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Cannabidiol, or CBD, is a new medical treatment that may be effective for back pain. It has relatively few side effects and does not come with the high associated with marijuana. Which is better for back pain: CBD oil vs CBD cream? There are tons of different products to choose from, so let's do some learning. People with arthritis may consider CBD products for pain relief. Learn what science and experts say about CBD’s benefits, risks, different ways the product can be used and how to be a smart shopper.

Understanding CBD (Cannabidiol) for Back Pain

Cannabidiol, commonly referred to as CBD, is a new and relatively understudied treatment for pain, including back pain. Studies suggest it may help relieve inflammation, which is often a factor in chronic back pain. 1

CBD is available in many forms; topical creams and gels have shown promising results for inflammation and neuropathy, which may make them a good option for back and neck pain. 2

CBD requires more research in order to prove and explain its effectiveness as well as to better understand potential side effects (especially long-term) and potential drug interactions.

What Is CBD?

CBD oil is derived from a plant called cannabis sativa. The plant has over 100 chemical compounds, called cannabinoids, that have a range of effects, including anti-inflammatory and analgesic (pain relieving) qualities.

The cannabis sativa plant has two main varieties that are grown for specific purposes:

  • THC content. THC is the compound associated with the “high” feeling of marijuana use.
  • Industrial (non-drug) uses. This form of the plant contains trace amounts of THC (less than .03%) and can be used to make paper, clothing, and some building material. This variation of the cannabis plant is called hemp.

While CBD is present in both varieties, many of the CBD products available to consumers are from the hemp plant. CBD does not come with the high or psychogenic effects of marijuana.

Ways CBD Treats Back Pain

Research indicates that CBD may reduce back pain by:

  • Reducing inflammation 3
  • Combating anxiety, often associated with long-lasting or chronic back pain 4
  • Helping with sleep and improving overall state of relaxation 5

Some studies suggest that CBD can have an effect on how an individual perceives pain, but more robust research is needed. CBD is generally considered a full-body treatment, which means that it does not target back pain specifically—except in the case of topical products—but contributes to an overall feeling of relaxation and pain relief.

Advocates of CBD believe it can be used to treat a range of conditions in addition to back pain, such as anxiety-related disorders. 5

Potential Risks and Side Effects of CBD

Cannabidiol, even in high amounts, is generally safe. Side effects from CBD may include:

  • Drowsiness
  • Dizziness
  • Dry mouth
  • Low blood pressure

More severe side effects, while rare, include:

  • Mental confusion
  • Nausea
  • Vomiting
  • Diarrhea

As with other natural products, there is potential for adverse reactions when taken with other medications, especially those that come with grapefruit warnings, such as certain blood thinners. These warnings indicate that certain medications should not be taken with products containing grapefruit.

CBD use prior to surgery

Before having surgery, all cannabis use, including CBD and marijuana, should be disclosed to the surgeon or anesthesiologist. A recent study suggests that cannabis use may have an effect on medications used to sedate patients. 6

CBD Oil vs. CBD Topicals for Back Pain – Which Is Best?

People worldwide have reached for cannabis to treat pain for hundreds of years. These days, the growing legality of marijuana means that users are spoiled for choice regarding products. However, not everyone wants the intoxicating high associated with THC, and the substance remains illegal in numerous locations. Fortunately, CBD oil from hemp is widely available and broadly tolerated in most states.

When it comes to chronic back pain, which affects 8% of all Americans, knowing which CBD product is a good fit is potentially tricky. When faced with such a plethora of choices, the search can certainly be overwhelming!

CBD oil and topicals are viable options for those with chronic back pain. So, which is best? This article looks at CBD oils vs. CBD topicals as the best option for chronic pain. It also outlines how to use both products. Keep scrolling to see the top-rated CBD brands at the end of the article.

Back Pain 101

Unlike many other conditions, back pain has no prejudice and can affect anyone at any age! It can also occur for various reasons, from injury to bad posture or other underlying conditions. There are so many occurrences that could lead to back pain, some of which are listed below:

  • Sprained ligaments
  • Strained muscles
  • Ruptured discs
  • Irritated joints
  • Obesity
  • Arthritis
  • Blood clots
  • Kidney infections
  • Kidney stones

While many cases of back pain are short-lived, there are plenty of cases where back pain gets progressively worse, which can be incredibly debilitating.

According to the American Chiropractic Association, lower back pain is the single leading cause of disability worldwide, a massive indicator of its severity.

Cannabis for Back Pain

Millions of people worldwide reach for a joint to ease pain symptoms as the drug is associated with fast-acting relief. However, with such a large number of people living with back pain, there has been a shift towards non-intoxicating variants of the plant, which is where CBD oil and CBD topicals come in.

