Use of THC Amongst Patients with Chronic Back Pain in a Rural American State: A Cross-sectional Survey

Introduction: Low back pain affects 50-80% of adults during their lifespan. Resources for pain control are limited in rural areas, leaving patients with few evidence-based options. Patients may consider transitioning to cannabis for pain control, which can be more easily accessed. The purpose of this cross-sectional study was to define the demographic characteristics, characteristics of use, and efficacy for those utilizing cannabis for back pain.

Methods: A survey was sent to 10,000 patients over 18 years of age in a rural academic medical center with a documented non-cancer chronic pain diagnosis. Statistical analysis assessed differences between who did and did not use cannabis for back pain, satisfaction with pain control, and use of other medications for pain.

Results: 1,161 patients reported chronic back pain, and 269 (23%) utilized cannabis for pain control. Patients using cannabis tended to be younger and report more years of having low back pain. After adjusting for potential confounders, those who used cannabis reported significantly more pain than those who did not use cannabis, but there were no significant differences in satisfaction with pain management between groups. Those using cannabis were also more likely to utilize or have tried several other alternative, non-pharmacological methods of pain management and were less likely to use other medications for pain.

Conclusion : Cannabis is being utilized as a method of managing chronic back pain in a rural Appalachian population, particularly by those who have experienced pain longer or have unsuccessfully tried multiple other treatment modalities. While the use of cannabis for treatment of chronic back pain is controversial, it is essential for physicians to recognize and investigate this possibility where clinically relevant. Future research is indicated to explore longitudinal outcomes of patients utilizing cannabis for back pain, including medical efficacy and socioecological outcomes.