The Endocannabinoid System
To understand how cannabis might help with chronic back or neck pain, you first need to understand how cannabis interacts with the human body.
Cannabis affects humans when it’s active chemicals, called cannabinoids, are processed by the body’s endocannabinoid system. This crucial system present throughout the human body controls or effects some of its most important functions, such as:
- Stress response
- Memory building
- Muscle control
The endocannabinoid system is made up of three main parts: endocannabinoids, receptors and enzymes. The endocannabinoids are molecules very similar to the cannabinoids found in cannabis, but they are produced by the human body naturally. These endocannabinoids bond with endocannabinoid receptors (specifically called CB1 and CB2 receptors), which are found throughout the body on the surface of cells. Then special enzymes break down endocannabinoids, clearing them from our system.
When working properly, this system is thought to help maintain homeostasis (or balance) in the human body.
One of the key functions of the endocannabinoid system is regulating pain sensation throughout all the stages of pain processing. While humans have been using cannabis as a pain killer for thousands of years, it was the relatively recent discovery of the endocannabinoid system, and study of its key functions, that has finally given us the ability to understand why.
The endocannabinoid system accomplishes its analgesic effects primarily through stimulating CB1 and CB2 receptors with the body’s natural endocannabinoids.
CB1 receptors are found throughout the peripheral and central nervous systems and can play a big role in pain signaling. Activating CB1 negatively regulates neurotransmission throughout the nervous system, reducing pain signals and our perception of pain. Stimulating CB1 receptors can even modify the emotional pain component, thereby modifying our emotional response to pain.
In one study demonstrating how CB1 affects pain, scientists genetically deleted CB1 from the peripheral nervous system (while still preserving it in the central nervous system) of mice, and then treated them with cannabinoids. In those mice without CB1, the analgesic effects of cannabinoids were greatly reduced, suggesting that peripheral CB1 stimulation is an important way that our endocannabinoid system can reduce pain.
CB2 receptors, on the other hand, are found primarily on immune cells, but these can also play a role in the resolution of pain states by regulating the activity of the central nervous system’s immune cells. For example, in one study, scientists chemically stimulated CB2 in mice and saw decreased behavior indicating a pain response. In studies looking at CB2, activating this receptor was able to reduce markers of both inflammatory pain and nociceptive pain (pain related to damage to the body).
While these effects were originally thought to come entirely from CB2’s presence on immune cells, new evidence has emerged suggesting CB2 receptors may also express on sensory neurons and nerve fibers. Scientists now believe that additional pathways exist through which CB2 may mediate pain signaling, such as an indirect activation of opiate receptors.
While scientists are still figuring out some of the finer details on how this all works, the research we have so far is clear that stimulating the endocannabinoid system can lead to reductions in pain. So theoretically, by activating into the endocannabinoid system’s receptors, cannabis should be able to produce pain relieving properties for the back, neck, and beyond.
Cannabis and Neck / Back Pain
When it comes to using cannabis specifically for back or neck pain, research is fairly limited. Most studies on cannabis and pain focus on neuropathic pain, or pain from conditions like cancer or HIV. Still, we can learn a lot about how cannabis might help back or neck pain from looking at the studies on how cannabis affects pain in general.
As we delve into the studies on cannabis and chronic pain, one thing is clear: pain is one of the most common reasons that patients report using medical cannabis. Surveys of why cannabis patients use cannabis medicinally have found that high percentages of patients use cannabis for chronic pain, with one study reporting numbers as high as 97%.
Even more interesting, these patients seem happy with the results. In one survey conducted by UC Berkeley, 81% of patients reported that cannabis alone was more effective at relieving their pain than using opioids, with similar results reported for patients using non-opioid painkillers.
Of course, survey data is notoriously unreliable because patients might not be able to tell whether they are being affected by cannabis, the placebo effect, or something else, when they are noticing pain relief. So, it’s important to also look at pre-clinical and clinical data where scientists can perform more controlled studies.
Researchers studying cannabis and pain have been mixed on their analysis of this research. There have been several large meta-reviews of the pain relieving properties of cannabis, and authors seem to disagree on just how convincing the evidence is. Still, pretty much everyone agrees that more research is needed to fully understand both how to best use the cannabis products that are commercially available, and whether the pain relief benefits outweigh any potential risks from cannabis.
For example, in a 2017 meta-review on the cannabis literature, the National Academies of Science and Engineering reported that there is substantial evidence that cannabis is an effective treatment for chronic pain in adults, and tends to produce a moderate level of relief. However, they specified that “very little is known about the efficacy, dose, routes of administration, or side effects of commonly used and commercially available cannabis products,” and the authors recommended more research be done to clarify these questions.
The authors of a 2019 review agreed both that there was some research pointing to cannabis’ efficacy for pain, and that the current research doesn’t adequately represent the cannabis products currently being used, and recommended caution.
