Updated on April 1, 2020. Medical content reviewed by Dr. Joseph Rosado, MD, M.B.A, Chief Medical Officer
If you’ve ever experienced chronic pain, you know it’s extremely uncomfortable, saps your energy and ruins your mood. Taking pain relievers on a regular basis creates other problems, the most severe being addiction. Pain relievers can also affect your bowels, digestive system, appetite and energy level.
Depending on the source of your pain, traditional pain relievers might not help. Pain caused by damaged, injured or impinged nerves can be very difficult to relieve — most chronic back pain is caused by some type of nerve involvement. It can be difficult to relieve nerve impingement, and nerves heal very slowly compared to other types of tissue in the body.
Medical marijuana has proven to be effective in many chronic pain situations. It doesn’t cause dangerous addiction and has almost no side effects. The application of medical cannabis for back pain, before and after surgery, is becoming recognized as a viable treatment and an answer to chronic pain.
A laminectomy is a surgery performed on the back to relieve pain, and is also referred to as a decompression surgery. This procedure removes the lamina from the spinal canal. A laminectomy is used when the spinal cord is impinged inside the spinal column and causing pain.
The lamina is a covering for the spinal cord that fits in the narrow space down the center of the spine. By removing the lamina, the surgeon opens up more space in the spinal canal, lessening the pressure on the spinal cord. The spinal cord can become impinged by damaged disks or vertebrae and the accompanying inflammation.
Following a laminectomy surgery, most patients recover well and no longer deal with constant back pain. However, in some cases chronic pain develops when nerves are damaged or don’t heal fully from the surgery. Post Laminectomy Syndrome (PLS) can persist for years or indefinitely.
PLS is caused by nerves that were either damaged by the compression of the spine or during the surgery. Nerves are very delicate, as is spine surgery. Sometimes it’s not possible to perform a laminectomy without injuring the nerves. The hope is that when the proper circulation is restored to the nerves, they’ll repair themselves.
Spinal compression can also damage nerves. Whether it’s the result of an accident or an injury that occurred over time from bad posture or poor form when working out, nerve damage can be part of the original condition. The spinal cord and the root of all the peripheral nerves are carefully fit in the center of the interlocking vertebrae of the spine. The disks between each vertebra provide cushion, but if they slide out of place or become injured, they can damage the nerves.
A laminectomy will relieve the pressure on the nerves, but it won’t heal the damage that already exists. The spinal cord and nerve roots need to heal themselves once they’re in a more optimal condition. Unfortunately, the healing process often involves scar tissue. Sometimes the scar tissue that develops around the spine following a laminectomy fills in some of the new space that was created for the nerves. Scar tissue is particularly dense and hard, and can press on the nerves, causing pain.
Radiculopathy is a condition that can accompany PLS, making the pain worse and causing further debilitation. Radiculopathy emanates from the spine where the spinal cord sits. All the peripheral nerves for the entire body branch off the spinal cord. They must pass out of the spinal canal between the vertebrae and disks to reach the extremities of the body.
When spine surgery is performed, the spaces where the nerve roots branch through are altered. It’s possible during a laminectomy for some nerve roots in that area of the spine to become impinged by the surrounding material. This is the root cause of radiculopathy following a laminectomy.
Pain resulting from PLS with radiculopathy radiates from the spine to the extremities. Symptoms of radiculopathy can be felt in the arms and legs and include:
Radiculopathy affects the arms and legs based on which area of the spine is involved. The nerves that run from the spinal cord to the arms and other areas of the upper body radiate from the cervical region of the spine. A laminectomy in the neck is more likely to affect these upper body nerves.
The legs are served by nerves that run through the lumbar region of the spine. Lower back surgery has a greater chance of affecting the legs with radiculopathy than the arms. Sciatica is one common form of radiculopathy effecting the legs. The sciatic nerve is the largest one in your body, running from your lumbar spine down to your feet.
Each year there are approximately 500,000 laminectomies performed in the United States. The number of these procedures doesn’t vary greatly from year to year, while other back surgeries typically trend upward or downward. Many people who seek back surgery hope it will be an end to chronic pain. For a certain percentage of patients, this isn’t the case — they end up enduring back surgery and painful physical therapy only to live with chronic PLS with radiculopathy.
At least 31 million Americans suffer from chronic back pain. The amount of money spent on surgeries and treatments for back pain is near $50 billion annually. Back pain is a common problem, and in many cases, there’s no easy solution. About 80% of the population experiences back pain at some point in their lives. It’s one of the leading causes of disability and missed work, and most back pain is not caused by disease.
PLS can be hard to diagnose because the rate at which each patient heals from surgery is different. The symptoms of pain and radiculopathy may be present, but the initial assumption is that they’ll resolve on their own in time. Following surgery and while waiting for the PLS to resolve, strong pain medication is usually given.
Physical therapy may be another approach taken to resolve PLS. Manipulating the spine and loosening the muscles around it could relieve some pain. Movement may also keep scar tissue from forming and hardening around the area. Physical therapy is often painful and leads to more medication to reduce pain and inflammation.
