Intervention: Cannabidiol
Trial phase: Phase 4
ATC code: N03AX24
SMILES: C=C(C)[C@@H]1CCC(C)=C[C@H]1c1c(O)cc(CCCCC)cc1O
Sex: All
Age groups: Adult | Older Adult
Healthy volunteers: No
Participants at risk: 3
Group description: Evaluation with Magnetic Resonance-Positron Emission Tomography Imaging and/or behavioral pain assessment before and after a 4-week trial of a liquid formulation of CBD.

Cannabidiol: Epidiolex, an agent within the anti-epileptic drug class, will be used. Epidiolex, Greenwich Biosciences Inc.'s CBD formulation, is a 100 mg/mL purified oral solution. The recommended starting dosage is 2.5mg/kg taken twice daily (5mg/kg/day). After one week, the dosage will be increased to a maintenance dosage of 10 mg/kg twice daily (20 mg/kg/day). At the end of the first week, the patient will increase the dose to 10 mg/kg twice daily for the following week.
Eligibility criteria:
Inclusion Criteria:

age ≥ 18 and ≤ 75;
the ability to give written, informed consent;
ongoing pain that averaged at least 4, on a 0-10 scale of pain during a typical week, and present for at least 50% of days during a typical week;
fluency in English;
on a stable pain treatment (pharmacological or otherwise) for the previous four weeks.
Medical records confirming diagnosis of low back pain
Chronic low back pain, ongoing for at least 6 months prior to enrollment.

Exclusion Criteria:

outpatient surgery within 2 months and inpatient surgery within 6 months from the time of scanning;
elevated baseline transaminase (ALT and AST) levels above 3 times the Upper Limit of Normal (ULN), accompanied by elevations in bilirubin above 2 times the ULN
any interventional pain procedures within 6 weeks prior to scanning procedure or at any point during study enrollment;
surgical intervention or introduction/change in opioid regimen at any point during study enrollment
contraindications to functional magnetic resonance imaging scanning and positron emission tomography scanning (including presence of a cardiac pacemaker or pacemaker wires, metallic particles in the body, vascular clips in the head or previous neurosurgery, prosthetic heart valves, claustrophobia);
current or past history within the last 5 years of major medical illness not affecting the central nervous system, other than chronic pain;
implanted spinal cord stimulator (SCS) for pain treatment;
any history of neurological illness or major medical illness affecting the central nervous system, unless clearly resolved without long-term consequences;
current or past history of major psychiatric illness;
PTSD, depression, and anxiety are exclusion criteria only if the conditions were so severe as to require hospitalization in the past year.
pregnancy or breast feeding;
history of head trauma requiring hospitalization;
major cardiac event within the past 10 years;
any use of recreational drugs in the past 3 months
any marijuana use, medical or recreational, in the past 3 months
an abnormal physical exam (e.g., peripheral edema);
routine use of opioids ≥ 60 mg morphine equivalents;
use of immunosuppressive medications, such as prednisone, TNF medications within 2 weeks of the visit;
current bacterial or viral infection;
Any other contraindications to CBD administration noted by the study physician.
If undergoing blood draws through an arterial line during scan, contraindications to placement of arterial line, such as abnormal result on modified Allen's test on both hands; Raynaud syndrome; bleeding disorder; use of anticoagulants such as Coumadin, Plavix or Lovenox