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A noteworthy new trial of CBD for acute back pain

PainSci » bibliography » Bebee et al 2021
Tags: back pain, cannabis, pain problems, spine

Three articles on PainSci cite Bebee 2021: 1. The Complete Guide to Low Back Pain2. The Complete Guide to Neck Pain & Cricks3. Marijuana for Pain

PainSci commentary on Bebee 2021: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Despite its reputation for treating pain, CBD alone has rarely actually been tested (most studies of cannabis for pain have used THC or a THC/CBD mixture).

For this trial, researchers tested CBD in the same situation where doctors might normally prescribe powerful anti-inflammatories or opioids: in people who have gone to the emergency room with severe back pain. A hundred patients were given an ibuprofen and paracetamol plus either 400mg of CBD or a bogus pill that looked just like it.

This a fair test in several ways. If CBD actually has anti-inflammatory properties, the people who got a CBD booster should certainly have gotten some extra relief. Severe acute back pain is a tough pain-killing challenge, but we should expect anything touted as “good for pain” to help out at least a little in this situation.

Unfortunately, CBD made no difference at all: it was like it wasn’t even there. •sad trombone• The groups were identical on all outcomes: pain levels, how long the patient stayed, the need for “rescue analgesia” (the Oxycodone), and adverse events.

It is conceivable that CBD alone, or repeated doses, would have performed at least as well as standard meds, and maybe more safely — safer than NSAIDs anyway — but it’s a long shot. This was quite a fair test, and CBD just bombed.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: To assess the analgesic efficacy and safety of single-dose oral cannabidiol (CBD) as an adjunct to standard care for patients presenting to an emergency department with acute low back pain.

DESIGN: Randomised, double blinded, placebo-controlled clinical trial.

SETTING: The tertiary emergency department of Austin Hospital, Melbourne.

PARTICIPANTS: Patients who presented with acute, non-traumatic low back pain between 21 May 2018 and 13 June 2019.

INTERVENTION: One hundred eligible patients were randomised to receiving 400 mg CBD or placebo in addition to standard emergency department analgesic medication.

MAIN OUTCOME MEASURES: Pain score two hours after administration of study agent, on a verbal numerical pain scale (range, 0-10). Secondary outcomes were length of stay, need for rescue analgesia, and adverse events.

RESULTS: The median age of the 100 participants was 47 years (IQR, 34-60 years); 44 were women. Mean pain scores at two hours were similar for the CBD (6.2 points; 95% CI, 5.5-6.9 points) and placebo groups (5.8 points; 95% CI, 5.1-6.6 points; absolute difference, -0.3 points; 95% CI, -1.3 to 0.6 points). The median length of stay was 9.0 hours (IQR, 7.4-12 hours) for the CBD group and 8.5 hours (IQR, 6.5-21 hours) for the placebo group. Oxycodone use during the four hours preceding and the four hours after receiving CBD or placebo was similar for the two groups, as were reported side effects.

CONCLUSION: CBD was not superior to placebo as an adjunct medication for relieving acute non-traumatic low back pain in the emergency department.

TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12618000487213 (prospective).

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