Can you get medical cannabis for back pain in the UK?
Back pain is the single most common musculoskeletal complaint in the UK and one of the most common reasons people approach a private clinic. It is also a label covering several different problems, and which one you have changes the answer.
The short answer
- Back pain is commonly assessed privately, but nothing is licensed for it.
- NICE recommends against most drug treatments for chronic primary pain, cannabis-based medicines included.
- The evidence that exists is mostly for nerve pain, not for mechanical back pain.
- Whether your pain is nerve-related matters — it changes both the evidence and the assessment.
- Exercise and physical therapy remain first line, and a specialist will expect them to have been tried.
Is back pain treated with medical cannabis in the UK?
It is one of the conditions UK private specialists assess most often, usually under the broader heading of chronic pain. It is not an NHS treatment and no cannabis-based product is licensed for back pain.
NICE guidance on low back pain and sciatica recommends exercise programmes as the core treatment, with manual therapy and psychological approaches as part of a package, and it advises against a long list of drug treatments including opioids for chronic low back pain. Separate NICE guidance on chronic primary pain recommends against cannabis-based medicines specifically.
That is the same position that applies to chronic pain generally, covered in Can you get medical cannabis for chronic pain in the UK?
Which kind of back pain do you have?
This is the question that shapes everything else. Back pain that comes from irritated or damaged nerves behaves differently, responds differently, and has a different evidence base from pain arising from muscles, joints and discs.
- Mechanical or non-specific back pain — the most common kind, with no single identifiable structural cause. Least evidence for cannabis-based medicines.
- Nerve-related back pain, including sciatica and radiculopathy — pain that travels down a leg, often with numbness or tingling. This is where the cannabinoid evidence, such as it is, sits.
- Back pain with a specific structural cause — fracture, inflammatory disease, infection or tumour. These need their own treatment, and warning signs must be excluded before anything else is considered.
If your pain radiates into a leg, the sciatica guide is more specific. If it is nerve pain elsewhere, see neuropathic pain.
What the evidence actually shows
The most reliable synthesis covers neuropathic pain rather than back pain as a whole, and it is cautious. The Cochrane review of cannabis-based medicines for chronic neuropathic pain found the evidence of low to very low quality, with any benefit needing to be weighed against side effects.
The review behind that paragraph
Mücke M, Phillips T, Radbruch L, Petzke F, Häuser W. Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews. 2018;3:CD012182. Sixteen studies, 1,750 participants. The authors concluded the potential benefits might be outweighed by potential harms.
For mechanical low back pain specifically the controlled evidence is thinner still. There is no body of randomised trials establishing that cannabis-based medicines relieve non-specific back pain, and NICE reviewed the field for chronic primary pain and recommended against.
UK registry data reports improvement in pain and quality-of-life scores among people prescribed for chronic pain including back pain. It is observational, and cannot establish that the medicine caused the change.
What a specialist will want to see
There is no UK list of qualifying conditions. For back pain, a specialist is largely checking that the diagnosis is settled and that the treatments with better evidence have genuinely been tried.
- How long the pain has lasted and what investigations have been done
- Whether serious causes have been excluded, and whether any imaging was reported
- Whether the pain has a nerve component — radiation, numbness, weakness
- What physiotherapy or structured exercise you have completed, not just been referred for
- Which medicines you have tried, including any opioids, and what happened
- How the pain affects sleep, work and daily function, which is often what actually gets measured
New weakness, numbness around the groin, or loss of bladder or bowel control are emergency symptoms. Do not wait for a private appointment — go to A&E.
The general requirements — age, a documented diagnosis, the convention that two standard treatments have been tried, and access to your medical records — are covered in What are the requirements?
Risks and reasons a specialist may say no
The ordinary cautions apply — drowsiness, dizziness, dry mouth, impaired concentration and driving impairment. For back pain there is one additional consideration worth naming.
Back pain improves with movement, and the treatments that work best are active ones. A medicine that makes you sleepy or slows you down can undercut the programme that is actually doing the work. A good specialist will ask how a trial would fit alongside your exercise, not instead of it.
A personal or family history of psychosis, unstable mental illness, pregnancy or breastfeeding will normally count against treatment, and a history of problematic opioid use makes the assessment more cautious rather than less.
If you want to take this further
The useful next step is a proper assessment, not a longer reading list. Gather your diagnosis, the treatments you have already tried and what happened with each, and a current list of your medicines — that is what a specialist needs in order to give you a straight answer.
The consultation itself, and what happens after it, is set out in What is the process to get a medical cannabis prescription? If back pain is not the only thing you are being treated for, say so early: other conditions and other medicines change the assessment.
Frequently asked questions
Can I get medical cannabis for back pain in the UK?
You can be assessed for it privately, and back pain is among the most common reasons people ask. Nothing is licensed for it and NICE guidance on chronic primary pain recommends against cannabis-based medicines. A specialist decides case by case.
Does it work for back pain?
The controlled evidence does not establish that it does. What evidence exists is mostly in nerve pain rather than mechanical back pain, and the Cochrane review of cannabis-based medicines for chronic neuropathic pain judged the evidence low to very low quality.
Does it matter whether my pain goes down my leg?
Yes. Pain radiating into a leg suggests a nerve component, which is where most of the cannabinoid pain evidence sits. Non-specific mechanical back pain has the least evidence behind it.
Do I have to have done physiotherapy first?
In practice, yes. UK specialists work to a convention that at least two appropriate standard treatments have been tried without adequate benefit, and for back pain that normally includes structured exercise or physiotherapy actually completed.
Sources and further reading
Every factual statement on this page is drawn from the following public sources. Links open in a new tab and are not affiliated with Flora House.
- Mücke M, et al. Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews (2018)
- NICE guideline NG59: Low back pain and sciatica in over 16s
- NICE guideline NG193: Chronic pain (primary and secondary) in over 16s
- NHS: Back pain
- NICE guideline NG144: Cannabis-based medicinal products
- NHS: Medical cannabis (and cannabis oils)
- MHRA: The supply, manufacture, importation and distribution of unlicensed cannabis-based products for medicinal use