Often, the most active course to resolve PLS is to repeat the back surgery. There’s a chance the additional scar tissue could be removed or that a larger part of the lamina needs to be taken out. A follow-up back surgery may also include implanting hardware to shore up the structure of the spine and make it more stable. The more bone and cartilage that is removed, the more instability there will be.
Ultimately, most back pain is a result of instability in the spine. A disk moves out of place or a vertebra is fractured and weakened, causing the spine to lose some of its ability to hold you up and remain intact during bending motions. Removing material from the spine takes pressure off o the spinal cord and peripheral nerves, but it may also exacerbate the instability problem.
Cannabis is a proven pain reliever that works well on nerve pain. Many people suffering from chronic pain find it more effective than any other treatment they have tried.
Using medical marijuana for post-laminectomy syndrome is beneficial because the treatment goes directly to the area of your brain that regulates pain. Medical marijuana binds to the cannabinoid receptors in your brain and controls the messages you get. By attaching to those receptors, the THC and CBD in cannabis block out other neurotransmitters from delivering pain messages.
Because of the active ingredients, cannabis blocks nerve pain that other pain relievers can’t. After trying various strong pain relievers with no real relief, many people with post laminectomy syndrome found medical marijuana reduced their pain.
Opioid pain relievers are the only other medicine that come close to relieving serious nerve pain and the pain following surgery. These are a good alternative for short term use, but aren’t safe for chronic conditions. Opioids are highly addictive and can cause other health problems when taken consistently for long periods of time.
Cannabis doesn’t create addiction the way opioids do. The active ingredients in cannabis provide a different balance of message-blocking in your brain and leave few side effects. It’s not possible to overdose on cannabis in any form, and the substance is not life-threatening.
Cannabis also offers some healing properties that can be helpful for PLS. Marijuana protects nerves, can limit nerve damage and has also been shown to promote the recovery of damaged nerves. While cannabis is relieving chronic pain from nerve damage, it’s also helping to heal the damage and reduce the pain naturally.
These study results on using cannabis for post laminectomy syndrome are encouraging:
When it comes to back problems, the biggest issue is always pain. Back pain can be debilitating, and recovery from back surgery is also painful. If you develop PLS, you may have to live with chronic back pain or endure another painful surgery — or both.
The primary treatment for post-laminectomy syndrome is pain medication. Nerve pain is a challenge for typical pain relievers because most over-the-counter drugs aren’t strong enough to relieve nerve pain. People with this type of chronic pain usually turn to opioids for relief.
Opioid pain relievers, derived from opium, are a popular medication for serious pain relief. Discovered during the Civil War, morphine is an opioid with a long history of use for the pain of surgery. As it turns out, morphine and other modern opioid pain relievers are very addictive, too.
Addiction and overdose are the most serious side effects of opioid pain relievers, and both can result in death. Opioids block nerve pain and slow vital functions, most notably respiration. An overdose of opioid pain killers can slow your breathing to a point where it actually stops. Even when opioid pain relievers are taken with a prescription, overdose can still happen.
Opioids work in the pleasure centers of your brain, developing a habit. When the addiction takes hold, relieving pain in your back is no longer your primary focus. Your behavior changes to ensure you have an increasing supply of opioids to satisfy your craving. You increase your dose to get the same feeling until you run out of pills or resort to illicit drugs to maintain your habit.
Marijuana doesn’t pose a risk of overdose or addiction. It’s used to fill various needs for pain relief in different strengths and forms. If you consume more marijuana than your system can handle, you may experience some paranoia. This side effect will wear off as soon as the drug exits your system. There’s no hangover or residual affect from marijuana.
An overdose of cannabis is also not life-threatening. It will not stop your heart or your breathing — no one has ever died from a marijuana overdose. Cannabis doesn’t hijack the pleasure centers of your brain and make you focus only on getting more marijuana.
The effects of marijuana include stress reduction, a calming effect, a bigger appetite and reduced nausea. Other types of pain relievers can have a negative effect on your digestive system and cause constipation, irritable bowel syndrome and nausea. The side effects of marijuana are helpful to your digestive system.
Back surgery can be the most effective way to improve back health or repair your back following an injury. A laminectomy can relieve pressure on your spine and release spinal cord impingements. However, the recovery from a laminectomy may include post laminectomy syndrome with radiculopathy. Back injuries are painful, and so is back surgery and recovery.
Medical marijuana can provide the pain relief you need to recover from back surgery and resist needing a repeat surgery. If your laminectomy results include a post laminectomy syndrome with chronic radiculopathy diagnosis, cannabis may be the treatment for you. Cannabis for chronic pain is an alternative to addictive opioid pain relievers.
To find out if marijuana for post laminectomy syndrome with chronic radiculopathy is the right treatment for you, you need to find a marijuana doctor in your area. Search for a doctor who’s experienced in recommending marijuana therapy and has knowledge of the potential cannabis brings to pain management.