Spinal Cord Injuries & CBD Oil: Addressing Chronic Pain & Depression
Spinal Cord Injuries & CBD Oil: Addressing Chronic Pain & Depression
CBD oil may not restore motor function, but it has been shown to help with a handful of other symptoms associated with spinal cord injuries.
Spinal cord injuries (SCIs) impact nearly five million Americans each year. Some call the spinal cord an “information superhighway” because it’s what connects the brain to the nerves that provide feedback from all the different parts of the body. Because it plays such a crucial role in pain perception and bodily function, those who have a spinal cord injury can often have reduced quality of life.
It appears that CBD oil may offer some welcome relief to those suffering with a spinal cord injury. CBD oil can be an effective pain reliever and provide plenty of other potential benefits that could improve physical and mental health.
Benefits of Using CBD Oil for Spinal Cord Injuries
While there are plenty of treatment options available to those dealing with a spinal cord injury, they aren’t always effective. Treatments such as acupuncture, cognitive restructuring, physical therapy, psychotherapy, and therapeutic massage are all viable options, but they can have mixed results and they’re not for everyone.
For those dealing with a spinal cord injury, pain medications are often prescribed, but due to their many side effects and risk for addiction, many patients are looking elsewhere for relief. One such alternative option which has been getting a lot of attention lately is cannabidiol (CBD).
If you’re someone with a spinal cord injury and are considering adding CBD oil to your current treatment plan, first speak with your doctor and take a look at this chart to better understand the potential risks and benefits of using CBD alone or in tandem with your current medication.
|Common Medications Used for Spinal Cord Injuries (SCIs)||Potential Side Effects of SCI Medication||Potential Benefit of CBD Oil for SCIs||Potential Side Effects of Combining CBD Oil w/ SCI Medication|
|Intravenous methylprednisolone (A-Methapred; Solu-Medrol)||Nausea; vomiting; heartburn; headache; dizziness; insomnia; appetite changes; acne; increased sweating; redness or pain at injection site.||CBD oil can reduce inflammation and suppress an immune response without causing any of these side effects.||There are no known side effects of using CBD oil and methylprednisolone but that does not mean they don’t exist. Always consult a doctor before using CBD oil.|
|Acetaminophen||Nausea; vomiting; loss of appetite; severe stomach pain; weakness; yellowing of the eyes; stomach ulcers; liver damage.||CBD oil can relieve pain without causing any of these side effects.||Using CBD oil and Acetaminophen can increase the risk of liver damage. Always consult a doctor before using CBD oil.|
|Opioids||Sedation; constipation; nausea; vomiting; respiratory depression; dizziness; depression; increased risk of addiction.||CBD oil can relieve pain without causing any of these side effects.||Using CBD oil with opioids can increase the risk of experiencing dizziness; drowsiness; confusion. Always consult a doctor before using CBD oil.|
|Ibuprofen||Nausea; vomiting; upset stomach; heartburn; dizziness; headache; ringing in ears; stomach ulcer; liver damage.||CBD oil can relieve pain without causing any of these side effects.||Using CBD oil and Acetaminophen can increase the risk of liver damage. Always consult a doctor before using CBD oil.|
While CBD oil may not be a miracle cure for treating spinal cord injuries, it is non-habit-forming and is generally well-tolerated. The World Health Organization (WHO) has even stated, “ In humans, CBD exhibits no effects indicative of any abuse or dependence potential,” and, “no public health problems… have been associated with the use of pure CBD.”
CBD oil is looking like it could have significant potential for those looking to improve their quality of life following a spinal cord injury.
Effectiveness of Using CBD Oil for Spinal Cord Injuries
One of the most common symptoms of spinal cord injuries is paralysis, or loss of movement in the arms and legs. There is not enough conclusive research to suggest CBD oil could help restore motor function to paralyzed limbs in humans.
However, CBD oil could help with other symptoms associated with spinal cord injuries including chronic pain, muscle spasms, and depression.
CBD Oil for Chronic Pain
In one study done on CBD oil’s pain-relieving effects, CBD was found to reduce chronic pain through its effect on glycine receptors in the central nervous system. These are inhibitory receptors that play a role in the perception of nerve pain. The study reads, “We report that systemic and intrathecal [spinal injection] administration of cannabidiol (CBD), a major non psychoactive component of marijuana, and its modified derivatives significantly suppress chronic inflammatory and neuropathic pain.”
In a different study performed on patients with self-reported spinal cord injuries, researchers asked test subjects to try different methods for pain relief, including opioids, marijuana, and massages. In the end, the most effective and preferred treatments for chronic pain were massages and marijuana.
