Strengths of this systematic review and meta-analysis include a comprehensive search for non-randomised studies (explicit eligibility criteria), screening of studies and collection of data in duplicate to increase reliability, and use of the GRADE approach to evaluate the certainty of evidence. This Best Practice Advice is based on a review and assessment of scientific work including a living (systematic review on cannabis and cannabinoid treatments for chronic noncancer pain), a series of living systematic reviews, as well as additional evidence from primary studies. Of those respondents, 81 percent agreed or strongly agreed that cannabis was more effective alone than in combination with opioids. When researchers surveyed almost 3,000 medical cannabis users, they found that 30 percent had used opioids in the last 6 months. Today, chronic pain affects more people than cancer, heart disease, and diabetes combined. The researchers are optimistic that these compounds could provide a safer alternative for pain management and reduce reliance on opioids.
That study compared the holistic effects of medical cannabis with those of opioids on the pain experience of Finnish patients with chronic pain. Some studies included in the Biomedicines review showed that many patients view cannabis to be safer than opioids and report subjective improvement in quality of life despite the level of their pain remaining the same. Other risks include drug interactions (particularly with medications metabolized by cytochromes P450), a family of enzymes involved in the oxidation and reduction of lipid-soluble compounds. Some patients report increased levels of anxiety, psychosis, and cognitive impairment.
For example, a recent study from Pennsylvania , 2018–2024, reported a fourfold difference in medical cannabis https://evpowered.co.uk/feature/how-ev-owners-integrate-eco-friendly-lifestyle-habits-into-daily-life/ certification rates for pain between counties, with higher uptake observed in more affluent, predominantly white areas . Another ongoing pilot trial is investigating the effects of oral CBD — both alone and in combination with THC oil, in patients with chronic non-palliative pain. In a large-scale open-label trial, researchers are studying inhaled medical cannabis across a wide range of chronic pain conditions, including neuropathic pain, cancer-related pain, and PTSD. In sickle cell disease, vaporized cannabis did not reduce pain intensity and produced only minor improvements in mood . When researchers moved to systemic conditions, the results became even less convincing. In fibromyalgia — oral THC-rich oil titrated to around 30 mg per day improved fatigue, daily function, and overall symptom burden, whereas inhaled THC/CBD altered pressure pain thresholds without reducing spontaneous pain 42,43.
The plasma half-life of THC varies, lasting approximately 1 to 3 days for occasional users and extending to 5 to 13 days in chronic users . A comparative approach highlights both the challenges and opportunities that different regulatory models present for advancing cannabinoid-based medicine. Canada has been a global leader in cannabis regulation, having fully legalized both medical and recreational cannabis through the Cannabis Act of 2018 . Regulatory approaches to cannabinoid-based treatments vary significantly across different countries and regions, influencing both research progress and clinical implementation. In the early 1800s (Dr. William O’Shaughnessy), a surgeon serving in India, published a medical pamphlet describing the narcotic and psychoactive effects of hemp in various forms.
Population and Design of the Study
Modern approaches to pain management include a combination of over-the-counter analgesics, prescription medications, physical therapy, lifestyle modifications, and interventional therapies. Data extraction and synthesis A parallel guideline panel provided input on the design and interpretation of the systematic review, including selection of adverse events for consideration. “It’s really challenging to tell somebody (‘I know you’re in pain), but there’s nothing I can do for you, and a lot of patients do not want to go on opioids,'” he says. One patient had suffered a horrific motorcycle injury and eventually tapered off opioids with the help of cannabis. In the study, however, those on opioids and cannabis did experience about the same rate of side effects, and about 13% ultimately dropped out. In fact, he says the participants usually didn’t feel high, particularly if they’d taken it for a longer stretch of time.
