Short answer
Evidence for cannabis as a back pain treatment is limited. Cochrane reviewers pooled 16 trials with 1,750 adults who had chronic neuropathic pain. They rated the evidence low quality and the average pain drop small. Back pain was not the target of most of those trials. The FDA has approved no cannabis or CBD product for pain. The American College of Physicians places cannabis outside first-line care for low back pain. First-line care is heat, exercise, massage, acupuncture, yoga, and NSAIDs.
What studies show
About 39% of US adults reported back pain in the past 3 months, based on 2019 National Health Interview Survey data. Most cases have no clear cause on imaging.
Cannabis for Back Pain Relief: A Guide to CBD and Medical Options
Two bodies of research apply:
- THC-dominant cannabis. Trials test smoked or oral products against neuropathic and cancer pain. A 2017 National Academies review found substantial evidence for chronic pain in adults. Cochrane found the same trials flawed and small.
- CBD products. Human trials of CBD alone for back pain are few. Most CBD pain data come from animal models or from products that also contain THC.
THC and CBD differ
THC binds CB1 receptors. It causes intoxication, sedation, and impaired coordination. CBD does not cause intoxication. CBD inhibits cytochrome P450 enzymes, which can raise blood levels of warfarin, clobazam, and other drugs. Check every current prescription before you start.
Risks
- NIDA reports about 3 in 10 people who use marijuana develop cannabis use disorder.
- Short-term effects include dizziness, dry mouth, raised heart rate, and memory problems.
- Smoked cannabis irritates airways and carries smoke-related risks.
- Federal law lists cannabis as Schedule I. State laws differ.
- Hemp CBD under 0.3% THC is legal under the 2018 Farm Bill. State rules still differ.
What guidelines recommend
The ACP guideline for low back pain puts nonpharmacologic treatment first. NSAIDs are the first drug option. Opioids come after other drugs fail. The guideline does not endorse cannabis.
Product testing
Third-party lab tests report cannabinoid content and screen for pesticides, heavy metals, residual solvents, and microbials. Ask for a certificate of analysis. Check the batch number, the test date, and the lab name. Studies have found mismatches between labeled CBD content and measured content on untested products.
Questions for a clinician
- Do my prescriptions interact with CBD?
- What form and what dose?
- How long before I judge whether it works?
- Which side effects mean I stop?