86 An Emerging Role of Cannabis as an Anti-Nociceptive Agent in the Treatment of Chronic Back Pain

Abstract

Abstract Aim This review aims to provide insight into current research regarding a role for the endocannabinoid signalling pathway as a target in the treatment of chronic pain with particular emphasis on potential use as part of the treatment of lower back pain. Method A literature review was conducted using PubMed, Google scholar, and web of science database. The terminologies used were endocannabinoids, cannabis-based medicines, chronic pain, and lower back pain. Results The analgesic effect of cannabinoids is produced by stimulating cannabinoid receptors within the endocannabinoid system. Animal studies show cannabinoid type 2 receptors stimulate the release of endogenous opioids, further enhancing anti-nociceptive properties. Pre-clinical studies demonstrated the amount of morphine required to achieve median effective dose was around 3.6 times lower when morphine was administered with cannabinoids compared to morphine alone. A systematic review of 24 RCT trials and 1334 participants revealed that inhaled cannabis results in improved neuropathic pain symptoms compared to placebo; however, only two studies showed clinical significance. The medicinal use of cannabis comes with adverse effects. Up to a tenth of users are at risk of developing Cannabis use disorder, characterized by psychosocial problems, increased drug-seeking behaviours including craving, withdrawal, and tolerance. Conclusions The use of cannabis is gaining traction as an alternative to opiates despite the ethical and legal considerations. There is scope for cannabinoids to be successful anti-nociceptive agents in the management of chronic back pain. The long-term effects and side effect profile of cannabis- based medicines need more research.