Lastly as part of the 2014 Spinal Cord Injury Wellness Summit at the University of Washington, Dr. Gregory T. Carter spoke on the advantages of using medical marijuana, and CBD specifically, to treat the painful symptoms of spinal cord conditions like ALS. He suggested using high-CBD and low-THC cannabis strains to find pain relief without the intoxication often associated with recreational marijuana use. Furthermore, when speaking on a review of 18 human studies examining cannabis’ analgesic properties performed as part of the summit, Carter states, “we now know on the basis of science and clinical trials that cannabis and cannabinoids work very well for neuropathic [nerve] pain and spasticity.”
CBD Oil for Muscle Spasms
Aside from offering SCI patients relief from pain, CBD oil may also be an effective muscle relaxer. Full- or broad-spectrum CBD oils will contain all of the terpenes found in the hemp plant, including myrcene and limonene, which have both been found to exhibit motor relaxant effects.
For many patients with spinal cord injuries, muscle spasms are common, and it can be difficult to find relief. In one study, the sublingual spray Sativex, a combination of CBD and tetrahydrocannabinol (THC), was found to be an effective anti-spasm treatment. Sativex is currently legal in the United Kingdom for mitigating the symptoms of multiple sclerosis (MS).
In 2012, the University of California conducted a study on cannabinoids and spasticity in patients with multiple sclerosis. The randomized, placebo-controlled crossover study found that of the 30 people who completed the trial, those that smoked cannabis reported an average 2.74-point reduction in the Modified Ashworth scale compared to the placebo. (The Modified Ashworth Scale is used to measure spasticity in MS patients.) It’s important to note here that cannabis, and not CBD specifically, was responsible for the improvement in MS symptoms.
CBD Oil for Depression
Because spinal cord injuries can leave people paralyzed, the sudden change in physical capability, and ultimately lifestyle, can bring on depression. While it’s no replacement for talk therapy, CBD oil may be an effective, supplementary option for dealing with the symptoms of depression.
CBD activates a serotonin receptor called 5-HT1A, which elevates serotonin levels in the brain. Low serotonin has been linked to both depression and anxiety, and usually selective serotonin reuptake inhibitors (SSRIs) are prescribed to increase the amount of serotonin available in the brain. CBD oil works similarly to SSRIs but does not carry the same side effects as traditional antidepressant medications.
CBD oil can also increase the amount of adenosine and anandamide in the brain. These neurotransmitters play a role in the regulation of mood. Anandamide is responsible for feelings of joy and motivation, and adenosine for clarity and mood elevation.
How to Take CBD Oil for Spinal Cord Injuries
Before taking CBD oil it is essential that you first speak to a doctor. CBD oil is fairly safe but it can interact with some medications so it is important to get the all-clear before starting.
Once you have your doctor’s blessing, you’ll need to choose which types of CBD products you’d like to use. CBD oil is available in a variety of forms. Depending on the severity of your spinal cord injury, some options may be better than others.
For SCI patients with limited or no mobility, a CBD oil capsule may be the best option. Capsules can be administered easily by a third party and will provide a consistent dose of CBD. CBD oil capsules may take up to an hour to show effects but these effects can last for 4-6 hours, providing a nice window of relief.
CBD oil topicals and transdermal patches may also be effective in these instances. Topicals, like CBD creams, gels, and salves, can be applied directly to the site of pain, offering targeted relief. This can be especially effective for muscle spasms and cramping. And, if massages are part of your SCI treatment plan, you’re in luck! There are some companies that make CBD massage oils. These formats are slow to show effects but can last for a very long time. CBD topicals can show effects for up to 8 hours, and transdermal patches can last up to 48 hours.
For SCI patients that maintain full mobility, edibles, CBD tinctures and drops, vaporizers or flower may be especially enticing options.
CBD oil tinctures and drops are applied directly under the tongue and show effects within 30 minutes and can last 2 to 4 hours. This delivery format provides superior dosage control making it easy to shift up or down as needed.
CBD vape oils and flower are the fastest-acting option. Because the CBD is absorbed through the lungs, it enters the bloodstream right away, providing near-instant relief. Unfortunately, these effects do not last long and are typically spent within an hour.
CBD Oil Dosage for Spinal Cord Injuries
In terms of dosing, it is a good idea to start with the lowest recommended dose listed on your CBD product. Starting slow will help you determine how your body will react to CBD and minimize the risk of experiencing any side effects or interactions.
If you can’t find a starting dosage, at CBD Oil Review, we have analyzed hundreds of products and come up with the following:
The CBD Oil Review Serving Standard is 25mg of CBD, taken twice daily
If this amount is not enough, slowly increase the dose by 25mg every 3 to 4 weeks until the desired effects are achieved.
For more information on dosing, check out our dosage guide, or consider having a consultation with a naturopathic doctor who can give you the most personalized action plan.
While CBD oil will not be able to cure a spinal cord injury, it can help relieve some of the more complicated symptoms associated with the condition. By reducing pain and muscle spasms while improving mood, CBD oil may provide a pathway towards better quality of life.
