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Cannabis for Chronic Pain

The evidence is real, but more modest than it sounds

Chronic pain is the condition with the strongest published evidence behind it among the topics covered on this site. A 2017 National Academies of Sciences report, one of the most thorough reviews of cannabis research ever conducted, placed chronic pain in adults in its highest evidence category: conclusive or substantial evidence that cannabis is effective. (National Academies, 2017)

That said, "effective" in a research review does not always mean a dramatic difference for any one person. A 2018 review the NIH cites, covering 47 studies and 4,743 participants, found only a small benefit from cannabis and cannabinoids for chronic pain, small enough that the NIH's own summary notes "the difference may be too small to be meaningful to patients." The same review found side effects were more common among people taking cannabis or cannabinoids than those taking a placebo. (NCCIH) Both things are true at once: chronic pain has more research support than most conditions people ask about, and the average effect size found in trials is still modest.

Not an FDA-approved pain treatment

Unlike chemotherapy-induced nausea, which has FDA-approved cannabinoid medications behind it, there is no FDA-approved cannabis or cannabinoid product specifically for chronic pain. The FDA-approved cannabinoid medications on the market are approved for seizures (Epidiolex, a CBD medication), chemotherapy-related nausea (dronabinol, nabilone), and HIV/AIDS-related appetite loss (dronabinol), not pain. Whole-plant cannabis products from a dispensary have not gone through the same clinical trial process as any of those.

The opioid-alternative question, honestly answered

Cannabis is often discussed as an alternative or complement to opioids for chronic pain. The honest answer is that the evidence for this specific claim is weaker than the pain evidence above. A review the National Academies cites found results on cannabis reducing opioid use were inconsistent, and none of the higher-quality studies in that review showed cannabis actually leading to decreased opioid use. (NCCIH) If you are on opioids for chronic pain and interested in cannabis, that is a real conversation to have with your prescribing doctor, not a substitution to make on your own.

What to bring to that conversation

Chronic pain treatment is often a combination of medications, and cannabis is processed by the same liver enzyme pathway that handles many prescription drugs. Bring your full medication list, including any other pain, sleep, or anxiety medications, to your doctor or pharmacist before adding cannabis, and ask specifically about sedation stacking if you are on anything else with a drowsiness side effect. Our drug interactions guide covers the general mechanism in more depth.

If you and your doctor decide to try it, our relaxation and inflammation effect pages list strains other users associate with those effects, and our beginner's guide covers dosing basics and what to expect from each consumption method.