

Another alternative remedy for spinal stenosis is chiropractic treatment^[33].

A literature review in the Journal of Chiropractic Medicine investigated the effects of chiropractic treatment on lumbar spinal stenosis. The researchers concluded that the alternative practice might have beneficial effects on the spine-related condition^[34].

Still, they recognize that the research is very limited and that further clinical investigations should be conducted on chiropractic medicine as an alternative treatment for the different types of spinal stenosis.

Chiropractic treatment involves trained specialists using a small instrument or their hands to apply controlled and sudden forces to the spinal joint. This procedure aims to improve spinal motion and the body’s physical function^[35].

Like massage therapy, CBD may help relieve pain due to its analgesic properties^[36].

Meanwhile, compared to chiropractic treatment, CBD may also help improve the mobility of people with some conditions that affect the central nervous system, like multiple sclerosis^[37].

Surgeries and Future Treatments

Individuals who do not experience pain relief from conventional spinal stenosis treatments, such as physical therapy and pain medications, should consider surgery^[38].

Surgery relieves spinal cord and nerve root pressure by creating more space in the spinal canal.

Still, spinal stenosis surgery may have risks, including infection, bleeding, nerve injury, and stiffness^[39].

The latest treatment being developed for spinal stenosis is the use of stem cells to treat degenerative spinal diseases. This approach is called regenerative medicine^[40].

Stem cells have great potential to develop into various body cell types. They are seen as a repair system for the body^[41].

How to Choose the Right CBD for Spinal Stenosis

A 2020 review of scientific research showed that CBD and THC had analgesic properties useful in managing chronic neuropathic pain^[42].

However, medical marijuana use is not legal in all US states^[43]. 

Full-spectrum CBD products contain legal amounts of THC. This CBD type also uses all the components of the cannabis plant, such as terpenes, flavonoids, essential oils, and fatty acids. 

It is believed that all these ingredients work together to derive the full therapeutic benefits of the Cannabis sativa plant in a process known as the entourage effect. Thus, full-spectrum CBD oils may be beneficial for treating spinal stenosis.

However, individuals should note that some drug tests may still detect the THC composition of full-spectrum products. 

A THC-free CBD type that contains all the other ingredients of the cannabis plant may also be an option. This type is called broad-spectrum CBD. 

Another option is pure, isolated cannabidiol, known as CBD isolates.

Buyers should refer to the following guidelines to ensure that CBD products are of high-quality:

1. Check with the local government if CBD purchase and use are legal in the area.
2. Ensure that the products are high-quality, non-GMO, and organic hemp-derived CBD. 
3. Read online reviews, especially when the CBD manufacturer has no brick-and-mortar store. These comments and feedback offer genuine and often useful insights from real customers. Always ensure that the government has authorized the store to sell CBD products.
4. CBD products have different extraction methods. Learning about the extraction process of a CBD product is essential. According to research, the US FDA in pharmaceutical manufacturing acknowledges that CO2 extraction is safe^[44].
5. Search for reports, such as the certificate of analysis of CBD products. These documents verify the validity of the product’s claims and potency. Credible CBD companies employ third-party, independent laboratories to examine their products.
6. Ensure that the products are legitimate. Researchers reviewed 84 CBD products bought online and found that 26% contained less CBD than labeled, while 43% contained more CBD than what was declared on the product label^[45]. They also discovered that 21% contained THC amounts that were enough to get children high.
7. Consult with a healthcare professional before using any CBD products.

CBD Dosage for Spinal Stenosis

CBD remains to be unregulated. Hence, there is no standard dosage chart for cannabidiol use in treating spinal stenosis nerve pain and other symptoms. 

For CBD dosing, people are recommended to“start low and go slow.” Initial dosage may be small amounts and, if no harmful side effects are observed, the dose may be increased gradually.

Individuals are encouraged to document their reactions to CBD during treatment. Recording their experiences with CBD in a journal may help. 

Always first consult with a doctor before taking any CBD product.

