Chronic Pain Research

VER-01 (full-spectrum cannabis extract) shows potential as a new, safe and effective treatment for chronic low back pain.

In this landmark comparison of 90 trials with 22,028 patients, cannabis was found to be similarly effective to opioids for chronic pain relief, but with a critical advantage: patients on cannabis were 45% less likely to stop treatment due to adverse events compared to those on opioids.

This 2024 systematic review of 15 studies found that most research shows 42-66% pain reduction with CBD or CBD+THC. However, 3 studies found no benefit, and the evidence overall is limited by small study numbers and varied methods.

These 2024 clinical practice guidelines, based on 70 studies, conclude that cannabis-based medicines show "moderate benefit" for chronic pain and also help related conditions like sleep problems and anxiety. The guidelines provide practical dosing and titration recommendations for clinicians.

This comprehensive umbrella review of 101 meta-analyses found high-certainty evidence that CBD effectively reduces seizures in epilepsy, and cannabis-based medicines help chronic pain (30% pain reduction), MS spasticity, and IBD—but also identified clear risks during pregnancy, for mental health, and while driving.

This 2023 review of 77 articles concludes that medical cannabis provides adequate pain management for chronic nonmalignant pain. THC and CBD work through the endocannabinoid system to reduce pain perception and symptom frequency.

Moderate-certainty evidence shows that nabiximols (THC/CBD spray) and THC are ineffective for relieving moderate-to-severe cancer pain that does not respond to opioids.

The present study shows minimal benefit of combining dronabinol (10 mg) and hydromorphone (4 mg) for analgesia and improving physical functioning in adults with knee osteoarthritis.

This scoping review found cannabis has been shown useful for both acute and chronic pain, with the strongest evidence for MS-related pain and as an adjunct in cancer pain. However, evidence is weak for neuropathic pain, rheumatic conditions, and headache, and there is no strong evidence for using cannabis to reduce opioid use.

Cannabis users had significantly worse outcomes after surgery: higher pain scores, higher opioid consumption, and more sleep disturbance than non-users. This suggests preoperative cannabis use is a risk factor for postoperative pain.

In this rigorous 12-week trial, CBD (20-30mg daily) showed NO benefit over placebo for hand osteoarthritis or psoriatic arthritis pain. Pain intensity, sleep, anxiety, depression, and function were all the same as placebo.

Cannabinoids are effective therapeutics for several medical indications if their specific pharmacological properties are considered. Different cannabinoids have different evidence levels for different conditions.

Medical cannabis and cannabinoids may improve impaired sleep among people living with chronic pain, but the magnitude of benefit is likely small.

Cannabinoids provide moderate pain relief for chronic neuropathic pain, with patients 1.5 times more likely to experience 30% or greater pain reduction compared to placebo.

Analyzing 32 clinical trials with 5,174 patients, this BMJ meta-analysis found that medical cannabis provides a small but real improvement in chronic pain—about 10% more patients experience meaningful relief compared to placebo. Sleep quality also improved, though side effects like dizziness occur in some patients.

The endocannabinoid system (ECS) regulates pain, mood, appetite, memory, and immune function. Because this system is involved in so many conditions—from chronic pain to neurological diseases—cannabis-based medicines have potential for treating diverse disorders.

Pain intensity of chronic non-cancer patients was reduced by cannabinoids consumption, but effect sizes were small. Efficacy for neuropathic and non-neuropathic pain was similar.

Serious adverse effects related to CBD in RCTs are rare and include mainly elevated transaminases, convulsion, sedation, lethargy, and upper respiratory tract infections. These are related to drug-drug interactions with valproate and clobazam.

81.1% of fibromyalgia patients reported significant improvement after 6 months of medical cannabis treatment, with 73% achieving at least moderate improvement in pain.

Cancer patients in Minnesota's medical cannabis program showed significant improvement across ALL 8 symptoms tracked—anxiety, appetite, depression, sleep, fatigue, nausea, pain, and vomiting—within 4 months. Only 10.5% reported adverse effects.

This Cochrane review of 16 studies found that cannabis-based medicines provide modest pain relief for neuropathic pain—about 1 in 11 patients achieve meaningful improvement. However, side effects are common, with nervous system and psychiatric effects occurring more frequently than with placebo.

This rigorous meta-analysis of 104 studies found cannabis provides modest pain relief—about 1 in 24 patients benefit—but with a high side effect burden: 1 in 6 experience harm. The authors concluded it "seems unlikely that cannabinoids are highly effective medicines" for chronic pain.

There is reasonable evidence that cannabinoids improve nausea and vomiting after chemotherapy. They might improve spasticity. There is uncertainty about whether they improve pain, but if they do, it is neuropathic pain and the benefit is likely small. Adverse effects are very common.

There is conclusive or substantial evidence that cannabis or cannabinoids are effective for chronic pain in adults, chemotherapy-induced nausea and vomiting, and spasticity associated with multiple sclerosis. Evidence for most other conditions is limited, insufficient, or absent.

97% of patients agreed or strongly agreed that cannabis helped them decrease the amount of opioids they use, with 92% preferring cannabis over opioids for pain management.

Cannabis-based medicines might be effective for chronic pain treatment, based on limited evidence, primarily for neuropathic pain patients. However, the clinical significance of these findings is uncertain as the majority of studies did not show an effect.

Selective cannabinoids provide a small analgesic benefit in patients with chronic neuropathic pain.

There is no convincing, unbiased, high quality evidence suggesting that nabilone is of value in treating people with fibromyalgia. The tolerability of nabilone was low in people with fibromyalgia.

Currently, there is insufficient evidence for recommendation for any cannabinoid preparations for symptom management in patients with chronic pain associated with rheumatic diseases.

This comprehensive review of 79 trials found moderate-quality evidence that cannabinoids are effective for chronic pain and spasticity, with most studies showing improvement in symptoms.

Inhaled cannabis may provide short-term relief for 1 in 5 to 6 patients with neuropathic pain. Number needed to treat = 5.6. Pragmatic trials are needed to evaluate long-term benefits and risks.

Long-term use of THC/CBD spray was generally well tolerated, with no evidence of a loss of effect for the relief of cancer-related pain with long-term use. Patients did not seek to increase their dose over time, suggesting no tolerance development.

Smoked cannabis was superior to placebo in symptom and pain reduction in participants with treatment-resistant spasticity. Future studies should examine whether different doses can result in similar beneficial effects with less cognitive impact.

THC:CBD extract is efficacious for relief of pain in patients with advanced cancer pain not fully relieved by strong opioids. THC alone showed no significant benefit over placebo.