Cannabis offers new hope to those with chronic back pain

Medical cannabis is offering new hope to those living with chronic back and spinal pain, writes Dr Anthony Ordman, hon. medical director of Integro Medical Clinics.

Anthony Ordman spent over 20 years working in the Pain Management Clinic of London’s Royal Free Hospital, having set it up in 1997 and is a former president of the Pain Medicine section of the Royal Society of Medicine.

Awarded the Fellowship of the Royal College of Physicians in 2005 in recognition for his work, Anthony is now senior clinical adviser and hon. medical director of Integro Medical Clinics and is a medical advisor to charities helping musicians, and those in the performing arts. 

Dr Anthony Ordman

I became a consultant in pain medicine some 24 years ago, and have always had a special interest in back and spinal pain which trouble so many of the people attending the pain clinic as patients, and indeed so much of the general population.  

Perhaps back pain is so common because our spines are designed by evolution for walking on all four limbs and supported at both ends.

But we, as humans, insist on walking only on our hind limbs and sitting upright, putting much more mechanical strain on every structure in our backs than they were designed for. Many of us also mobilise our backs through exercise rather less than we perhaps should.

We only have to look at our pet cats, to see how regular bending and stretching of our spines should be done several times a day, to keep spines healthy.

We also tend to be much more sedentary than we should be, and so the postural ‘core stability’ muscles surrounding our spines, can become rather less effective as “guy ropes” than they should be. Then, as intervertebral discs become worn, and facet joints at the back of the spine become enlarged and stiff, nerve roots leaving the spine to go down the arm or leg become pinched, and spinal muscles can become painfully tight, and spines can become stiff and painful.  

Often, with the right balance of rest and exercise, and simple pain medicines such as paracetamol and ibuprofen, an episode of back pain can settle down relatively quickly.

But sometimes people are not so fortunate, and pain in the spine and limbs can go on to become long-term or chronic. 

There are many other people, who suffer spinal pain brought on by their long-term medical conditions, such as multiple sclerosis, inflammatory arthritis, fibromyalgia, or hypermobility and Ehlers-Danlos syndromes, who have a very difficult time, despite the best medical treatment of the underlying condition itself.

Modern physiotherapy and medicine can often be of great help in such circumstances.

But sometimes, even in the best of pain clinics, with x-ray guided spinal injections, the best pain medicines, expert physiotherapists, clinical psychologists, acupuncture and homoeopathy, are not enough, and we struggle to help people rid themselves of back pain, enough to be able to enjoy life again. Often, this is because the pain has been ‘centralised’ by changes in the nerve cells of the central nervous system. 

Thinking in particular of the specialist pain medicines we have to offer, choices can be surprisingly limited, and we have to be careful not to do more harm than good.

Opioids such as codeine, tramadol and morphine don’t often help after a few weeks but continue to cause sedation, brain fog and constipation, with a high risk of dependency.

Medicines such as amitriptyline used for nerve pain, low mood and poor sleep, often take more away more from patients in terms of memory and alertness, than they give through pain reduction. The same is so often true for gabapentin and pregabalin, and many of the other medicines licensed for treating pain. And while we are hopeful that the new classes of pain medicines will come along soon, we can’t expect any miracles just yet.

The role of the endocannabinoid system

But throughout my years in pain medicine, I’ve always attended national and international scientific medical meetings and, interestingly, almost every scientific conference seemed to have at least one lecture on the mysterious endocannabinoid system (ECS).

This is a system of natural biological pathways present in all of our bodies, where nerve cells, and immune and others cells use natural ‘cannabinoid’ substances to signal to each other, regulating bodily processes such as pain transmission, inflammation, and so on.

The function of the ECS seems to have to do with normalising body activity after illness or injury. The hope had always been that, very soon, the big mainstream pharmaceutical companies would find us the medicines we needed to modulate the ECS to reduce pain and improve lives. 

Exploring medical cannabis

I was keen to find out for myself what cannabis medicines might have to offer patients who I could not help in other ways

I was extremely fortunate to be approached by the chief executive of Integro Medical Clinics to see if I would take up the medical leadership role in a service that would specialise in using the new cannabis-based medicines.

With the partnership and expert support of IPS, the country’s, leading expert pharmacy in dispensing pharmaceutical cannabis medicines, and several months of study on cannabis medicine, I found myself prescribing cannabis medicines for people whose lives were on hold because of pain.

Many had already tried CBD oil and found this just wasn’t enough to help, something we’re seeing more and more now. But in the clinic, we find that by blending just the right amount of THC and terpenes in each patient’s cannabis oil or flower, we are improving patients’ nerve and inflammatory joint pain and the painful muscle spasm of spinal pain, as well as improving sleep at night, without the daytime sedation or dependency of conventional pain medicines.

People can begin to get back to their work and childcare and leisure activities, with a clear head and sharper memory.

Within two or three months we can begin to relieve people of the burden of their conventional pain medicines. The very same cannabis medicines can also restore healthy sleep to patients, and lift mood, which had been depressed by pain for so long. People also felt brighter and less anxious than before.

Integro Medical Clinics Ltd always recommends remaining under the care and treatment of your GP and specialist for your condition while using cannabis-based medicines. The Integro clinical team would always prefer to work in collaboration with them.

If you would like further information or to speak to Dr Anthony Ordman please contact Integro Clinics:  www.integroclinics.com email: Contact@integroclinics.com and Twitter: @clinicsintegro

Visit backcare.org.uk further support with your back pain