How to Take CBD for Spinal Stenosis

Researchers of a study found that the transdermal application of CBD was optimal for inflammation and pain relief in rodent models of arthritis. They stated that topical CBD application avoided first-pass metabolism and provided more constant plasma levels^[46].

The first pass effect happens when a substance or drug gets metabolized at a specific body location, resulting in the reduced active drug concentration when it reaches the site of action^[47]. 

To relieve neck pain and other spinal stenosis symptoms, topicals, like CBD creams, balms, lotions, and salves, may be applied to the painful body part. 

Some topicals have ingredients, like menthol and peppermint, which may be soothing, especially when massaged to the affected area.

CBD oils and tinctures may also be useful for individuals with spinal stenosis. Oils may be taken directly or mixed with food and beverages.

These oils may also be massaged into the painful areas. Meanwhile, tinctures (drops) may be applied under the tongue for added efficacy. 

Some formats allow CBD to be ingested, such as pills, soft gels, edibles, and gummies. 

These ingestible forms may be useful for individuals with spinal stenosis who need a convenient and consistent dosage of CBD.

CBD is available in a vape pen format. Inhalation of CBD may be useful for those with spinal stenosis who want to see instantaneous effects.

However, it may be hard to determine the exact CBD amounts when the substance is taken through vape. Lung problems are also associated with vaping^[48].

Understanding Spinal Stenosis

Spinal stenosis is characterized by the narrowing of spaces within the spine. This occurrence may add pressure to the nerves that travel through the spine. In most cases, the condition affects the lower back and neck^[49].

Some individuals do not exhibit spinal stenosis symptoms, while others experience pain, numbness, tingling sensations, and muscle weakness. 

This medical condition is commonly caused by the wearing down of the spine, which is related to osteoarthritis.

Spinal stenosis is classified according to where it occurs in the spine. The two primary types are cervical stenosis (neck area) and lumbar stenosis (lower back area)^[50].

Cervical stenosis symptoms include^[51]:

• Tingling sensations or numbness in the hand, arm, foot, or leg
• Weakness in the hand, arm, foot, or leg
• Walking and balancing problems
• Neck pain
• Bowel or bladder dysfunction (in more severe cases)

Meanwhile, lumbar stenosis symptoms include:

• Tingling sensations or numbness in the foot or leg
• Foot or leg weakness
• Pain or cramping on the legs after a person walks or stands for a long time
• Back pain

Lumbar Spinal Stenosis vs. Ruptured Disc

Lumbar spinal stenosis is different from a ruptured disc. A ruptured disc, or an intervertebral disc that has undergone herniation, pinches one or two nerves at a time. The pain caused by a herniated disc at the L4-S2 nerve roots is known as sciatica^[52]. 

Sciatica, which causes back pain that affects the leg, may happen at any time. This occurrence is different from pain experienced during stenosis, which happens when those with the condition stand or start walking.

CBD Legality

During the passage of the 2018 Farm Bill, hemp was removed from the controlled substances act of the US Drug Enforcement Administration^[53]. Hence, federal laws allow the production and marketing of hemp.

The law defines industrial hemp as any part of the Cannabis sativa plant that contains less than 0.30% of THC on a dry weight basis. Therefore, CBD is legal under federal laws.

Meanwhile, THC, which is being promoted by marijuana doctors for medical use, is not legal in all US states^[54].

Under the DEA, marijuana, heroin (an opiate), lysergic acid diethylamide (LSD), ecstasy, peyote, and methaqualone are listed as schedule I drugs or substances^[55].

Schedule I substances are not accepted for medical use. They also have a high potential for abuse.

Conclusion

Currently, there are no studies on CBD’s effects on spinal stenosis. However, research found that CBD might have therapeutic benefits on symptoms related to the medical condition.

Researchers discovered that CBD might help with back pain, neuropathic pain, anxiety, depression, and other spinal stenosis symptoms.

For spinal stenosis, topical or transdermal CBD is recommended. Other formats, such as CBD oils and tinctures, may also be useful. 

Further research on CBD as a potential treatment for spinal stenosis is warranted. 

Before taking CBD for any medical condition, individuals are encouraged to speak to medical professionals first.

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50. Ibid. 
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