Comparing Sublingual and Inhaled Cannabis Therapies for Low Back Pain: An Observational Open-Label Study

Abstract

Background and Objective: Medical cannabis is becoming an acceptable treatment modality in medicine, especially for pain relief. Concurrently, cannabis use is becoming more prevalent worldwide, a public demand-driven trend despite the lack of established scientific basis. This observational open-label study sought to investigate the effectiveness of cannabis therapy for alleviating low back pain symptoms. Methods: Two types of cannabis treatment modalities were sequentially administered to chronic low back pain patients. After an initial 1-month washout period (WO1), the first modality was cannabidiol (CBD)-rich sublingual extract treatment administered for 10 months. Following another washout period, the second modality, Δ⁹-tetrahydrocannabinol (THC)-rich smoked inflorescence (whole dried cannabis flowers) was administered for 12 months. Results: Enrolled in the study were 24 patients whose advanced imaging studies (i.e. computerized tomography or magnetic resonance imaging of the lumbar spine) revealed disc herniation or spinal stenosis. Three patients dropped out of extract therapy treatment but resumed study participation to receive THC-rich smoking therapy. After a minimum of 2 years, cannabis therapy had reduced lower back pain symptoms, as assessed by Oswestry Disability Index, the SF-12 patient-reported outcome questionnaire, and the visual analogue scale. Pain reduction was not significant during the extract treatment part of the study; however, pain reduction was significant during the inhaled therapy part of the study. Conclusions: Our findings indicate that inhaled THC-rich therapy is more effective than CBD-rich sublingual extract therapy for treating low back pain and that cannabis therapy is safe and effective for chronic low back pain.

Three Decades of Cannabis Research: What are the Obstacles?

“…Dror Robinson and colleagues compared the sublingual administration of cannabis oil extracts to inhaled cannabis in patients suffering from chronic low back pain. 11 Their study represents a real-world situation in which the exact cannabis ingredients were variable. Few studies have compared different forms of cannabis administration.…”

The Use of Compounds Derived from Cannabis sativa in the Treatment of Epilepsy, Painful Conditions, and Neuropsychiatric and Neurodegenerative Disorders

“…Liquid cannabis extracts can be administered sublingually, where the extract is placed under the tongue for absorption into the bloodstream. This method allows for the rapid onset of effects due to the high vascularity of the sublingual mucosa [ 69 , 70 ]. Cannabis extracts can be formulated into topical products such as creams, lotions, or patches for application to the skin.…”

Co-Dispersion Delivery Systems with Solubilizing Carriers Improving the Solubility and Permeability of Cannabinoids (Cannabidiol, Cannabidiolic Acid, and Cannabichromene) from Cannabis sativa (Henola Variety) Inflorescences

“…The value ranges from 10% to 35% for THC and varies among patients due to divergence in number, duration, interval of puffs, breath hold time, inhalation volume, used device, and the site of deposition within the respiratory system; for CBD, the average value is 11–45% [ 11 ]. An alternative is to use sublingual drops, which are an extract diluted in a carrier oil to ensure the dissolution of cannabinoids, allowing for rapid absorption through the oral mucosa [ 17 ]. The bioavailability of cannabinoids after sublingual administration was assessed for CBD as 13–19%, whilst for THC it was 13–14% [ 18 ].…”