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Spinal cord injuries can be debilitating and treatment options are limited – luckily, CBD oil may help address some symptoms of SCIs. Here’s what to know!
Characteristics of Individuals with Spinal Cord Injury Who Use Cannabis for Therapeutic Purposes
1 Eastern Michigan University, Department of Psychology, Ypsilanti, Michigan
2 University of Michigan Health Center, Department of Physical Medicine and Rehabilitation, Ann Arbor, Michigan
Michelle A. Meade
2 University of Michigan Health Center, Department of Physical Medicine and Rehabilitation, Ann Arbor, Michigan
Background: People with spinal cord injury (SCI) are accessing cannabis for therapeutic purposes (CTP), the use of which has been legalized in more than 20 states. In the past, illicit marijuana use had positive correlations with other health risk behaviors. It is not known whether access to CTP has shifted patterns of use and altered health outcomes. Objective: To describe the self-reported patterns of CTP use among individuals with SCI and correlations with health behaviors and health indicators. Method: Secondary analysis of data from a cross-sectional study involving community-dwelling individuals with chronic SCI and neurogenic bladder and bowel, at least 5 years post injury. Data were collected via structured interviews. Results: 92.2% of the current sample (n = 244) lived in states that, at the time of the study, permitted the use of CTP. 22.5% reported using CTP at least monthly to relieve pain (70.4%) and spasticity (46.3%). Of those 54 participants, 52.7% were daily users. Whereas 23.0% of non-CTP users endorsed having prescriptions for at least one opioid-based medication, 38.1% of CTP users did so, suggesting that CTP use does not mitigate opioid use. Users were more likely to be single and live alone, report more bladder complications, and perceive their psychosocial functioning as more compromised than non-users. Conclusion: A relatively large percentage of individuals with chronic SCI appear to use CTP on a regular basis. Results suggest that they may be more vulnerable to complications and to risk factors for substance use disorders in SCI, such as social isolation. Although the generalizability of these findings is limited by the sampling strategies and the eligibility criteria of the larger study, CTP use should be assessed and considered when planning health interventions.
Human use of cannabis goes back thousands of years, but the discovery of its mechanism of action – the endocannabinoid system – occurred fairly recently, with the cloning of the first receptor in 1990.1 Since then, our basic understanding of the endocannabinoid system has grown considerably, and its participation in immune, metabolic, and cognitive functioning as well as pain modulation and sleep has been established.2 Neuroprotective effects of cannabinoids have been shown preclinically when administered within hours following cerebral or spinal lesions3–6 and have been broadly publicized.7,8 While creating visions of novel therapeutic potential, the basic neuroscience of cannabinoids raises significant concerns: The cannabinoid system is complex and exerts direct and indirect actions upon a wide range of fundamental physiological processes. The clinical impact of chronic use of cannabis-based products is not known, especially when users’ central nervous system is already compromised.9
Today, public advocacy and commercial interests have outpaced a systematic approach to the use of cannabinoids in clinical populations. Without evidence-based guidelines for dosing, administration, or drug-drug and drug-disease interactions, and with great uncertainty regarding short and long-term risks and benefits, 23 states and Washington, DC, have legalized cannabinoids for therapeutic purposes (CTPs) in general, and an additional 16 states restrict therapeutic applications to cannabidiol.10,11 In contrast to medicinal products regulated by the US Federal Drug Administration (FDA), such as synthetic cannabinoid receptor ligands (eg, dronabinol, nabilone), plant-based CTP products that are illegal at the federal level are not receiving any oversight.12,13
Because of the wide gap between clinical evidence and practice, it is important to know about the characteristics of current users of CTP as well as their self-reported reasons for use. Cross-sectional studies have repeatedly shown that chronic pain and associated conditions are the main reasons cited for cannabinoid use among medical populations.14 In the United States and the United Kingdom, younger age, male gender, and previous recreational use predict the use of CTP.15 A study of applicants for the medical marijuana card in the United States found that only a minority ( (p115) Whereas some users report reduction in SCI-related pain and potentially spasticity for hours after administration, evidence for the efficacy of CTP use in clinical trials is mixed and complicated by the lack of methodological consistency (eg, in administration and dosing). Further challenging the interpretation of CTP use in SCI is the circumstance that many individuals with SCI have clinically significant substance use histories, just as the general users of CTP described previously.23 The use of cannabinoid-based products may be a continuation of preexisting behavior patterns that can result in increased vulnerability to adverse health effects following SCI, such as bladder and bowel complications.24,25 However, little is known about complications and potential correlations with CTP use in particular.
The purpose of the current cross-sectional study was to describe the characteristics of individuals with chronic SCI who self-reported use of cannabinoid-based products and to examine their stated reasons for use, self-reported SCI-related complications and health behaviors, and relationships with health care providers. When sample size allowed, comparisons were made between CTP users and non-users within this sample.
