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 https://evpowered.co.uk/feature/how-ev-owners-integrate-eco-friendly-lifestyle-habits-into-daily-life/ . 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.
1. Study Design and Population
Pain management today employs a variety of methods, such as physical therapy, lifestyle changes, interventional procedures, and both prescription and over-the-counter pain relievers. The design and interpretation of the systematic review (including the selection of adverse events to consider), were influenced by a guideline panel that worked in parallel. He mentions that it’s quite difficult to inform someone — “I understand that you’re in pain, but I can’t help you with that, and many patients prefer not to use opioids. After a severe motorcycle accident, one patient successfully reduced their opioid use with the aid of cannabis. However (in the research), participants who used both opioids and cannabis faced similar rates of side effects, with approximately 13% choosing to discontinue participation. He actually notes that participants typically did not experience feelings of euphoria, especially if they had been using it for an extended period.
“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 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 .
Medical cannabis for chronic pain: can it make a difference in pain management?
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 certainty of evidence was low to very low for both studies due to risk of bias and imprecision. The certainty of evidence was very low overall due to serious risk of bias. The certainty of evidence was low to very low due to risk of bias and imprecision. Another study suggested that nabilone may reduce the risk of adverse events leading to discontinuation compared with gabapentin (−9.4%; 95% CI −18.5% to −0.2%). One study suggested herbal cannabis may increase the risk of adverse events leading to discontinuation compared with standard care without cannabis , 4.7%; 95% CI 1.8% to 7.5%,. We observed substantial unexplained heterogeneity and so summarise the results descriptively (online supplemental appendices 10–12).