Published: Jan 26, 2022

What Strain of Cannabis is Best for Pain Due to a Spinal Fusion?

In our latest question and answer, our medical cannabis expert discusses what strain of cannabis is best for pain management.

Answered by: Dr. Geoffrey Brown, PharmD

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back pain

Dell Asked

Is there a strain best suited or geared towards pain management? I recently had a c-spine c5,6,7 fusion, having to retire from active duty. I transitioned off pain meds and into cannabis, however, I haven’t found a strain for my chronic pain

Summary

W

No strong evidence suggests that one strain will work better than another strain for your chronic pain.

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Cannabis may be particularly effective at treating the emotional/affective component of chronic pain and with only minor effects on pain intensity.

W

Some studies suggest smoked or vaporized cannabis or oral doses in the range of 10-20 mg THC are effective for chronic non-cancer pain.

Answer

Hi Dell, thank you for your question. Let’s take an in-depth look at your question in more detail below. 

What is a Spinal Fusion?

A spinal fusion is a procedure where a surgeon places bone or other material between your spinal vertebrae and encourages the bones to heal or “fuse” together by the use of metal rods or screws. The procedure is often done after the removal of a herniated disc in order to stabilize the spine. In your case, a c5-7 fusion means that the bottom three vertebrae in your neck, or cervical spine, were fused together.

Can Cannabis Help with Pain following a Cervical Spine Fusion?

I couldn’t find any data on cannabis for pain due to a cervical fusion specifically, but I did find some information about neuropathy and spasticity, which commonly co-occur with spinal injuries. I also found some studies that examined cannabis’ effects on postoperative pain and spinal fusion outcomes.

In 2017, the National Academy of Sciences published a report about the health effects of cannabis and found that cannabis may be helpful in the management of neuropathic pain and spasticity, which again, may co-occur with spinal injuries and even after a spinal fusion.

Cannabis’s Effects on Spinal Fusion

At least one study has evaluated the effect of cannabis on surgical outcomes after Lumbar spinal fusion. Lumbar refers to the vertebrae in the lower back. This study found that there weren’t any significant differences in surgical outcomes between patients that used cannabis and didn’t use it. While it’s not quite groundbreaking, it’s encouraging that there were no significant differences in adverse events or negative outcomes associated with cannabis use.

Contrary to the previously mentioned study, cannabis has also been associated with negative outcomes following spinal surgery. In 2021, researchers from the University of Illinois evaluated a nationwide database and found that patients with cannabis use disorder had a higher occurrence of complications following spinal surgery.

The following complications occurred more frequently in individuals that used cannabis:

  • Respiratory complications
  • Blood clots
  • Stroke
  • Infection
  • Longer hospital stay
  • Discharge to another healthcare facility instead of home

Does Cannabis Help with Chronic Pain?

Many observational studies, surveys, and anecdotal reports suggest cannabis does help reduce chronic pain. However, these studies are generally considered weak due to the amount of bias, lack of control, and subjective nature of their design.

Well-controlled studies suggest that cannabis produces a minor reduction in pain intensity with some studies even suggesting it increases pain (a phenomenon called hyperalgesia). Cannabis appears to be particularly good at reducing the perceived unpleasantness of pain, treating neuropathic pain and the affective (emotional) component of pain most effectively.

What Strain is Best for Pain Due to a Spinal Fusion?

There isn’t any strong data that would support that one strain would work better than another strain for your pain. Part of this is due to the inherent nature of research on cannabis and part is due to the fact that the “strain” of cannabis does not provide much useful information medically speaking. That might come as a surprise, but I’m hoping after I explain things in detail you’ll understand better as to why “strain” is somewhat of a misnomer and why chemotype or “chemovar” matters much more than the strain does. Unfortunately, there is often a lack of reliable information (such as laboratory testing) that would inform on the chemotype which is essentially the chemical profile of the plant and/or product; that is what chemicals are present and at what concentrations.

The Nature of Cannabis Research & Strains

Research with cannabis focuses on standardized products and dosages, not strains. This is for a number of reasons. One reason is because research needs to be replicable. This means that scientists need to be able to repeat each other’s experiments in order to validate the results. It’s impossible for this to be done if the products used aren’t standardized. Another reason is to ensure the effects of the intervention (or product) being studied can be directly attributed to the product itself and nothing else. If an extraneous variable (something else) causes an effect other than the product being studied, it damages the validity of the study. Using products with standardized dosages and exact chemical compositions limits extraneous variables because there’s not something unknown in the product. This allows researchers to draw the conclusion that the effect they observe is due to the known ingredients in the product.

