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 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.

Research design and the sampled population.

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

Among enrichment trials, low certainty evidence suggests that there may be little to no difference in discontinuations due to adverse events between cannabis for medical use and opioids , OR 0.77, 95% CrI 0.07 to 8.83,. Low certainty evidence from 32 RCTs involving https://evpowered.co.uk/feature/how-ev-owners-integrate-eco-friendly-lifestyle-habits-into-daily-life/ 8201 patients suggests that there may be little to no difference in sleep quality between cannabis for medical use and opioids (WMD 0.49 mm on a 100 mm VAS, 95% CrI −4.72 to 5.59) (table 2, online supplemental eTable 4). Treatment effects and certainty of evidence (GRADE) for opioids and cannabis for medical use in patients with chronic non-cancer pain Moderate certainty evidence showed that, compared with placebo, opioids provide small 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%). For studies that reported outcomes at several time points — we used data from the longest follow-up.

Further research may be beneficial to evaluate limits in pain treatable by medical cannabis products and variances observed in the perceived effectiveness of medical cannabis. Based on qualitative findings from this study, more than half of adult female and male participants found medical cannabis to be effective for the management of their chronic pain. So — I need to play around with it a little. ” 58 years, female I really like the CBD oil but that alone doesn’t do it 100%. ” 45 years, female During the day it helps cut down my inflammation and to be able to customize it so that I’m not high is really nice. ” 40 years, male

For example, cannabis can cause either hypotension or hypertension, weight gain or weight loss, euphoria or anxiety. Side effects of short-term treatment are very common, but in the most part these are not serious.43 They may differ from person to person, and even the same person may experience different side effects at different times. The consequences of long-term treatment with medical cannabis have not been fully examined.46 Most of the RCTs with medical cannabis were of very short duration — generally several days.47 Longer-duration studies rarely lasted more than four weeks. In a systematic review of cannabinoids for the treatment of non-cancer pain, 18 trials published between the years of 2003 and 2010 involving 766 participants were included.27 The quality of the trials was good, and in 15 of the 18 trials there was a significant analgesic effect for the cannabinoid being tested.

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 examined the perceived effectiveness of medical cannabis for chronic pain management among middle-aged and older adults newly initiating medical cannabis. Patient-reported outcomes are critical to evaluate the effectiveness of medical cannabis as an alternative treatment for chronic pain. Future research should focus on refining these approaches to enhance the safety and acceptability of cannabinoid-based pain therapies. In contrast — transdermal or topical formulations may allow localized pain relief with limited systemic absorption, reducing psychoactive effects . THCV (in particular), acts as a CB1 receptor antagonist at lower doses and may counteract some of THC’s psychoactive effects .

Does medical marijuana have the capacity to influence chronic pain management?

All results were evaluated at critical risk of bias — with the exception of the comparative findings from two studies,40 49 which received ratings of serious and moderate risk of bias. The risk of bias for the studies included is detailed in online supplemental appendix 5. A total of 39 non-randomised studies were found to be eligible for review from these records (refer to online supplemental appendix 3)36–74, with Figure 1 providing further information on the study selection process. In cases exhibiting high clinical heterogeneity (meaning significant disparities in the estimates of individual studies and little overlap in the confidence intervals), we opted for a narrative presentation of the results.

Due to the presence of risk of bias and imprecision, both studies were assessed to have low to very low certainty of evidence. The overall certainty of evidence was assessed as very low because of serious risk of bias. Both risk of bias and imprecision contributed to a low to very low certainty of evidence. According to another study, nabilone might lower the risk of adverse events leading to discontinuation when compared to gabapentin , −9.4%; 95% CI −18.5% to −0.2%,. One study indicated that herbal cannabis might elevate the risk of adverse events resulting in discontinuation compared to standard care without cannabis , 4.7%; 95% CI 1.8% to 7.5%,. We noted considerable unexplained heterogeneity and therefore present the results in a descriptive manner (see online supplemental appendices 10–12).