Cannabidiol in low back pain: scientific rationale for clinical trials in low back pain

ABSTRACT

Introduction

The pooled worldwide prevalence of low-back pain-related presentations in primary care varies between 6.8% and 28.4% in the high-income countries rendering it a major healthcare/economy problem. To best manage this complex bio-psycho-social condition a 360-degree approach is needed, as the psycho-social components are often more important than the scant pathophysiology. Pattern analysis of cannabis users suggested that attempts to alleviate musculo-skeletal pain is often seen as a major drive to use cannabinoids.

Areas covered

Unlike NSAIDs/opioids, cannabidiol might directly affect more than one modality of pain signaling/perception. The 2019 guideline of the National Institute for Clinical Excellence recommended further studies with cannabidiol in pain medicine because of its excellent safety profile and presumed therapeutic potential. Therefore, we have researched relevant databases for pharmaco-physiological papers published between 2000 and 2021 to collate evidence in a narrative fashion to determine the clinical rationale for this cannabinoid in low-back pain.

Expert opinion

Observational research reported good results with CBD in pain and fear reduction, which are both key factors in low-back pain. Given the paucity of high-quality evidence, further research is needed to determine the efficacy/non-inferiority of CBD in primary/emergency care setting, using multimodal assessment of various patient-reported outcomes.

KEYWORDS:

• Cannabidiol
• low-back pain
• emergency medicine
• primary care setting
• pain reduction
• fear reduction
• epidiolex
• bedriol
• CBD
• nabiximols

Article highlights

• Low-back pain is a major medical/economy problem.

• Management is complex often necessitating interdisciplinary approach.

• Cannabinoids seemed potentially feasible alternatives to morphine in certain areas of medicine.

• Cannabidiol, one of the non-psychoactive component of Cannabis sative is well received by both the medical and lay community.

• The pharmaco-pathophysiology of cannabidiol is promising in pain signalling/perception.

• Strong in vitro evidence for pain and fear reduction.

• Multimodal assessment in pain perception in low-back pain may help to achieve better compliance in this complex patient group.

• Correction of methodological flaws may help us better understand the role of cannabidiol in low-back pain.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One reviewer has declared being a member of the International Advisory Board of the Australian Centre for Cannabinoid Clinical and Research Excellence (ACRE) – National Health and Medical Research Council (NHMRC). They have received travel support to attend scientific meetings and personal consultation fees from BSPG-Pharm. They are also a co-inventor of a patent on ‘fluorinated CBD compounds’. There institution has licensed this patent to Phytects Pharm and has an agreement with Prati-Donaduzzi. They are also a coinventor of cannabinoid-containing oral pharmaceuticals. Full disclosures were provided to the editorial team, but that to maintain referee anonymity, some of the details have not been included here. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.