Chronic Back Pain is one of the most common illnesses seen by physicians. Almost everyone has back pain at some time in their adult life. Back pain occurs most commonly between the ages of 30 and 50 due to the aging process and due to a more sedentary lifestyle that begins in this age group. The pain can be neuropathic or nociceptive. Neuropathic pain is caused by damage to a nerve. This kind of pain is felt as a sharp stabbing or burning. Nociceptive pain is caused by disease to the tissues outside of the nerves. It is felt as a dull ache or sense of pressure. Examples of these kinds of pain are a pinched nerve (neuropathic pain), and arthritis (nociceptive pain). It is frequent for patients to have both types of pain at once, called mixed pain.
Fifty percent of patients with back pain have experienced some type of trauma, such as a sports injury or motor vehicle accident. But the other fifty percent have no known cause of their back pain. Most patients who seek care for their back pain will undergo some type of evaluation that may include x-rays, CT scan, and/or MRI; occasionally some patients will have a myelogram (dye injected into the spinal cord area followed by x-rays) or bone scan (dye injected into the blood which will then concentrate in an abnormal area of bone). Many times no obvious cause of the pain is found.
Patients who have acute back pain will often improve or recover in six to eight weeks. Patients with acute pain occurring more than three times in one year or who experience longer episodes of back pain that interfere with daily activities (e.g., sleeping, sitting, standing, walking, bending, riding in or driving a car) are more likely to develop a chronic back condition. Sometimes these chronic back pain patients will have pain, numbness or tingling in their legs. Some patients with chronic pain do not respond to conventional therapy and have to find a way to live with their pain. Physicians have found that living with chronic pain is extremely difficult and can lead to opioid dependency (addiction), anxiety, depression, and insomnia.
Medical marijuana is increasingly becoming the treatment of choice for many chronic back pain patients. Conventional treatment therapies such as over the counter non-steroidal anti-inflammatory medications – NSAIDS – (such as ibuprofen, naproxen sodium, or aspirin) can be helpful but can cause side effects such as stomach upset, nausea, gastric bleeding, and ulcers. Prescription medications like other NSAIDS (like Celebrex) or opiates (like Vicodin or Norco) can be effective at treating pain but can also cause many adverse and unacceptable side effects. The addictive potential of opiates is very concerning to patients who struggle with chronic pain and need relief; it is this concern that leads patients to consider using medical marijuana, a very effective treatment for chronic back pain.
In 1975, scientists began studying THC in cancer patients and found that it was a very effective pain reliever without significant or toxic side effects. Other studies followed and the conclusion was the same: marijuana safely and effectively treats chronic pain with little to no side effects. No nausea, no stomach upset, no ulcers, no addiction – many patients jokingly only refer to an increased appetite (”munchies”) the only “bad” side effect. Marijuana side effects of elevated mood, improved sleep, and reduced anxiety are welcomed by most patients and considered beneficial to having a good quality of life when you suffer daily with chronic pain.
In 1999, the Institute of Medicine (IOM) issued an evidence-based report on medical marijuana. It listed conditions that may be helped by cannabinoids, including neuropathic pain, acute pain, spinal cord injury, post operative pain, cancer pain, multiple sclerosis, nausea and appetite control among others.
The report says that discovery of a cannabinoid receptor in the parts of the nervous system that detect and control pain perception means that marijuana is a very promising source of pain relieving medications in the future.
The IOM found that cannabinoids are capable of giving mild to moderate pain relief comparable to codeine. In one study cited in the report, 10 milligrams of THC (marijuana's active ingredient) yielded the same amount of pain relief as 60 milligrams of codeine. Side effects were similar with both drugs, but the THC seemed to be more sedating than the codeine. The patients taking the THC reported a greater sense of well-being and less anxiety.
The IOM also found that by combining cannabinoids with an opioid, the opioid may work better. This may decrease the dose of addictive narcotics needed to control pain.