So, what are the medicinal alternatives to high-THC cannabis? Luckily, there is a significant number to choose from, with CBD oil and CBD topicals among the most popular.

What Is CBD Oil?

Cannabidiol (CBD) is a non-intoxicating compound found in the marijuana plant that has grown in popularity. Arguably more sought after now than THC, studies have shown CBD to have some potential in helping to manage various medical ailments.

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Researchers have found that CBD interacts with the body’s endocannabinoid system (ECS), which is vital for regulating many of our bodily functions. This ranges from core temperature to how we feel pain, emotion, hunger, and more.

When consumed, CBD interacts with cannabinoid receptors found throughout this system to help combat different issues. In the case of back pain, taking CBD might help our bodies fight off pain symptoms (including inflammation) much more effectively.

Does CBD Help with Back Pain? What Does the Research Say?

There are few clinical trials outlining the efficacy of CBD for back pain. However, a study published in the Journal of Opioid Management in 2020 investigated CBD’s ability to treat chronic back pain. The researchers looked into two patient case reports. The individuals in question used a specific CBD cream that contained 400mg of the cannabinoid per two-ounce container.

The patients experienced significant symptom relief after using the cream. The researchers concluded that additional studies are warranted to determine if CBD products should have a more central role in treating chronic and acute pain.

Although the available research into CBD for back pain is promising, there is very little of it. Significantly more studies are needed before drawing any conclusions. Nonetheless, many people are adamant that cannabidiol helps reduce back pain symptoms. While there is a wide array of CBD products to choose from, they all fall into one of three distinct forms, which will be covered below.

Comparing CBD to conventional …

Types of CBD for Back Pain

Generally speaking, one can categorize CBD products as follows:

  • Full-Spectrum: Contains dozens of cannabinoids, terpenes, and flavonoids. Crucially, such products may contain up to 0.3% THC when derived from hemp.
  • Broad-Spectrum: These items contain everything one will find in a full-spectrum product except THC. Broad-spectrum CBD should contain 0% THC.
  • CBD Isolate: Any products containing no other cannabinoids or hemp compounds barring CBD are known as isolates. On occasion, a manufacturer may add terpenes after the initial extraction phase.

Proponents of full-spectrum CBD point towards the so-called entourage effect. This is a suggestion that the cannabis plant’s compounds work better together than in isolation. However, individuals who don’t want any THC in their system tend to gravitate towards broad-spectrum or CBD isolate products.

How to Use CBD Oil for Back Pain

One can use CBD oil in many ways, so this is down to personal preference. Many patients do not like the taste of CBD oil, so they may opt to put a few drops into their food to mask the flavor.

For those seeking a quick hit of relief, applying a couple of drops beneath the tongue is among the fastest ways of benefiting from the cannabinoid. There are beds of tiny blood vessels called capillaries under the tongue. They allow for rapid absorption directly into the bloodstream without having to go through any of the metabolic breakdown processes of the digestive system.

How Much CBD Oil to Use for Back Pain?

Regardless of the CBD product one uses, its effects vary depending on:

  • The user’s bodyweight
  • Body chemistry
  • The user’s general health
  • The condition someone uses CBD for
  • CBD concentration

As always, the best idea is to start low and go slow – meaning start with a very low dose and increase slowly until the desired effect is reached.

What Are CBD Topicals?

CBD topicals have become more popular over recent years as we have moved further away from the traditional ways of using cannabis to help with our ailments. However, what exactly are cannabis topicals, and how are they used for back pain?

A CBD topical is a cannabis-infused ointment, cream, balm, or lotion used externally on the skin for localized relief.

Many users try topicals to help with skin conditions like eczema and psoriasis. However, this is not their only application.

So, can a topical cause one to get high? The short answer is no. Topicals absorb through the skin, potentially offering the anti-inflammatory benefits of cannabis. However, they do not reach the bloodstream but merely penetrate the CB2 receptors in the affected area. Consequently, they do not cause a high. CBD topicals extracted from hemp contain little or no THC, meaning they wouldn’t lead to intoxication even if they did reach the bloodstream.

However, it is important to note that while topicals typically won’t penetrate the bloodstream, this isn’t the case with transdermal patches. Patches pass cannabinoids through to the bloodstream and can cause a high if they contain THC.

For those living with back pain, topicals can also offer a pleasant sensation due to the essential oils they often contain.

How to Use CBD Topicals for Back Pain

CBD topicals are useful for anyone who dislikes the taste or texture of CBD oil. Whether the product is a cream, ointment, or balm, one should apply it directly to the affected area. There are many topicals with other ingredients to target particular issues, so shop around to find the best product.

How Much CBD Topical to Use for Back Pain?

