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Post laminectomy syndrome is persistent pain that develops following a surgical back procedure. Research has shown that chronic pain patients, such as those suffering from post laminectomy syndrome, can find significant pain relief with cannabis.
Overview of Post Laminectomy Syndrome
Post laminectomy syndrome is a condition that causes persistent pain in the back or neck following a laminectomy surgical procedure. During a laminectomy, part of the vertebra that protects the spinal cord is removed to relieve pressure caused from a protruding disc. While most patients recover from the procedure without problems, in a small number of cases, pain can develop and persist. The pain is commonly isolated to the back but will sometimes also affect the leg.
A variety of factors can cause post laminectomy syndrome, but most cases are due to the spinal nerve root being decompressed by the surgery and not fully recovering from the trauma. Chronic pain may arise because of the formation of scar tissue around nerve roots. Structural changes surrounding the spine of the surgery, a new disc herniation, and postoperative spinal ligament instability can also lead to problems.
The type of pain caused by the syndrome can vary. Some patients will report a dull, achy pain at the spinal column, while others will describe a sharp, pricking and stabbing pain. The persistent pain can subsequently cause depression and anxiety.
Post-laminectomy syndrome is most commonly treated with pain killer medications, physical therapy and specialist therapies like epidural nerve blocks, radiofrequency denervation, and platelet rich plasma therapy.
Findings: Effects of Cannabis on Post Laminectomy Syndrome
Cannabis has proven to be an effective and safe pain-reliever, with studies showing it can reduce pain associated with neuropathy, headache and migraines, cancer, spasticity, and other chronic pain conditions5,8. Tetrahydrocannabinol (THC) and cannabidiol (CBD), two compounds found in cannabis, activate the cannabinoid receptors CB1 and CB2, which are responsible managing pain levels16.
THC and CBD have shown they are effective at reducing chronic pain related to neuropathic conditions and can even help manage pain that has proven refractory to other treatments6,7,9,14. Surveys have shown chronic pain patients experience significant pain relief after using cannabis13,15. A study examining chronic pain medical marijuana users in the state of Washington found four of the 139 patients to have failed back surgical syndrome. Those four patients reported significant pain improvements and two of the four claimed that medical marijuana was the most effective method for relieving pain1. Additionally, a research review concluded that cannabis is effective at treating several chronic pain conditions, including post laminectomy syndrome, and is a safer option than opioids3.
While research examining cannabis’s effect on treating the underlying cause of post laminectomy syndrome are lacking, studies have shown that cannabinoids have neuroprotective effects and can limit nerve damage and facilitate recovery following trauma4.
States That Have Approved Medical Marijuana for Post Laminectomy Syndrome
The state of Connecticut is the only state to have approved medical marijuana specifically for the treatment of post laminectomy syndrome.
Several states have approved medical marijuana specifically to treat “chronic pain,” a symptom commonly associated with neuropathy. These states include: Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Maryland, Michigan, Montana, New Mexico, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, and West Virginia. The states of Nevada, New Hampshire, North Dakota, Montana, Ohio and Vermont allow medical marijuana to treat “severe pain.” The states of Arkansas, Minnesota, Ohio, Pennsylvania, Washington, and West Virginia have approved cannabis for the treatment of “intractable pain.”
In Washington D.C., any condition recommended by DC-licensed physician can be approved for medical marijuana.
Recent Studies on Cannabis’ Effect on Post Laminectomy Syndrome
- Aggarwal, S.K., Carter, G.T., Sullivan, M.D., ZumBrunnen, C., Morrill, R., and Mayer, J.D. (2009, September – October). Characteristics of patients with chronic pain accessing treatment with medical cannabis in Washington State. Journal of Opioid Management, 5(5), 257-86. Retrieved from https://www.oregon.gov/pharmacy/Imports/Marijuana/StaffReview/CharacteristicsofpatientswithchronicpainaccessingtreatmtwithmedicalcannabisinWAStateSep-Oct-2009.pdf.
- Aggarwall, S.K. (2013, February). Cannabinergic Pain Medicine: A Concise Clinical Primer and Survey of Randomized-controlled Trial Results. The Clinical Journal of Pain, 29(2), 162-71. Retrieved from http://journals.lww.com/clinicalpain/Abstract/2013/02000/Cannabinergic_Pain_Medicine__A_Concise_Clinical.11.aspx.
