A Surprising Treatment for Chronic Lower Back Pain: Cannabis

Two new drug trials find a THC-based cannabis extract could help with the condition that affects millions.

It’s the leading cause of disability and one of the most costly health challenges of our time: chronic lower back pain.

More than 70 million U.S. adults suffer from chronic lower back pain.

Yet effective and safe treatments are few and far between, leading patients to try everything from supplements to acupuncture to cannabis for relief.

Now, two new studies provide some of the most comprehensive evidence yet that THC—the psychoactive compound in cannabis that creates the high—in combination with other parts of the cannabis plant may provide safe and effective relief. The two large, Phase 3 clinical trials demonstrated that the THC product is safe and more effective at reducing chronic lower back pain than placebo or opioids.

Unfortunately, the news, while promising, won’t provide immediate relief for the more than 70 million U.S. adults who suffer from chronic lower back pain. The product tested is expected to be available in parts of Europe next year, while the path to approval in the U.S. will require another clinical trial.

Doctors say the studies may make healthcare providers more likely to prescribe federally approved medical cannabis for chronic lower back pain off-label. And consumers can try experimenting with products with similar combinations of cannabis compounds so long as they start with low doses of THC.

Meanwhile, the White House directed federal agencies to reclassify cannabis as a less-dangerous drug, a move that will likely further increase its popularity in states where cannabis is sold legally.

The studies were conducted by Vertanical, a German pharmaceutical company. It used a proprietary cannabis extract from a sativa strain, containing majority THC, as well as smaller amounts of other cannabinoids, such as CBD and CBG, and other compounds from the cannabis plant.

Ziva Cooper, director of the UCLA Center for Cannabis and Cannabinoids, said even though the commercial version of the product from the studies won’t be available in the U.S. anytime soon, physicians can use the results to help guide patients.

“I think these might be landmark studies that physicians can look to and might make them more comfortable prescribing dronabinol with chronic lower back pain,” says Cooper, who wasn’t involved with the study. Dronabinol is a synthetic form of THC that is approved by the U.S. Food and Drug Administration to treat patients with AIDS-related anorexia and chemotherapy-induced nausea.

Some doctors are already doing that.

Dr. Kevin Hill, an associate psychiatry professor at Harvard Medical School and director of addiction psychiatry at Beth Israel Deaconess Medical Center, says he prescribes cannabis to treat pain in his practice but not as a first-line treatment.

The first of the cannabis studies, published in journal Nature Medicine earlier this year, included more than 800 chronic lower back pain patients. It found after 12 weeks of treatment that the patients taking the cannabis extract reported less pain than those taking a placebo.

The effects continued for up to a year and were particularly pronounced in those with neuropathic and severe pain. Participants also reported improvements in sleep quality and physical function. When stopping the cannabis product, participants had no withdrawal symptoms.

A second study enrolled more than 380 patients and found cannabis was more effective at alleviating pain than opioids and resulted in less constipation.

Vertanical is applying to have a licensed drug product in Germany and several other European countries next year. It says it’s also in talks with the FDA to conduct another Phase 3 trial in the U.S.

Kevin Boehnke, an assistant professor of anesthesiology at the University of Michigan Medical School, says the two studies “are a big deal.”

THC is the cannabinoid most associated with dependence and getting high. But the research found that once people went through a three-week titration period, side effects—such as feeling a high—stabilize at a much lower frequency.

Despite the fact that the product used in the studies won’t be available in the U.S. anytime soon, Boehnke says the research is still informative for consumers. If deciding to try cannabis for lower back pain relief, start low and go slow, he says.

“Don’t overshoot, do it over a number of weeks,” he says.

In the studies, participants started taking 2.5 milligrams of THC twice a day. Patients increased doses every 3 days, capping out at about 10 milligrams twice a day.

Once patients reached an effective dose, it wasn’t increased. This is notable given the studies were three to six months, says Cooper.

In the study comparing opioids to cannabis, patients had to increase their dose of opioids while those taking the cannabis medication didn’t.

“We know that tolerance does develop to certain effects of THC,” says Cooper. “Here, patients didn’t need to increase their dose to relieve their pain, reducing the chances of unwanted side effects.”

Boehnke says cannabis can potentially be a good alternative to opioids. Still, people should be cautious of the potential for addiction, he says.

Studies show that chronic pain is the most common reason people take medical marijuana.

Nearly 26% of people with chronic pain reported managing it with cannabis over the past year and a quarter said they had taken it in the last 30 days, according to a 2023 Jama Network Open study. More than half said their use of cannabis allowed them to decrease their use of opioids or over-the-counter pain medications.

That jibes with the findings of a recent JAMA Internal Medicine study that followed more than 200 patients with chronic pain over 18 months.

Researchers were looking to see if those patients taking cannabis reduced their use of opioids.

“We found that…controlling for confounding factors including time and mental health symptoms and pain, medical cannabis reduced opioid use consistently,” says Dr. Deepika Slawek, an associate professor of medicine at Montefiore Einstein in New York City and first author of that study.

But before you think THC is going to solve all your chronic back pain, keep in mind that the average differences in pain between the group that took the cannabis extract versus placebo was statistically significant but relatively small, notes Dr. Devan Kansagara, a professor of medicine at Oregon Health and Science University in Portland.

“Pain in general is a tough thing to move the needle on,” says Kansagara.

Write to Sumathi Reddy at Sumathi.Reddy@wsj.com