It is significantly more challenging to track one’s dosage when using a CBD topical than oil. In general, brands provide vague advice on how to use it. They usually suggest that the user apply the topical directly to the affected area without recommending a precise dosage. In reality, it is up to the user to decide whether they want to apply the topical liberally or not.

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However, pay attention to the CBD concentration of the topical. For example, a 60-gram container with 1,500mg of CBD has 25mg of the cannabinoid per gram. Individuals in severe pain should shop for topicals with the highest CBD concentration.

What About CBD Cream for Back Pain?

It is easy to get confused by the different CBD topicals available. There are CBD creams, balms, ointments, lotions, and more. However, it is important to note that the main difference lies in the topical’s consistency. Here’s a quick overview:

  • CBD Cream: Creams are relatively thick because they contain a high proportion of oil. In general, a cream is about half oil and half water and may also have additional ingredients such as shea butter.
  • CBD Lotion: This topical has a high-water content and is thinner than a cream. Typically, lotions are formulated with lightweight products such as hyaluronic acid.
  • CBD Balm: A balm is thicker than a cream but not as thick as an ointment. It doesn’t contain water and usually has a waxy texture. A balm may also have added ingredients such as beeswax.
  • CBD Ointment: An ointment is thicker and greasier than any other topical on this list.

Overall, lotions are the easiest topical to apply and good options for individuals with acne-prone skin. Creams are suitable for users with sensitive or dry skin, while balms and ointments stay on the skin longer.

CBD Oil vs. CBD Topicals for Back Pain – Which Is Best?

While CBD oil and CBD topicals can help manage back pain and discomfort, is there one that rules over the other regarding efficacy?

When we consider how topicals and CBD oil are absorbed into the body, CBD oil seems to offer better overall benefits. Rather than targeting one specific problem area, CBD oil can provide its purported benefits across the entire body.

However, as we have mentioned – plenty of people prefer to target the affected area as and when necessary. As a result, CBD topicals seem like the obvious option for back pain specifically.

Final Thoughts on CBD Oil vs. CBD Cream for Back Pain

Regarding variety, it is clear that CBD topicals offer the broadest range of choice for long-suffering back pain patients. One can opt for CBD-rich products containing everything needed to help ease the pain with a few added extras.

CBD oil is the most popular hemp product for a reason. It is potentially effective and takes effect very quickly, given it goes directly into the bloodstream after administration. Want to learn more about CBD oil? Check out the top brands below.

CBD Oil For Back Pain Forum

Online resource that helps patients better understand health coverage options, choose the right coverage, manage the denial process and reduce health care costs.

CBD for Arthritis Pain: What You Should Know

Learn what the science says about the risks and benefits of CBD use for arthritis and what to shop for.

What is CBD? CBD, short for cannabidiol, is an active compound found in the cannabis plant. CBD is not intoxicating but may cause some drowsiness. The CBD in most products is extracted from hemp, a variety of cannabis that has only traces (up to 0.3%) of THC, the active compound that gets people high.

Does CBD work for arthritis? Animal studies have suggested that CBD has pain-relieving and anti-inflammatory properties, but these effects have not been validated in quality studies in humans. Anecdotally, some people with arthritis who have tried CBD, but not all, report noticeable pain relief, sleep improvement and/or anxiety reduction.

Is CBD safe to use? Research evaluating the safety of CBD is underway. At this point very little is known. So far, no serious safety concerns have been associated with moderate doses. CBD is thought to have the potential to interact with some drugs commonly taken by people with arthritis. Talk to your doctor before trying CBD if you take any of the following: corticosteroids (such as prednisone), tofacitinib (Xeljanz), naproxen (Aleve), celecoxib (Celebrex), tramadol (Ultram), certain antidepressants, including amitriptyline (Elavil), citalopram (Celexa), fluoxetine (Prozac), mirtazapine (Remeron), paroxetine (Paxil), sertraline (Zoloft), and certain medications for fibromyalgia, including gabapentin (Neurontin) and pregabalin (Lyrica).

Are CBD products legal? CBD products derived from hemp are no longer considered Schedule I drugs under the federal Controlled Substances Act, but they still remain in a legal gray zone. There are changes underway on federal and state levels that will ultimately clarify the laws and regulations related to CBD-based products and sales. Despite that, they’re widely available in nearly every state and online. People who want to use CBD should check their state laws.

Taking the First Step

Should I give CBD a try? Without quality clinical studies on CBD and arthritis, doctors have not been able to say who might benefit from CBD, at what dose and in which form, who likely won’t benefit and who should avoid it. Still, there is agreement on several points:

  • CBD is not a substitute for disease-modifying treatment for inflammatory arthritis.
  • Patients who are interested in trying CBD should first talk to the health care provider who treats their arthritis before trying CBD. Together, they can review what has worked or not worked in the past, whether there are other options to try first, how to do a trial run, what to watch for and when to return for a follow-up visit to evaluate the results. Keep a symptom and dose diary to track effects.
  • Quality CBD products can be expensive, especially when used for prolonged periods. To avoid wasting money, be completely sure that the product is truly having a positive effect on symptoms.
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What type of product should I consider? CBD-based products can be taken orally, applied to the skin or inhaled. There are pros and cons for each.