This study represents a secondary analysis of data collected as part of an ongoing investigation of bowel and bladder complications and their impact on quality of life (QOL) in SCI. Participants with chronic SCI were recruited via the SCI Research Registry of a large medical center in the Midwest region of the United States, advertisements in SCI-related newsletters, lectures at rehabilitative settings, and from SCI outpatient clinics at this medical center. Effectively, participants were recruited across the United States, regardless of whether a state had legalized medical cannabis use at the time of the interviews. Potential participants were screened for the following inclusion criteria: (a) at least 18 years old; (b) neurogenic bowel and/or bladder; (c) having incurred a traumatic SCI at least 5 years before the time of the interview; (d) English-speaking; (e) American Spinal Injury Association (ASIA) Impairment Scale grades of A-D inclusive; and (f) not having cognitive limitations impairing their ability to complete the study interview.
Trained interviewers conducted telephone and in-person interviews. Face-to-face interviews were conducted at the local site only. The assessments used in this study occurred over a period of 27 months.
Measures included demographic information (gender, age, race/ethnicity, education, vocational status, marital status, primary living situation) and characteristics of the SCI (years since injury, neurological status, level of injury).
Functional status and QOL were assessed with the following instruments:
(a) Selected items from the Bowel and Bladder Treatment Index (BBTI)26: Degree of bowel assistance needed, degree to which bowel management, bladder management, sexual functioning changes, and pain interfered with daily life. Scores ranged from 1 (no effect) to 10 (worst effect).
(b) Medication use, self-reported and recorded by interviewers as part of the Bowel and Bladder Treatment Index (BBTI): Two authors of the study (C.D., M.F.) independently coded opioids, with 97% interrater agreement. Other drug classes were coded by C.D.
(c) The SF-Qualiveen27: 8-item questionnaire that assesses the interference of urinary problems with QOL, with 2 items addressing each of the following areas: feeling bothered by limitations, frequency of limitations, fears, and feelings. Item scores range from 0 to 4, and lower average scores indicate less interference. The total score is the mean of the subscales means scores.
(d) Spinal Cord Injury Multidimensional Quality of Life (SCI-QOL)28: Computerized adaptive test that produces T-scores for bladder complications, distress due to bladder management, distress due to bowel management, and ability to participate in social roles and activities. Higher T-scores reflect higher levels of the concepts measured (eg, if distress due to bowel management is measured, higher scores present greater disruption with functioning; if ability to participate is measured, higher scores present less disruption).
(e) Life Satisfaction Index, Form Z (LSI-Z)29: 13-item measure that assesses life satisfaction in retrospective. Responses take on values 0 (disagree), 1 (unsure), and 2 (agree) and total scores range from 0 to 26, with higher scores reflecting greater life satisfaction.
In addition, the degree of perceived social and instrumental support was assessed with a subscale of the Quality of Caregiving (QoC)30 measure (ie, relationship with the primary caregiver, 4 items) among those persons receiving caregiver services. The Working Alliance Inventory (WAI)31 was used to gauge the client-provider relationship. The WAI short-form is a 12-item measure that produces 3 subscales of 4 items each (alliance in terms of tasks, the client-provider bond, and the client’s goals). Items are presented on a Likert scale (1–7, where 7 represents a greater alliance).
Health behaviors that may have an indirect effect on complications were assessed with the Spinal Cord Injury Lifestyle Scale (SCI-LS).32 The SCI-LS is a 25-item questionnaire that asks about behavior over the last 3 months relevant to long-term cardiovascular (4 items), genitourinary (4 items), neuromusculoskeletal (8 items), skin (6 items), and psychosocial (2 items) health. Higher scores are indicative of greater health promotion. Self-reports of other behaviors related to bowel and bladder management, including cannabis use, were also obtained.
Cannabis use was self-reported by participants during the interview (“Have you ever used marijuana to make you feel better? All responses are kept absolutely confidential.”). “Yes,” “no,” and “refuse to say” answers were recorded by interviewers, who did not probe further about whether use occurred in legal or illicit contexts (eg, the status of marijuana card holders was neither assessed nor verified). Instead, the interview focused on purpose and mode of administration. Specifically, interviewees were asked if they used cannabis for bladder or bowel management, spasticity, pain, anxiety, or other purposes, including recreational use. If they answered “other,” they were asked to provide the reason. Participants were able to endorse more than one purpose and more than one mode of administration. Recreational use of cannabis was not independently assessed nor were alcohol use and other illicit drug use (eg, stimulants).
Characteristics of Individuals with Spinal Cord Injury Who Use Cannabis for Therapeutic Purposes Claudia Drossel 1 Eastern Michigan University, Department of Psychology, Ypsilanti, Michigan