THC Plus CBD Beats THC Alone for Cancer Pain: Landmark Trial
What Researchers Found About Cancer Pain and Cannabis
The Study at a Glance
Published
Journal of Pain and Symptom Management, 2010
Researchers
Multiple institutions (International)
Study Type
Randomized Controlled TrialParticipants
177 patients · 2 weeks
Key Finding
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.
Key Finding: 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.
What Researchers Studied About Cancer Pain and Cannabis
This study compared the efficacy of THC:CBD extract, THC extract alone, and placebo for relieving pain in patients with advanced cancer.
All patients had inadequate pain relief despite chronic opioid dosing, making this a study of treatment-resistant cancer pain.
177 patients were randomized to three groups: THC:CBD extract (n=60), THC extract alone (n=58), or placebo (n=59).
How This Randomized Controlled Trial Was Conducted
This was a 2-week, multicenter, double-blind, randomized, placebo-controlled, parallel-group trial.
The primary outcome was change from baseline in mean pain Numerical Rating Scale (NRS) score.
Secondary outcomes included 30% pain reduction responder rates, opioid dose changes, breakthrough medication use, sleep quality, and quality of life measures.
Cancer Pain Treatment Results
The Main Results:
- 1THC:CBD vs placebo: Pain improved -1.37 vs -0.69 (STATISTICALLY SIGNIFICANT)
- 2THC alone vs placebo: Pain improved -1.01 vs -0.69 (NOT significant)
- 330% responder rate: THC:CBD 43% vs placebo 21% (SIGNIFICANT odds ratio)
- 430% responder rate: THC alone 23% vs placebo 21% (NOT significant)
- 5No change in opioid dose or breakthrough medication across groups
- 6THC:CBD WORSENED nausea and vomiting vs placebo (P = 0.02)
- 7THC alone had no difference in nausea/vomiting (P = 1.0)
- 8Most adverse events were mild to moderate
By the Numbers
| Statistic | What It Means |
|---|---|
| 177 patients | Advanced cancer patients with pain not controlled by opioids |
| 43% vs 21% | Responders (30% pain reduction) with THC:CBD vs placebo (significant) |
| 23% vs 21% | Responders with THC alone vs placebo (NOT significant) |
| P = 0.02 | THC:CBD worsened nausea/vomiting compared to placebo |
Advanced cancer patients with pain not controlled by opioids
Responders (30% pain reduction) with THC:CBD vs placebo (significant)
Responders with THC alone vs placebo (NOT significant)
THC:CBD worsened nausea/vomiting compared to placebo
What This Means for Cancer Pain Patients
This landmark trial has an important finding for cancer patients: CBD makes a difference when combined with THC.
THC:CBD extract significantly reduced cancer pain compared to placebo, with 43% of patients achieving meaningful pain relief vs only 21% on placebo.
However, THC alone was NOT significantly better than placebo. This suggests that CBD contributes something important to the pain-relieving effect.
There is a trade-off: patients on THC:CBD experienced more nausea and vomiting (P = 0.02). Interestingly, THC alone did not cause this problem.
Opioid doses did not need to change, suggesting cannabinoids can provide additional benefit on top of existing pain medication.
Quick Answers: Cancer Pain and Cannabis
Direct answers based on the findings of this study:
Research Summary: Answers are based on published peer-reviewed studies and represent research findings, not medical recommendations. Individual results may vary. Always consult a healthcare provider before making treatment decisions.
Is THC or CBD better for cancer pain?
THC:CBD combination is best. A 177-patient RCT found THC:CBD significantly reduced cancer pain (43% vs 21% responders), but THC alone was NOT better than placebo (23% vs 21%). CBD appears essential.
Source: Johnson et al., J Pain Symptom Management, 2010 (PMID: 19896326)
Does cannabis help cancer pain not controlled by opioids?
THC:CBD combination does. In 177 patients with cancer pain inadequately controlled by opioids, THC:CBD achieved significant pain relief (43% responders). THC alone showed no benefit over placebo.