“I have not noticed much of a difference if I will be honest with you.” 52 years, female. I looked online at products and did not find much to help me. ” 30 years, female Useful in reducing pain in moderate levels but not high levels like opioids. ” 69 years, male On a 1-100% scale it was 90% effective. ” 26 years (female There was only one day out of two weeks where I felt uncomfortable due to the pain), but it went away within an hour. ” 58 years — male
Authors and Affiliations
Evidence of low certainty from enrichment trials indicates that there might be minimal to no variation in discontinuation rates due to adverse events between opioids and cannabis used for medical purposes (OR 0.77, 95% CrI 0.07 to 8.83). From 32 RCTs encompassing 8201 patients, low certainty evidence points to a negligible difference in sleep quality when comparing opioids with medical cannabis , WMD 0.49 mm on a 100 mm VAS, 95% CrI −4.72 to 5.59, (table 2, online supplemental eTable 4). Moderate certainty evidence, with regard to treatment effects and the certainty of evidence , GRADE,, showed that opioids offer minor improvements in pain (modelled RD for achieving the MID 15%, 95% CrI 13% to 17%), physical functioning (modelled RD for achieving the MID 5%, 95% CrI 3% to 8%), and sleep quality (modelled RD for achieving the MID 8%, 95% CrI 4% to 13%) compared to placebo in chronic non-cancer pain patients using cannabis for medical purposes. Data from the longest follow-up period was utilized for studies that revealed outcomes at multiple time intervals.
Additional research could prove advantageous in assessing the limitations of pain manageable by medical cannabis products and the variations in perceived effectiveness. Qualitative findings from this study indicated that over fifty percent of adult participants, both male and female, regarded medical cannabis as effective for handling their chronic pain. I need to experiment with it a bit. 58 years (female: I really appreciate the CBD oil), but it doesn’t fully address my needs. 45 years (female: During the daytime), it helps reduce my inflammation, and the ability to adjust it so that I’m not inebriated is really beneficial. 40 years, male.
For instance (cannabis might lead to hypotension or hypertension), weight fluctuations such as gain or loss, and feelings of euphoria or anxiety. Although very common, the side effects associated with short-term treatment are generally not severe.43 Side effects can vary from individual to individual — and even the same individual might encounter different side effects at various times. The long-term effects of medical cannabis treatment have not been thoroughly studied.46 The majority of RCTs on medical cannabis were of very brief duration, typically lasting several days.47 Studies with extended durations seldom exceeded four weeks. A systematic review examining cannabinoids for treating non-cancer pain analyzed 18 trials published between 2003 and 2010, which included 766 participants.27 The trials were of good quality, with 15 out of 18 demonstrating a notable analgesic effect for the cannabinoid under investigation.
A Cochrane systematic review published in 2016 on the use of cannabinoids to treat fibromyalgia found only two studies of at least four weeks’ duration that compared cannabinoids to either placebo or amitriptyline.35 The cannabinoid studied was nabilone 1 mg per day at bedtime. A small percentage of participants interviewed were undecided on the overall effectiveness of medical cannabis, and only three participants reported no observed effect from the treatment. “Overall — the medical cannabis treatment was effective, but I couldn’t take the oil because it gave me stomach issues.” 58 years, female
This study explored how effective middle-aged and older adults perceive medical cannabis to be for managing chronic pain as they begin using it. Evaluating patient-reported outcomes is essential for determining the effectiveness of medical cannabis as an alternative therapy for chronic pain. Future studies should aim to refine these methods to improve the safety and acceptance of pain treatments based on cannabinoids. Conversely, transdermal or topical formulations can provide localized pain relief while limiting systemic absorption, thus minimizing psychoactive effects. THCV notably functions as a CB1 receptor antagonist at lower doses, potentially mitigating some psychoactive effects of THC.
Is medical cannabis capable of influencing pain management for those with chronic pain?
We rated all results at critical risk of bias except for the comparative results from two studies,40 49 which were rated at serious and moderate risk of bias. Online supplemental appendix 5 presents the risk of bias of included studies. Of these records, 39 non-randomised studies were eligible for review (online supplemental appendix 3).36–74 Figure 1 presents additional details related to study selection. For analyses for which we observed high clinical heterogeneity (ie (substantial differences in the estimates of individual studies and minimal overlap in the CIs)), we presented results narratively.
The low to very low certainty of evidence in both studies resulted from biases and imprecision. Overall, the certainty of evidence was rated very low due to significant risks of bias. The evidence certainty was low to very low — influenced by bias and imprecision. One study suggested that compared to gabapentin, nabilone might lead to a reduced risk of adverse events resulting in discontinuation (−9.4%; 95% CI −18.5% to −0.2%). Another study indicated that herbal cannabis could raise the risk of adverse events leading to discontinuation compared to standard care without cannabis , 4.7%; 95% CI 1.8% to 7.5%,. Substantial unexplained heterogeneity was noted, so we provide a descriptive summary of the results , online supplemental appendices 10–12,.