- Aggarwal, S.K., Pangarkar, S., Carter, G.T., Tribuzio, B., Miedema, M., and Kennedy, D.J. (2014, April). Medical marijuana for failed back surgical syndrome: a viable option for pain control or an uncontrolled narcotic? PM&R: The Journal of Injury, Function, and Rehabilitation, 6(4), 363-72. Retrieved from http://www.pmrjournal.org/article/S1934-1482(14)00121-X/fulltext.
- Arevalo-Martin, A., Garcia-Ovejero, D., Sierra, Palomares, Y., Paniagua-Torija, B., Gonzalez-Gil, I., Oretega-Gutierrez, S. and Molina-Holgado, E. (2012). Early endogenous activation of CB1 and CB2 receptors after spinal cord injury is a protective response involved in spontaneous recovery. PLos One, 7(11), e49057. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3496738/.
- Baron, E.P. (2015, June). Comprehensive Review of Medicinal Marijuana, Cannabinoids, and Therapeutic Implications in Medicine and Headache: What a Long Strange Trip It’s Been… Headache, 55(6), 885-916. Retrieved from http://onlinelibrary.wiley.com/wol1/doi/10.1111/head.12570/full.
- Boychuck, D.G., Goddard, G., Mauro, G., and Orellana, M.F. (2015 Winter). The effectiveness of cannabinoids in the management of chronic nonmalignant neuropathic pain: a systematic review. Journal of Oral & Facial Pain and Headache, 29(1), 7-14. https://goo.gl/R28LWD.
- Burns, T.L., and Ineck, J.R. (2006, February). Cannabinoid analgesia as a potential new therapeutic option in the treatment of chronic pain. The Annals of Pharmacotherapy, 40(2), 251-60. Retrieved from http://journals.sagepub.com/doi/pdf/10.1345/aph.1G217.
- Jensen, B., Chen, J., Furnish, T., and Wallace, M. (2015, October). Medical Marijuana and Chronic Pain: a Review of Basic Science and Clinical Evidence. Current Pain and Headache Reports, 19(10), 524. Retrieved from http://link.springer.com/article/10.1007%2Fs11916-015-0524-x.
- Lynch, M.E., and Campbell, F. (2011, November). Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials. British Journal of Clinical Pharmacology, 72(5), 735-744. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3243008/.
- Post Laminectomy Syndrome. (n.d.). Center for Pain Medicine. Retrieved from http://www.centerforpain.com/conditions/post-laminectomy-syndrome.
- Post-Laminectomy Syndrome. (n.d.). National Spine & Pain Centers. Retrieved from https://treatingpain.com/condition/post-laminectomy-syndrome.
- Post Laminectomy Syndrome. (2013). Neurological Associates, PC. Retrieved from http://neurosurgicalassociatespc.com/post-laminectomy-syndrome/.
- Tripp, D.A., Nickel, J.C., Katz, L., Krsmanovic, A., Ware, M.A., and Santor, D. (2014, November). A survey of cannabis (marijuana) use and self-reported benefit in men with chronic prostatitis/chronic pelvic pain syndrome. Canadian Urological Association Journal, 9(11-12). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4277530/.
- Wallace, M.S., Marcotte, T.D., Umlauf, A., Gouaux, B., and Atkinson, J.H. (2015, July). Efficacy of Inhaled Cannabis on Painful Diabetic Neuropathy. Journal of Pain, 16(7), 616-27. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5152762/.
- Ware, M.A., Gamsa, A., Persson, J., and Fitzcharles, M.A. (2002, Summer). Cannabis for chronic pain: case series and implications for clinicians. Pain Research & Management, 7(2), 95-9. Retrieved from http://downloads.hindawi.com/journals/prm/2002/380509.pdf.
- Woodhams, S.G., Sagar, D.R., Burston, J.J., and Chapman, V. (2015). The role of the endocannabinoid system in pain. Handbook of Experimental Pharmacology, 227, 119-43. Retrieved from http://link.springer.com/chapter/10.1007%2F978-3-662-46450-2_7.