This is why there are no randomized controlled trials of “OG Kush”. OG Kush isn’t a standardized product; it’s a strain of cannabis and the chemical composition within it may vary greatly depending on numerous variables. 

Because the standard products, dosages, and formulations that are typically studied are different from what’s commercially available it’s difficult to take information obtained from these studies and apply it in a way that benefits patients using medical cannabis products.

“With the lack of standardization and reproducibility of these (products), it is impossible to generalize study outcomes to the products available to marijuana users.

The enigma of cannabis use in Spinal cord injury (Nature)

Leaning on Evidence-Based Resources & Chemotype Rather than Strain

Cannabis strains were originally developed as a way to classify cannabis plants based on appearance, but nowadays strains are somewhat of a misnomer. Cannabis companies often use strain classifications to their advantage; marketing products that likely have very similar chemical compositions for drastically different purposes despite a lack of science to support those claims.

Again, the strain name and Indica, Sativa, or Hybrid classification do not reliably inform on the biochemical composition of the cannabis plant or product produced from that plant. Even with the advent of websites like Leafly and their strain database; there’s no way to guess the biochemical composition of a cannabis plant and the ensuing effects, based on its physical characteristics, strain classification, or strain name.

Dr. Ethan Russo, a leading cannabis researcher and internationally recognized expert in cannabis sciences states that we should abandon the current strain nomenclature altogether!

“… I would strongly encourage the scientific community, the press, and the public to abandon the sativa/indica nomenclature and rather insist that accurate biochemical assays on cannabinoid and terpenoid profiles be available for Cannabis in both the medical and recreational markets.” -Russo 2016 (PubMed)

Instead, Russo suggests that reliable information on the chemotype be made available. This would allow patients and clinicians to use this information to make decisions regarding treatment. Again, the chemotype tells us the complete chemical profile within the plant and/or product. This includes common chemicals like THC and CBD, but also lesser known secondary cannabinoids such as cannabigerol, cannabichromene, cannabidivarin, as well as terpenes and flavonoids which may have numerous benefits.

Research on these lesser known compounds is still preliminary, but is evolving fast. Clinicians and patients could ultimately use information such as plant or product lab tests for these compounds to their advantage. 

For instance, some secondary cannabinoids or terpenes such as Beta-caryophyllene may have positive effects on pain, but without reliable information about the chemovar we’ll never know if these chemicals are present within the plant (or product) we intend to use. Another important factor to consider is drug delivery and whether these compounds are even capable of reaching their intended sites of action to produce clinical effects. For instance, some terpenes are not stable at high temperatures or are broken down by stomach acid, so depending on the route of administration the effects from some terpene compounds are likely moot.

To Summarize

There’s no strong evidence to support the notion that one strain will work better than another for your chronic pain. Overall, the use of cannabis for pain management following spinal fusion is controversial. I suggest you seek the information on the chemovar (not the strain) as well as the advice of a medical provider or pharmacist at a dispensary. They can help you identify cannabis products and dosages that have similar characteristics to what’s been evaluated in well-controlled studies. Then you can self-experiment using the provider’s guidance.

Good luck and I hope this helps.

References

Health Effects of Cannabis and Cannabinoids (Link)

The Effects of Marijuana Use on Lumbar Spinal Fusion (PubMed)

Cannabis Abuse and Perioperative Complications Following Inpatient Spine Surgery in the United States (PubMed)

The Enigma of Cannabis Use for Spinal Cord Injury (PubMed)

The Cannabis Sativa vs. Indica Debate (PubMed)

The cannabinoid CB₂ receptor-selective phytocannabinoid beta-caryophyllene exerts analgesic effects in mouse models of inflammatory and neuropathic pain (PubMed)

The influence of terpenes on the release of volatile organic compounds and active ingredients to cannabis vaping aerosols (Link)

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Dr. Geoffrey Brown, PharmD

Dr. Geoffrey Brown is a registered medical cannabis pharmacist in New York State and the founder of CannaBuff. He graduated from the University at Buffalo with a Doctor of Pharmacy degree in 2018. His cannabis research has been featured by the national advocacy group NORML and local news organizations. Please feel free to reach out to him if you want to connect!

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