By mouth. CBD that is swallowed, whether in capsules, food or liquid, is absorbed through the digestive tract. Absorption is slow and dosing is tricky due to the delayed onset of effect (one to two hours), unknown effects of stomach acids, recent meals and other factors.

Capsules can work for daily use after a safe, effective capsule dose has been established. Experts discourage taking CBD via edibles, like gummies and cookies, because dosing is unreliable, and they are appealing to children but do not come in childproof containers. Like any medicine, edibles should be secured out of sight and reach of children.

CBD can also be absorbed directly into the bloodstream by holding liquid from a spray or tincture (a liquid dosed by a dropper) under the tongue (sublingual) for 60 to 120 seconds. The taste may not be pleasant. Effects may be felt within 15 to 45 minutes.

On the skin. Topical products, like lotions and balms, are applied to the skin over a painful joint. Whether these products deliver CBD below the skin is unknown. Topical products may also include common over-the-counter ingredients such as menthol, capsaicin or camphor, making it difficult to determine if a positive effect is due to the CBD or another ingredient.

Inhaled. CBD can be inhaled via a vaporizing, or vape, pen. However, inhalation of vapor oils and chemical byproducts carry unknown risks, particularly for people with inflammatory arthritis. For this reason and because the Centers for Disease Control and Prevention is investigating vaping in association with widespread hospitalizations and deaths from severe pulmonary disease, vaping is not recommended.

How much CBD should I use? While there are no established clinical guidelines, the medical experts consulted by the Arthritis Foundation recommend the following for adults:

  • When preparing to take a liquid form, be aware that the CBD extract is mixed with a carrier oil, so there are two measures to know: the amount of the liquid product to take (the dose) and the amount of CBD in each dose.
  • Go low and slow. Start with just a few milligrams of CBD in sublingual form twice a day. If relief is inadequate after one week, increase the dose by that same amount. If needed, go up in small increments over several weeks. If you find relief, continue taking that dose twice daily to maintain a stable level of CBD in the blood.
  • If CBD alone doesn’t work and you are in a state where medical or recreational marijuana is legal, talk to your doctor about taking CBD with a very low-dose THC product. Be aware that THC, even at low levels, may get you high, creating cognitive, motor and balance issues. Try THC-containing products at home or at night first, so you can sleep off any unwanted effects.
  • After several weeks, if you don’t find relief with CBD alone or with a combination of CBD and very low THC, CBD may not be right for you.
  • If you experience any unwanted side effects when using a CBD product, immediately discontinue use and inform your doctor.

What to Look for When Shopping

There is good reason to be a cautious shopper. CBD products are largely unregulated in the U.S. market. Independent testing has shown mislabeling and lack of quality control. The biggest issues are strength of CBD (significantly more or less than the label says), the presence of undeclared THC, and contamination with pesticides, metals and solvents. Here’s what to look for:

  • Find products manufactured in the U.S. with ingredients grown domestically.
  • Choose products made by companies that follow good manufacturing practices established by the FDA for pharmaceuticals or dietary supplements (a voluntary quality standard because CBD products are not federally regulated under either category) or required by the state where they are manufactured.
  • Buy from companies that test each batch and provide a certificate of analysis from an independent lab that uses validated standardized testing 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 have disease benefits.
  • Be aware that marketers and people behind retail counters are not health professionals; they are salespeople. That’s why your doctor is your best source for guidance and monitoring when using an unregulated product.

Our gratitude to the following experts for their guidance and review:

Kevin Boehnke, PhD, a researcher at the Chronic Pain and Fatigue Research Center at the University of Michigan, focuses on medical cannabis as an analgesic and opioid substitute in chronic pain.

Daniel Clauw, MD, a professor of anesthesiology, rheumatology and psychiatry at the University of Michigan and director of the Chronic Pain and Fatigue Research Center, leads research on arthritis pain and fibromyalgia, and the effects of cannabis, particularly CBD, in pain.

Mary-Ann Fitzcharles, MD, an associate professor of medicine in the Division of Rheumatology at McGill University in Montreal, Quebec, conducts research on pain and rheumatic diseases. She is the lead author of the 2019 Canadian Rheumatology Association (CRA) position statement for medical cannabis.

During Pain Awareness Month in September and all year long, we’ve got you covered with unique pain management tools and resources you won’t find anywhere else.

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