They pointed out that it is still difficult to do clinically relevant studies on cannabis for pain because of research restrictions. The majority of the studies on cannabis’ pain relieving effects are using inhaled cannabis—rather than the tinctures and edibles being used by many chronic pain patients. And even these inhaled options are often supplied by governmental agencies and might not have chemical profiles similar to what is available in dispensaries. So there’s a big gap in research when it comes to scientists’ knowledge about the best ways to utilize the available cannabis products safely and effectively for pain relief.
A 2017 review of the evidence from Harvard University found “modest” evidence from clinical trials supporting the use of cannabis for pain. The survey also found initial evidence that cannabis could help with reducing opioid use when the two are used together. Still, like the other reviews, they recommended more research to better understand the potential side effects and gain more clarity around how to use cannabis for pain effectively.
Aside from these reviews, other studies have given us more insight into the ways different types of cannabis, or ways of using it, might affect pain. For example, one study found that using THC and CBD together improved pain relieving abilities of cannabis when compared to either one alone. Another study found that there were fewer negative gastrointestinal events when treating pain with cannabis when patients used inhaled methods, rather than taking cannabis orally.
Based on the available research, it’s clear that cannabis has big potential to help with chronic pain, and many people are already using it for this purpose. Using cannabis may help reduce pain and inflammation, which can make a big difference in quality of life. Scientists are still studying cannabis for pain, and there are many unanswered questions. Nonetheless, significant progress has been made and there is more to come.
Still researchers also caution that we don’t yet know all the risk factors for long term use of cannabis. Cannabis is a powerful substance that can come with side effects from long term use, especially for those with genetic predispositions to conditions like schizophrenia and depression. As with any medication, you should discuss the potential risks and benefits with your doctor before starting a cannabis treatment.
You should also make sure that cannabis is legal as a treatment for chronic pain where you live, before beginning cannabis use. Even if cannabis is legal for chronic pain where you live, you may need to get your doctor’s approval before you begin using cannabis.
Currently, patients with chronic pain are able to use cannabis in the following countries:
- Czech Republic
- Puerto Rico
You can also use cannabis for chronic pain in these US states:
- District of Columbia
- New Hampshire
- New Mexico
- Rhode Island
- South Carolina
Neck and back pain are extremely common and affect a majority of individuals at one time or another. While practically everyone experiences acute pain for a short period of time, many people go on to suffer from chronic pain, which can be very disabling and impact every aspect of one’s life.
Back pain is so common that nine out of 10 adults experience it at some point in their lives. Five out of 10 working adults have it every year, making it the most common reason for missing work and disability.
Normal back or neck pain usually improves within a few weeks or months, depending on the cause. Sometimes, it keeps coming back. Chronic back pain caused by herniated disks and stenosis or surgery can often go away only after a year.
Back pain is classified in terms of duration of symptoms. Back pain is considered acute if lasting less than six weeks. Subacute back pain lasts between six to 12 weeks and chronic back pain lasts more than 12 weeks.
Neck pain, on the other hand, is classified by its cause. Even though about half of individuals have mixed pain, in many cases the cause for it is neurological or non-specific. Others have neck pain due to another medical condition, such as cervical osteoarthritis. Neck pain can also be the result of a response to movement or due to a pathoanatomical source, meaning a certain area in the body that appears to have pathology without cause.
Causes & Risk Factors
Back pain can have either genetic, acquired, or lifestyle-oriented causes. The most common causes are:
- Excess activity. This can cause the muscles and ligaments in the back to stretch or tear, which may lead to lower back pain and muscle spasms. You can ease the pain by resting and taking over-the-counter medications.
- Disc injury. Disc injury is incredibly common and often happens to younger people. Discs are situated between bones called vertebral bodies in our spine, allowing us to bend and give flexibility. They often slip out of place leading to disc bulges and herniations, which cause injury and pain. This can happen due to someone’s anatomy, lifting a heavy object or abnormal movement, or even spontaneously. Poor posture can also contribute to disc injury.
- Sciatica. When a disc herniates backwards it can touch an exiting nerve root from the back that gives feeling to the legs. When it impinges the sciatic nerve, you can get a shooting pain, tingling, or feeling of numbness in the legs and feet. If left unchecked this can even lead to weakness of the muscles.
- Spinal stenosis. This occurs due to pressure on the spinal cord and spinal nerves caused when the spinal cord narrows. You may feel numbness and cramping anywhere in the body when you are standing or walking.
- Abnormal spine curvatures. This includes certain medical conditions that are usually diagnosed during childhood, most often including scoliosis and lordosis. These abnormalities cause pain and poor posture, which also leads to pain as a result of the pressure on the muscles and vertebrae.
- Other severe conditions. Chronic back pain is common among patients with arthritis, fibromyalgia, spondylitis and more.
What causes neck pain?
As previously mentioned, causes of neck pain can also lead to back pain, but not necessarily. The main causes of neck pain are:
- Degeneration of the discs and the vertebrae within the neck. These normally degenerate with age, which might lead to chronic or persistent pain. This type of pain can also be caused by specific medical conditions like inflammatory conditions, trauma, and other causes.
- Bad sleeping position. Many people will at times wake up with stiffness or soreness in the shoulders or back. This can be the result of either sleeping position, type of pillows used, the firmness or one’s mattress, and the stress levels felt before going to bed.
