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.2024 Sep 24:15:1464005.
doi: 10.3389/fphar.2024.1464005. eCollection 2024.

Edible cannabis for chronic low back pain: associations with pain, mood, and intoxication

Affiliations

Edible cannabis for chronic low back pain: associations with pain, mood, and intoxication

Samantha N Melendez et al. Front Pharmacol..

Abstract

Introduction: Cannabis, commonly known for both therapeutic and intoxicating effects, is gaining accessibility on legal markets and traction as a potential alternative therapy for pain mediation, particularly in those suffering from chronic low back pain. However, the effectiveness in this population of legal market forms of cannabis, particularly commonly used edibles, is unknown.

Methods: Therefore, this study utilized a naturalistic prospective design where participants with chronic low back pain with intentions to initiate cannabis use for treatment were recruited and self-selected edible cannabis products containing varying amounts of delta- 9 tetrahydrocannabinol (THC) and cannabidiol (CBD). Products were categorized as CBD-dominant, THC-dominant, or combined THC and CBD (THC + CBD).

Results: 249 participants [140 female (56.62%), mean (SD) age of 46.30 (16.02), 90% White] were tracked over 2 weeks ofad libitum use and assessed during a naturalistic acute cannabis administration session on changes in pain, mood, and subjective drug effects. During acute administration, a significant correlation between THC dose and short-term pain relief was found, suggesting that higher THC doses were associated with greater pain reduction (p < .05). In addition, THC was associated with higher levels of subjective cannabis drug effects (p < .001), regardless of whether CBD was also in the edible product. Acute CBD dose was primarily associated with short-term tension relief (p < .05); however, there were no associations between CBD dose and acute pain. Over the 2-week ad libitum administration period results suggested pain reductions across participants using all forms of cannabis. However, trends suggested that more frequent use of CBD-dominant edible cannabis may be associated with greater reductions in perceived pain over the 2-week observation period (p = .07).

Discussion: These findings support the short-term analgesic effects of THC and anxiolytic effects of CBD and further suggest that orally-administered THC and CBD should continue to be evaluated for the potential to provide both acute and extended relief from chronic low back pain.

Clinical trial registration: https://clinicaltrials.gov/study/NCT03522324?locStr=Boulder,%20CO&country=United%20States&state=Colorado&city=Boulder&cond=chronic%20low%20back%20pain&intr=Cannabis&rank=1, identifierNCT03522324.

Keywords: CBD; THC; cannabinoids; cannabis; chronic pain; edibles; observational; side effects.

Copyright © 2024 Melendez, Ortiz Torres, Lisano, Giordano, Skrzynski, Hutchison, Bryan and Bidwell.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Participant Consort and Inclusion Criteria. Figure 1 is a flow diagram of participant eligibility assessment, enrollment, product selection, and analysis. Subjects recruited for the study were assessed and those eligible were consented and enrolled. Participants self-selected an edible cannabis product and were grouped by THC, CBD, or THC + CBD.
FIGURE 2
FIGURE 2
Study Timepoints and Outcomes for Acute Use and Two-week Observation Periods. This diagram details the participant study visits over the Two-week and at the Acute Use timepoints, including the actives and assessments completed at each visit.
FIGURE 3
FIGURE 3
Plasma Concentrations (ng/mL) and Ingested Dose (mg) by Cannabis Product Group (CBD, THC + CBD, and THC) During Acute Mobile Laboratory Session. The bar graph depicts cannabidiol (CBD) plasma concentration and dose in red and tetrahydrocannabinol (THC) plus the blood THC metabolite 11-Hydroxy-Δ9-THC (11-OH-THC) plasma concentration and THC dose in blue for each cannabis product group.(A) Plasma concentration (ng/mL) of CBD and THC + THC-OH by product group at 1-h post-use and(B) CBD and THC ingested doses (mg) by product group during the acute use timepoint. Bars are graphed as ± mean (standard deviation). * = significant (p < 0.001) group difference between the CBD and THC + CBD groups, † = significant (p < 0.001) group difference between the CBD and THC groups, ‡ = significant (p < 0.01) group difference between the THC + CBD and THC groups. For cannabinoid exposure as measured by plasma concentrations (ng/mL), it was found that after acute cannabis use there was an expected and significant group by time interaction such that THC exposure (THC +11-OH-THC) was greater among the THC and THC + CBD groups compared to CBD, and CBD was greater within the CBD group compared to the THC and THC + CBD groups. In regard to ingested dose, these results also followed expected patterns by group such that the THC ingested dose was lower for the CBD group compared to both the THC + CBD and THC groups; the CBD ingested dose was greater for the CBD group compared to the THC + CBD and THC groups; and the CBD ingested dose was greater for the THC + CBD group compared to the THC group.
FIGURE 4
FIGURE 4
Changes in Pain Intensity, Negative Mood, and Intoxication Score by Cannabis Product Group (CBD, THC + CBD, and THC) During Acute Mobile Laboratory Session. The colored line graphs represent cannabis product group including CBD (red), THC + CBD (green), and THC (blue) and changes over time during the acute use session [before cannabis use (pre-use), 1-h post-use, and 2-h post-use].(A) Self-reported current pain intensity (Pain Intensity Short Form 3a) by product group by time(B) self-reported negative mood [Profile of Mood States (POMS)] by product group by time(C) self-reported drug effects [Cannabis Intoxication Scale (average of feeling high, mentally stoned, and physically stoned)] by product group by time. Bars are graphed as ± mean (standard deviation). Significant differences between timepoints and within groups are represented by colored lines corresponding to the color of the group and significant effects of time are represented by black lines. *** =p < 0.001, **p < 0.01, and *p < 0.05. For current pain intensity, all groups reported experiencing lower pain intensity over the course of the acute use session. For negative mood, there was a group by time interaction such that the CBD group experienced a decrease in tension over the course of the acute use session. Finally, for cannabis intoxication, there was a group by time interaction such that there were significant increases in intoxication scores from pre-use to both 1-h and 2-h post-use across all groups, however this increase was steeper for the THC and THC + CBD groups compared to the CBD group.
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