What is Back Pain? And How does it Occur?
Back pain is known as one of the most common reasons why many people visit doctors’ clinics regularly throughout the year. It is also one of the main causes of disability all over the globe. This pain usually limits the movements of affected people, making them unable to perform their daily life activities.
Fortunately, there are many measures that people can take to prevent the occurrence of back pain attacks. Also, there are many treatment options that relieve back pain within a period of a few weeks. However, in certain cases, the pain could be persistent and non-responsive to conventional analgesics and other medications.
Even though back pain is itself a symptom, it can present with many features, including muscle ache that may be exacerbated to a shooting, burning, or stabbing sensation. Moreover, pain can extend from the back to the legs. It may also be worsened with sudden movements, bending, twisting, heavy lifting, or prolonged sitting/standing.
What are the Causes of Back Pain?
Back pain is a very vague symptom that may occur with a long list of medical diseases or conditions. Therefore, the treating physician may ask you to do some tests or radiological exams in order to properly identify the cause.
That being said, there is a wide variety of diseases that can cause back pain, the most common of which include:
Muscular or ligamentous strain
This type of back pain usually occurs with repeated heavy lifting. It can also occur with a sudden violent movement, which can strain your back muscles and ligaments. If you are physically inactive, continuous strain on your back might lead to the occurrence of very painful muscular spasms.
Bulging or rupture of intervertebral discs
The intervertebral discs are the cushions that exist between the vertebral bones that form our spine. There is a disc between every two vertebral bones to facilitate the movement of the neck and back. Each disc is composed of a hard component and a soft component. Many conditions may cause the soft component of the disc to bulge or to rupture, pressing on the spinal nerves and causing severe back pain based on the sit of disc bulging.
The causes of disc bulging include trauma, road accidents, or sudden violent movement of the spinal cord. Disc bulging can be diagnosed by radiological exams, including magnetic resonance imaging (MRI)
Inflammation of the bony joints (osteoarthritis) can affect the back, leading to severe pain and hotness at the site of inflammation.
Osteoporosis is a very common medical condition that affects the bone by the loss of the minerals that give bones their solid nature. Reduction of the mineral composition of the bones makes them liable to fracture and severe pain, especially at the back.
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What are the Risk Factors of Back Pain?
Although back pain can occur at any age, there are some risk factors that might make you more liable to develop back pain. These factors include:
- Physical inactivity
- Obesity and excess weight gain
- Many bone diseases, such as arthritis, osteoporosis, and cancer
- Heavy lifting
- Violent exercises
The Endocannabinoid System and Pain Modulation
Naturally, cannabinoids exist in our bodies in the form of endocannabinoids. These endocannabinoids circulate in our blood system and reach their targets, which are known as cannabinoid receptors. There are two types of cannabinoid receptors: type 1 receptors (CB1), which are predominant in the brain, and type 2 receptors (CB2), which are present mainly in the immune system. The incorporation of these cannabinoid receptors with their endocannabinoids is known as the Endocannabinoid system (ECS).
Cannabidiol (CBD) and Tetrahydrocannabinol (THC) are the two most abundant cannabinoids in cannabis. These two cannabinoids are famous for their potent analgesic effects. They have similarities with endogenous endocannabinoid derivatives, including anandamide, an important mediator of mood, appetite, and nociception.
CB1 receptors are the most abundant G-protein-coupled receptors in the brain and are primarily localized in the brain, nerves, and spinal cord. CB1 receptors are expressed at far higher levels in the brain compared to the periphery and may play an important role in the affective component of pain by modulating activity in the limbic system. Studies have demonstrated an upregulation of CB1 in peripheral tissues in the setting of inflammation and neuropathy.
Both CB1 and CB2 receptors can be found on immune cells and can modulate inflammatory and immunosuppressive activity. CB2 is especially abundant in peripheral locations relevant to immunity, including leukocytes, macrophages, tonsils, spleen, and thymus. CB2 receptor activation inhibits the release of cytokines that promote inflammation, thus reducing pain and inflammation. Selective CB2 receptor agonists are promising options for analgesia, as alleviation of inflammatory, neuropathic, and nociceptive components of back pain may theoretically be achieved while avoiding the psychotropic effects of CB1 receptor activation. Numerous preclinical models provide evidence for the feasibility of this approach, particularly with the use of CBD in alleviating pain.
The Therapeutic Potential of Cannabinoids in Relieving Back Pain
The cannabinoid compounds are believed to have the potential to reduce the degree of pain in patients with back pain, especially when combined with low-dose opioids. Multiple preclinical studies suggest the potential synergy between cannabinoids and opioids for analgesia.
In a study of patients with failed back surgery syndrome without improvement after spinal cord stimulation, the addition of oral THC/CBD led to a significant improvement in pain, mood, and sleep. In another single-center Austrian study that included 30 patients with nononcologic spine pain refractory to NSAIDs and/or opioids, patients treated with nabilone had significant improvement in pain.
In 2006, a group of researchers conducted a randomized placebo-controlled study to determine the effectiveness of combined CBD and THC in treating back pain. Patients were either given a placebo or an oral spray containing 2.7 mg THC and 2.5 mg of full spectrum CBD oil. After a few months of follow up, it was noted that THC/CBD was effective in reducing resting pain (pain at rest) remarkedly compared to baseline pain scores. The degree of pain reduction was also significantly higher in patients treated with CBD/THC compared to placebo. Sleep was also improved in these patients significantly compared to placebo.
In conclusion, CBD is a very effective drug for the treatment of various kinds of pain, especially back pain and pain that is irresponsive to conventional analgesics. Prior to using CBD, make sure to consult your physician to adjust your dose.
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