Doctors in Austin Health's Emergency Department (ED) will soon offer cannabidiol - a medicinal cannabis extract - in addition to standard treatment for back pain. The cannabidiol will be given as part of a small clinical trial that will recruit 100 people to investigate whether taking cannabidiol results in greater pain relief, than the standard treatment does alone.
"We are including individuals with mechanical low back pain, who are not pregnant and do not regularly use cannabis. They'll be admitted to the Emergency Department Short Stay Unit where, along with usual care, which might involve simple analgesia, physiotherapy and potentially opioids, they will receive a single oral dose of either 400mg cannabidiol oil or a placebo," says Dr. Bebee, who is chief investigator of the trial.
"Over the following two hours, we'll record their pain score and any side effects from the medication - with follow up after discharge, around 48 hours later, to make sure there were no other adverse effects."
Dr. Bebee emphasises that this is a small pilot study. Cannabidiol has been chosen because it is thought to have analgesic (pain-relieving) properties, without the psychoactive properties that are usually found in cannabis.
Should cannabidiol prove to be effective for chronic back pain, there are clear benefits to its use over other painkillers - particularly opioids.
"Opioids don't reduce the time course of back pain, and have well-known negative consequences, such as addiction, nausea and quite severe constipation. They are not the right drugs for us to be using for back pain," says Dr. Bebee.
"We use opioids in the ED for acute pain, which is likely to resolve in a short period. Opioids are not ideal for non-cancer, long term pain, such as chronic musculoskeletal pain, migraines or chronic abdominal pains."
"The ideal analgesic for back pain would not be addictive, and would allow individuals to carry on with life while using it - cannabidiol is both an analgesic and an anti-inflammatory," Dr. Bebee says.
"It has also been shown to reduce opioid-seeking behaviours, as it operates on the same pathways," Dr. Bebee says.
Dr. Bebee's professional interest in pain - before working in ED, she worked in Palliative Care and as the pain registrar in Anaesthetics - is also based on some very personal reasons.
"I have an autoimmune arthritis, and at 26 was dealing with quite bad chronic pain myself, on a daily basis. I had an 18 month-old at the time, and had trouble even changing her nappy because I couldn't use my right hand," Dr. Bebee says.
"No-one ever gave me an opioid - and I'm really grateful for that," she says.
"Pain doesn't matter as much as being able to function. If the goal is a pain score of zero, then we risk severe side effects and over-sedation, to the point of turning individuals into zombies. It's more important for people to be able to do all the things they enjoy in life despite chronic pain," she says.
If the trial is successful, the team will look at running the trial again with a larger cohort - and ideally, as a multi-centre trial.
"If a treatment effect is established, then we can look at comparing it to other treatments on its own. We could also look at its effectiveness in other types of pain, such as kidney stones, or procedural pain," Dr. Bebee says.
Although people have used cannabis for pain for centuries, "Home-grown cannabis contains different quantities of the various chemical compounds, and we can't pull any useful scientific data from that. It's really important that we do trials that stand up to scientific scrutiny," she says.
"If we can use a medicinal cannabis with one compound that's been refined down - and ours is over 98 percent pure cannabidiol - we can actually look at what the properties of that compound are. Once we find out what symptoms each of the compounds in cannabis can target, we will have the chance to really help people."
'The CANBACK trial: A randomised, double-blind, placebo-controlled, clinical trial assessing the usefulness of CANnabidiol for BACK pain in the emergency department' is just one of the major ongoing research projects listed in the latest Emergency Department Research Report, which has just been published online.
The trial has been funded thanks to a donation from the Robert C. Bulley Charitable Fund.