Source: Johnson et al., J Pain Symptom Management, 2010 (PMID: 19896326)
Does THC:CBD cause nausea in cancer patients?
Yes. THC:CBD significantly worsened nausea and vomiting compared to placebo (P = 0.02). Notably, THC alone did not cause this problem (P = 1.0). This is an important trade-off to consider.
Source: Johnson et al., J Pain Symptom Management, 2010 (PMID: 19896326)
This is educational content, not medical advice
The research summarized here is for informational purposes only. Individual results may vary, and what works in studies may not work the same way for everyone. Always consult with a qualified healthcare provider before making changes to your treatment plan or starting medical cannabis therapy.
Important Limitations
This study has some caveats to keep in mind when interpreting the results:
- Short duration (2 weeks)
- THC:CBD worsened nausea and vomiting
- No long-term follow-up in this trial
- Specific to advanced cancer population
- THC alone showed no benefit over placebo
The Bottom Line on Cannabis for Cancer Pain
This RCT of 177 cancer patients found THC:CBD extract significantly reduces pain (43% vs 21% responders), but THC alone does NOT. This suggests CBD is essential for the pain-relieving effect. Trade-off: THC:CBD worsened nausea/vomiting (P = 0.02). For cancer pain not controlled by opioids, THC:CBD combination may help, but THC alone likely will not.
Do You Qualify for Medical Marijuana?
If you're living with Cancer Pain, you may qualify for a medical marijuana card. Our licensed physicians can evaluate you from home via telehealth.
Related Research & Resources
Related Research
Condition Research
Get Your Card
This condition qualifies for medical marijuana in:
Source
Johnson JR, Burnell-Nugent M, Lossignol D, et al. "Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of THC:CBD extract and THC extract in patients with intractable cancer-related pain" Journal of Pain and Symptom Management. 2010. DOI: 10.1016/j.jpainsymman.2009.06.008
Important Information
Study Age: This study was published 16 years ago. Newer research may have updated or refined these findings.
Not Medical Advice: This research summary is for educational purposes only. It should not be used to diagnose, treat, cure, or prevent any disease or medical condition. Always consult a qualified healthcare provider before starting or changing any treatment.
Individual Variation: Research findings represent group averages. Your individual response to cannabis may differ based on genetics, other medications, underlying conditions, and many other factors.
Last reviewed: January 25, 2026
Important Notices
Research Summary Disclaimer
This content represents our interpretation of published scientific research for educational purposes. It should not be used to make treatment decisions without consulting a qualified healthcare provider. Individual results may vary from study findings.
FDA Notice
These statements have not been evaluated by the FDA. Cannabis is not intended to diagnose, treat, cure, or prevent any disease. The FDA has not approved cannabis for any medical condition except specific prescription medications.
Copyright & Fair Use
Research summaries are provided under fair use (17 U.S.C. § 107) for educational purposes. We provide brief summaries with attribution, not full reproductions. All studies remain the intellectual property of their respective authors and publishers.
Data Sources
Study information sourced from PubMed®, U.S. National Library of Medicine. Inclusion does not imply endorsement by NLM, NIH, or the federal government.
For complete information, see our Terms of Use and Research Content Policy.
FAQs: Cannabis for Cancer Pain
Is THC or THC:CBD better for cancer pain?
THC:CBD combination is significantly better. In this 177-patient trial, THC:CBD achieved 43% responder rate vs 21% placebo. THC alone (23%) was NOT significantly different from placebo (21%).
Does CBD add benefit for cancer pain?
Yes. This trial showed THC:CBD was significantly effective, but THC alone was not. This suggests CBD contributes importantly to the pain-relieving effect of cannabis in cancer patients.
What are the side effects of THC:CBD for cancer pain?
THC:CBD significantly worsened nausea and vomiting compared to placebo (P = 0.02). Interestingly, THC alone did not cause this problem. Most other adverse events were mild to moderate.