The Straight Dope on CBD Oil

CBD oil is not medical marijuana and it cannot get you high. It may, however, give many people some relief from back pain.

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It seems every natural food store has a sign promoting their cannabis oils, or CBD oils. Dispensaries, as you might expect, sell CBD products. And you probably have at least one friend who claims to know where to buy “quality” CBD oil online.

CBD back painCan CBD oil help with back pain?

So, what exactly is this trendy treatment? And can it help your back pain?

What Is CBD?

CBD oil comes from the cannabis plant, which has two well-known chemical compounds: cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC). Both compounds have a range of possible health benefits, including back pain relief. But only THC can get you high.

“You have to separate medical marijuana from CBD. Medical marijuana is going to have a certain level of THC, a psychoactive ingredient. The CBD product you buy will not,” says orthopedic spine surgeon Dwight S. Tyndall, MD, who wrote about CBD oil in 2018 for the Northwest Indiana Times.

Fans of CBD oil claim it helps countless health concerns, from headaches to chronic diseases. The hype is ironic, considering there may not be much CBD oil in the products they buy.

“There’s no guarantee that what you buy in most stores actually has CBD oil in it. The product is completely unregulated,” Dr. Tyndall says.

However, high-quality CBD can be powerful medicine. The U.S. Food and Drug Administration (FDA) has approved one CBD drug, which treats seizures in two rare forms of epilepsy. Other CBD products are under clinical investigation and development.

CBD and Pain Relief

Despite the anecdotal evidence of CBD oil as a wonder drug, there aren’t many studies on it. Far more research has looked at the effect of cannabinoids in general, including combinations of CBD and THC. 

Overall, cannabinoids are a promising option for modest relief of some chronic pain conditions. Research published in 2011 and 2015 explored nearly 30 studies on cannabinoid use in chronic non-cancer pain, including neuropathic pain, fibromyalgia, rheumatoid arthritis and mixed chronic pain. Most of the studies found a positive analgesic effect.

A small study published in 2020 suggests that topical CBD oil may reduce pain, cold and itchy sensations in people with peripheral neuropathy. 

CBD topicalCBD can come in topical form, as well as other delivery methods.

Neurosurgeon Mark McLaughlin, MD, uses it on his hands after a long week of surgeries, despite the limited evidence. “I find that it helps when I have really sore hands. It seems to give symptomatic relief for joint pain and muscle pain,” says Dr. McLaughlin, founder of Princeton Brain, Spine and Sports Medicine in New Jersey.

CBD products may also improve insomnia and anxiety – two factors known to exacerbate back pain.

Potential Risks

Research suggests that most CBD products are well tolerated, but that doesn’t mean they’re completely safe.

Quality control issues: CBD oil isn’t FDA-approved, which means you can’t necessarily trust the claims on the label. Your bottle of CBD oil may:

  • Not treat the conditions listed
  • Have harmful ingredients
  • Have much less CBD oil than stated

Drug interactions: Check with your doctor about potential drug interactions, especially if you take medications for anxiety, panic, stress, or sleep disorders.

Minor side effects: CBD can cause drowsiness, diarrhea, decreased appetite, and changes in mood.

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How to Take CBD Oil

CBD oil comes in several forms and no reliable guidance on dosage. Here’s what you need to know:

  • Capsules: These are an easy way to take CBD oil daily once you’ve established an effective dose.
  • Tinctures: These are liquid formulations you take via a dropper. They may provide faster relief than a capsule can. Keep the CBD product under your tongue for a full minute or two. You may start to feel effects as quickly as 15 minutes.
  • Topical products: Lotions, creams, or ointments containing CBD oil may also have ingredients found in other topical pain relievers (such as capsaicin or menthol). You may get pain relief, but these ingredients make it hard to know whether CBD oil is the key.

Since the FDA hasn’t determined appropriate dosing, you may need to find your ideal dose through trial and error. The Arthritis Foundation offers some common-sense guidelines:

  • Start with a low dose and see how you feel after a week.
  • Increase your dose in small increments
  • If CBD alone doesn’t work, and you’re in a state where marijuana is legal, talk to your doctor about a combined CBD and THC product.

Tracking Down Quality CBD

Any unregulated health treatment comes with a host of potential problems. For instance, FDA testing of CBD products has found that many didn’t have the listed amount of CBD. The FDA is also investigating reports that some CBD products have unwanted ingredients, from THC to heavy metals.

Once again, the Arthritis Foundation offers clear, sensible guidance:

  • Look for ingredients grown and manufactured in the U.S.
  • Buy from companies that test each batch at a lab. Be sure the lab uses methods approved by the American Herbal Pharmacopoeia (AHP), the U.S. Pharmacopeia (USP), or the Association of Official Agricultural Chemists (AOAC).
  • Avoid companies that claim their products treat or cure diseases.

To this list, Dr. McLaughlin adds another piece of simple, sound advice. “Go to a compounding pharmacy,” he says. “They’re generally going to have a higher-quality product than something you would find by mail-order, online, or over the counter.” 

CBD oil not for you? Check out these other complementary and alternative treatments for back pain.

 

Updated on: 11/23/20
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Cannabis and CBD for Back and Neck Pain Q&A
Dwight S. Tyndall, MD, FAAOS
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