CBD for Back Pain - April 2024

How Does CBD Help With Back Pain?

Among the purported benefits of CBD is its anti-inflammatory potential, which may help relieve many types of pain⁽³⁾. CBD may be used for chronic pain or to alleviate inflammation at the injury site⁽⁴⁾.

CBD functions as an anti-inflammatory agent by engaging the cannabinoid receptors of the body’s endocannabinoid system (ECS)⁽⁵⁾.

The ECS regulates many essential body functions, such as learning, eating, pain control, and immune and inflammatory responses⁽⁶⁾. Within the ECS are various cannabinoid receptors, the most predominant of which are the CB1 and CB2 receptors.

CB1 receptors are present in the gastrointestinal tract, bones, liver, pancreas, and central nervous system⁽⁷⁾.

CB2 receptors reside within the peripheral nervous and immune systems⁽⁸⁾.

Studies suggested that CBD’s interaction with these receptors produces anti-inflammatory and pain-relieving benefits that may help with pain management⁽⁹⁾.

In a 2020 study on CBD’s effects on acute and chronic back pain, researchers suggested that hemp-based CBD transdermal creams may provide pain relief⁽¹⁰⁾.

Using CBD Oil for Back Pain

When choosing the best CBD oil to help manage back pain, individuals must consider several essential factors before purchasing the product. These details include the extraction methods, product category, lab results, and other personal preferences.

Before distributing CBD oil (sometimes called hemp oil) to the market, manufacturers extract CBD from the Cannabis sativa plant using carbon dioxide (CO2), ethanol, or hydrocarbon extraction methods.

In the CO2 method, highly pressurized and liquefied carbon dioxide is used to extract plant compounds. Many manufacturers prefer this technique since they consider it the safest way to extract CBD⁽¹¹⁾.

Ethanol extraction utilizes ethanol as a solvent to produce hemp extract. For centuries, this method has been used to create medicinal compounds from cannabis plants⁽¹²⁾.

In hydrocarbon extraction, manufacturers utilize hydrocarbon-based solvents like propane or butane to extract CBD.

Hydrocarbons are known to be flammable and neurotoxic. However, hydrocarbon extraction is considered safe as long as proper safety procedures are followed.

After extraction, CBD is processed and categorized as full-spectrum, broad-spectrum, or isolate products.

Full-spectrum CBD oil (also called full-spectrum hemp oil) products typically contain all essential cannabinoids and compounds from the hemp plant, including tetrahydrocannabinol (THC), terpenes, and flavonoids.

Terpenes provide plants with a characteristic scent, while flavonoids give plants a distinct color.

Combining these compounds in full-spectrum CBD oil produces an “entourage effect.” This phenomenon occurs when active cannabis compounds work synergistically to enhance their total benefits⁽¹³⁾.

CBD oil products that have almost all the components of full-spectrum CBD oil except THC are called broad-spectrum CBD products.

Meanwhile, CBD isolates contain pure CBD only. They do not have THC or any other cannabinoids and compounds.

Individuals who prefer CBD products without THC or its psychoactive effects may consider broad-spectrum CBD oil or isolates viable options.

For added credibility, CBD brands usually provide a certificate of analysis (COA) for their CBD products. COAs, produced by third-party labs, contain detailed information about a CBD product’s actual content.

Third-party lab results also reveal whether the CBD product contains heavy metals, pesticides, or solvents that may cause health risks to consumers.

Customers should consider purchasing high-quality CBD products with updated COAs posted on the CBD brand’s website. The availability of COAs allows buyers to compare the lab results to the product’s label to ensure consistency.

Some consumers may purchase CBD products based on personal preference. They may choose products that are non-GMO, gluten-free, added with natural ingredients, or extracted from organic hemp.

After selecting a CBD brand or product type, consumers considering taking CBD oil for managing back pain may consider the following delivery routes:

• Topical application: For pain, topical CBD products, like CBD creams, lotions, ointments, and balms, may be applied to the skin. 

CBD topicals do not enter the bloodstream.

• Oral administration: CBD passes through the gastrointestinal tract and is metabolized in the liver before being absorbed into the bloodstream.

Some orally administered products include CBD capsules or softgels and edibles, such as gummies, candies, and chews.

• Sublingual administration: CBD oil is applied under the tongue, allowing CBD to bypass the gastrointestinal tract and enter the bloodstream directly.

The compound is administered sublingually using tinctures, which are applied using droppers or oromucosal sprays.

CBD oil tinctures are typically combined with a carrier oil, such as MCT oil, to dilute the CBD concentrate.

• Transdermals: CBD is applied to the skin and absorbed into the bloodstream. Widely used transdermal products include patches and gels.
• Inhalation: Individuals may administer CBD through inhalation. This route is considered one of the fastest ways to take CBD⁽¹⁴⁾.

Individuals are cautioned that vaping can cause health risks related to lung disease⁽¹⁵⁾.

Individuals with adverse health conditions must consult a health care professional or clinician for diagnosis and treatment options before vaping or smoking CBD.

CBD Oil vs. CBD Topicals for Back Pain

CBD oil taken through oral administration goes through the stomach first. Afterward, CBD is metabolized in the liver before entering the bloodstream⁽¹⁶⁾.

The onset time for orally administered CBD oil is around 30 to 90 minutes, depending on the person’s metabolism. Effects of oral CBD products typically last for about six to eight hours⁽¹⁷⁾.

