Cannabis use for sciatica & chronic low back pain

Low back pain is a common condition affecting many individuals at some point in their lives. [1] The estimation is that between 5.0% and 10.0% of cases will develop chronic low back pain (CLBP), which is responsible for high treatment costs, sick leave, and individual suffering. [2]

CLBP increasing prevalence after 40 years of age & differences between male & female in general population

Given the poor outcome of the medicines currently in use for management of CLBP symptoms, and the increasing number of failed surgeries, CLBP is still today an highly disabling issue. [3] Not to mention the long list of side effects associated with traditional therapy (gabapentin, NSDAI, opioids and tricyclic antidepressant mainly); We have been comparing the effects & outcomes of the use of opioids and cannabinoids for the treatment of inflammatory pain in another article: “Cannabinoids and chronic pain. What your drugstore does not want you to know” .

Phytocannabinoids have been extensively used throughout history for various therapeutic purposes, particularly analgesic. It is well established that activation of the Endocannabinoid system reduces pain sensationat central and peripheral levels. [4] To deepen your understanding of this topic, you can read our review “Endocannabinoids are the body’s analgesic” here.

Anecdotal evidence indicates the possible efficacy of cannabis use as an adjunctive treatment in chronic low back pain. A recent study carried out by the Department of Orthopedics in the Hasharon Hospital, Israel, assessed the outcome of treating with medical cannabis patients suffering from chronic low back pain, reporting very encouraging results.

Crossover study 
Who was admitted in the study?

Patients recruited for the study were:

• Age over 25
• Evidence on CT or MRI scan of disc herniation or spinal stenosis
• Failure of at least 2 narcotic drugs
• Consent to use medicinal cannabis

Among these patients, were excluded those showing evidences of bone cancer, diabetic neuropathy or prior psychotic reactions.

Methods

• The total number of CLBP patients enrolled was 39.
• They were evaluated at baseline (month 0), at mid of the study (month 3) and at the end of it, at month 6.
• The scales, having to test pain, which is mainly subjective, were patients reported questionnaire such as Brief Pain Inventory, Visual Analogue Scale & SF-12 (quality of life scores).

Brief Pain Inventory

• Cannabis usage was fixed to 20 grams/month, with possibility for dose increase only following the first 4 months of treatment.
• The recommended method was via inhalation (vaporizing / smoking).
• Daily use was suggested as 16 mg dose, 4 times daily.
• Cannabis was not used to replace current treatment, but added to the ongoing treatment.

Outcomes of the study

There was an high reduction in the Visual Analogue Scale (VAS) for pain, which decreased substantially from 85 points at the beginning of the study to 32 after 6 months.

VAS for pain: higher score corresponds to more pain

The overall physical health was rated as twice better (SF12-PCS improved from 21 points to 52), and, with that, mental health & emotional happiness were estimated to having increased (SF12-MCS) from 23 points to 53.

Conclusions drawn from the investigators show that short term usage of smoked medical cannabis improve physical & mental function, while decreasing pain levels of chronic low back pain sufferers. [5]

These results were matched by a net increase in employment, which is generally low with current prescription of opioids, given that most of CLBP sufferers have to stay at home from work.

The major drawback evaluated is that, in Isreael, for patients to be allowed of benefiting of cannabinoid therapy, they are required at least 1 year follow up with a neurologist, which is an economically expensive & painfully frustrating situation, thus reducing only to an elite of people those who can improve the quality of their lives with cannabis.

Says Dr. Robinson, the main study investigator, during the International Cannabinoid Research Society ICRS 2016. Israel begun issuing medical cannabis in 2007, after specialists inquired the Ministry of Health of providing registrations for patients.

Today there are 23,000 patients using cannabis is Israel, the majority of which treated for cancer (56.6%) & secondly, pain(26.9%). A recent epidemiological study reported that 71.7% of cannabis patients described significant improvements of their condition after only 1 month of cannabis therapy, to reach 92% overall improvements after 2 months. [6]

According to these data, the hope is that cannabis may be used as first line treatment, without the detrimental side effects of keeping in pain patients for more than 12 months, having to fail expensive & invasive surgeries and opioid treatment.

References:

[1] Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999;354(9178):581-5[2] Melloh M, Röder C, Elfering A, Theis JC, Müller U, Staub LP, et al. Differences across health care systems in outcome and cost-utility of surgical and conservative treatment of chronic low back pain: a study protocol. BMC Musculoskelet Disord. 2008;9:81.[3] Selph, S Carson, S Fu, R et al. (2011). Drug Class Review Neuropathic Pain.Available: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0016164/pdf/TOC.pdf. Last accessed 4/3/15[4] Pertwee RG: Cannabinoid receptors and pain. Prog Neurobiol 2001, 63:569-611[5] Dror Robinson. Effect of cannabis use on severity of chronic low back pain and sciatica. ICRS2016[6] Bar-Lev Schleider, L Mechoulam, R Sikorin, I et al. Epidemiological characteristics of patients treated with medical cannabis. ICRS2016

Source: Nature Going Smart 
Author: Viola Brugnatelli