- Poor posture. People who are used to bend forward during the day to look at their phones or work on their computers may stimulate muscles tearing in the neck. To minimize the damage, try to stretch your neck to different sides for extended periods.
- Stress and anxiety. Holding tension in your neck and back isn’t just an expression. High levels of stress can cause muscles to tighten and you might feel pain from the excess strain.
- Torticollis. This is a medical condition in which, for an unknown reason, the head gets twisted to one side. Trying to straighten your head can be very painful. Torticollis often occurs overnight or due to exposure to very cold temperatures for extended periods. In this case, your neck should be back to normal within a few hours or days. However, it could also be a symptom of a severe medical condition like infection, tumor, or side effects of certain medications.
- Whiplash. In a whiplash, the head jolts forward and back due to a sudden injury in the neck. It is usually associated with car accidents but can also occur as a result of sports activities.
- Cervical radiculopathy. This occurs when the nerves in the neck connecting to the spinal cord are irritated, mostly because of associated conditions like neck arthritis or a herniated disc. Other than pain in the neck, this might end in numbness or pain and weakness in the arms.
- Other Causes. Sometimes neck pain may indicate other problems such as cancer, systemic diseases, or other rarer conditions.
Many people report having a chronic back pain after moving homes or offices. Others might suffer for years due to a physically demanding job. However, people with poor posture, sedentary lifestyles, or obese individuals are also at high risk since they constantly apply pressure on their muscles and vertebrae. The same goes for women at late stages of pregnancy. It is worth noting that smokers are also at a higher risk of developing back problems, although the cause for that is not clear.
Recent studies point out several psychological factors that contribute to back pain, such as on-the-job stress, family problems, and even the stress caused by a relationship break up. Inactivity can worsen back pain, but so can a sports injury.
It is important to note that back pain also occurs in those who have no risk factors at all. It may also appear even if you don’t pick up something heavy, have great posture, sleep well, and live perfectly. It just happens.
Normally, it is not necessary to see a doctor following mild to moderate pain or discomfort, as the passage of time or over-the-counter medications should resolve it. However, if the pain is severe, persistent, or is accompanied by additional symptoms, you should seek out medical advice. Advanced tests can uncover underlying conditions causing the pain, as well as point out to medications that will target its source.
Upon reporting back or neck pain to your doctor, he/she will conduct a comprehensive history and physical examination. Your pain will be characterized by its location, duration, and possible causes. The doctor will also consider your age, prior history, and pain, and co-existing medical conditions. A neurologic exam may be used to assess changes in sensation and motor function.
Other tests that may be performed include:
- X-ray- X-rays can reveal what is going on in the space between two spinal bones, as well as arthritis-like diseases and tumors.
- MRI- This can reveal the details of nerve-related elements, as well as problems with the joints, tendons, and ligaments. Myelography/CT scanning may be used as an alternative.
- Electrodiagnostic studies- Electromyography (EMG) and nerve conduction velocity (NCV) are sometimes used to diagnose neck and shoulder pain.
Normal back pain usually goes away after a few days, and in more severe cases—weeks or months. To treat it effectively, get some rest and take over-the-counter medications. There are several ways in which you can prevent it from recurring or getting worse, depending on the source of pain.
- Stay active. People who exercise regularly recover from back pain more quickly. Walking, swimming. and yoga are particularly recommended for a healthy back. Also, instead of staying in bed, get back to work quickly after recovering from back pain as the activity will help you heal faster.
- Stretching. Stretching is one of the most important things you can do for your body and can prevent many chronic pain conditions, including neck and back pain.
- Massage. Have someone apply mild pressure on your painful muscles and joints to relieve tension.
- Hot and cold packs. Many people take a hot bath or use a hot water bottle on the painful area to ease the pain when it first starts. Others place an ice pack to ease the pain in the short term. Be careful not to put the ice pack directly on your skin as it can cause a cold burn.
- Manage your sleep. Make sure your posture doesn’t hurt your back and your pillow supports your neck properly. If pain continues, try sleeping without a pillow or with a special neck pillow
- Abdominal strengthening. Having your abdominal muscles contribute more to your stability and having your core more evenly distributed is a great way of preventing and improving back pain.
- Relax. Optimistic people are known to recover faster from injuries. Staying positive is crucial, even when experiencing back pain, since worrying about it might tighten the muscles, thus making things worse.
- Soft neck collar. Your doctor can provide it to you to relieve discomfort. However, don’t use this for a long time as it can weaken the muscles in your neck.
- Surgery. This option is only recommended if the cause for the pain (sciatica, for once) can be treated via surgery.
- Smoking Cessation. People who smoke take much longer to recover from injuries, including acute and chronic pain. Another reason to stop smoking!
- Radiofrequency denervation. This procedure involves inserting needles into the nerves that supply the affected joint. Radio waves are sent through the needles to heat the nerves, which prevents them from sending out pain signals. This procedure is sometimes recommended for people with moderate to severe back pain originated in the joints within the spine. Note that its complications include bleeding, infection, and possible nerve damage.