On the other hand, CBD topicals are applied directly to the skin to provide localized pain relief⁽¹⁸⁾.

CBD administered topically does not get absorbed into the bloodstream. Instead, CBD binds to the CB2 receptors in the skin to relieve pain in a specific area⁽¹⁹⁾.

These benefits of CBD topicals suggest that these products may be recommended to help alleviate back pain. For instance, CBD oil may be used during massages to help with back pain.

 Still, consulting a doctor for medical advice and proper diagnosis is the best course of action.

How Much CBD to Take for Back Pain

To date, there is no standard CBD dosage recommended for back pain.

However, the general dosing suggestion is to start low and go slow. This dosing strategy means that consumers new to CBD should consider taking a low initial dose when starting a CBD regimen⁽²⁰⁾.

For example, individuals taking a CBD-dominant product may start with 10 milligrams (mg) of CBD per day. If the product has trace amounts of THC, consumers may start with a THC dose of 2.5mg⁽²¹⁾.

Potential Side Effects and Risks of CBD for Back Pain

Currently, no conclusive studies have been conducted regarding CBD’s side effects when used for back pain.

General side effects of CBD include fatigue, appetite loss, dry mouth, diarrhea, and drowsiness. Humans usually have an acceptable tolerance to these side effects⁽²²⁾.

In a 2020 study, researchers noted that some individuals who took CBD oil prescriptions experienced vivid dreams and sedation⁽²³⁾.

Another study mentioned that CBD’s side effects include tiredness and changes to their appetite or body weight⁽²⁴⁾.

CBD Legality

To date, the only CBD product endorsed by the Food and Drug Administration (FDA) is Epidiolex, a prescription medication for treating epilepsy⁽²⁵⁾.

The 2018 Farm Bill legalized industrial hemp cultivation in the United States. Additionally, the law removed hemp-based CBD products with less than 0.3% THC from the controlled substances list of the Drug Enforcement Administration (DEA).

CBD products containing more than 0.3% THC are prohibited under federal law⁽²⁶⁾.

All U.S. states have laws regarding CBD oil and medical marijuana use. However, restriction levels may vary among states⁽²⁷⁾.

States with legalized medical cannabis programs include Arizona, California, Colorado, New York, and Washington⁽²⁸⁾.

Individuals contemplating using CBD must review their state’s laws to know whether CBD use is legal in their area.

The FDA warns marketers that labeling CBD products as dietary supplements or selling CBD as food additives is illegal⁽²⁹⁾.

Different Types of Back Pain

Some of the common types of back pain include:

• Thoracic or upper back pain: Occurs in the area around the thoracic spine where the ribs connect.
• Middle back pain: Occurs above the spine’s lumbar region and below the rib cage.
• Lumbar or lower back pain: Occurs in the area around the lower part of the spine. Low back pain typically results from muscle strain, disk injuries, structural problems, or arthritis

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1. CBD oil: What is it and how does it work?
   https://www.eehealth.org/blog/2019/09/cbd-oil/
2. Cannabidiol (CBD) as a treatment of acute and chronic back pain: A case series and literature review
   https://pubmed.ncbi.nlm.nih.gov/32421842/
3. Page 167 of Healing With CBD
   https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
4. Ibid.
5. Page 103-104 of Healing With CBD
   https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
6. The endocannabinoid system: Essential and mysterious
   https://www.health.harvard.edu/blog/the-endocannabinoid-system-essential-and-mysterious-202108112569
7. Page 66 of Healing With CBD
   https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
8. Page 45 of Healing With CBD
   https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
9. CBD oil: What is it and how does it work?
   https://www.eehealth.org/blog/2019/09/cbd-oil/
10. Cannabidiol (CBD) as a treatment of acute and chronic back pain: A case series and literature review
    https://pubmed.ncbi.nlm.nih.gov/32421842/
11. CBD oil: An introduction
    https://www.projectcbd.org/wellness/cbd-oil-introduction
12. Ibid.
13. Page 91 of Healing With CBD
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
14. Best way to take CBD
    https://www.projectcbd.org/guidance/best-way-take-cbd
15. Can vaping damage your lungs? What we do (and don’t) know
    https://www.health.harvard.edu/blog/can-vaping-damage-your-lungs-what-we-do-and-dont-know-2019090417734
16. Page 202 of Healing With CBD
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
17. Ibid.
18. Page 210 of Healing With CBD
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
19. Ibid.
20. CBD Dosing
    https://www.projectcbd.org/guidance/cbd-dosing
21. Page 218 of Healing With CBD
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
22. What are the benefits of CBD — and is it safe to use?
    https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/is-cbd-safe-and-effective/faq-20446700
23. Cannabidiol prescription in clinical practice: an audit on the first 400 patients in New Zealand
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330185/
24. Dosage, Efficacy and Safety of Cannabidiol Administration in Adults: A Systematic Review of Human Trials
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7092763/
25. What are the benefits of CBD — and is it safe to use?
    https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/is-cbd-safe-and-effective/faq-20446700
26. CBD & THC: Myths and misconceptions
    https://www.projectcbd.org/cbd-101/cbd-misconceptions
27. Cannabidiol (CBD)-what we know and what we don’t
    https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476
28. Page 24-25 of Healing With CBD
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
29. What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD
    https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis.
    

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