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Chronic Pain

From large randomized controlled studies to systematic reviews, a substantial amount of evidence conclusively supports the use of cannabis/cannabinoids in the treatment of chronic pain in adults. Under mindful and educated use, cannabis has further shown to be a powerful tool to help reduce opioid use and withdrawal symptoms. 

Our own study conducted with the University of Michigan in 2016 found that chronic pain patients were able to decrease their opioid use, number of medication classes and side effects of those medications by including cannabis into their medical regimen. **Please note: Consult your primary doctor before adjusting any prescribed medications.**

Key Research Findings:

A collection of summaries, quotes and/or conclusions from relevant scientific studies and systematic reviews.

Chapter Highlights: The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. (2017)
  • The National Academies of Science, Engineering & Medicine reviewed over 10,000 scientific studies and released a report concluding that there was substantial and conclusive evidence that cannabis and cannabinoids were effective for the treatment of chronic pain in adults.”  
Physician Guide to Cannabis-Assisted Opioid Reduction. (2017)
  • An evidence-based summary sheet with references for using cannabis to help reduce opioid use. This sheet was passed out to all Congress members in September of 2017 by Congressman Earl Blumenauer.
Emerging Evidence for Cannabis’ Role in Opioid Use Disorder (2018)
  • “Despite the vast array of cannabis products and administration routes used by patients in states with medical cannabis laws, cannabis has been consistently shown to reduce the opioid dose needed to achieve desirable pain relief.”
Brief Commentary: Cannabinoid Dosing for Chronic Pain Management (2019)
  • General dosing guidelines proposed by Dr. Daniel Clauw & Kevin Boehnke to help guide physicians and patients on how to best utilize cannabis for chronic pain management. 
Cannabis in Pain Treatment: clinical and research considerations. (2016)
  • “There are over 5 high-quality randomized controlled clinical trials that concluded analgesic efficacy of smoked cannabis  in neuropathic pain.  One study reported significant sustained reduction in CP at 12 months with continued use of cannabis containing 12.5% THC.” 
The endocannabinoid system, cannabinoids, and pain. (2013)
  • “Clinical trials involving over 1000 patients have shown significant efficacy in different categories of chronic pain, including central and peripheral neuropathic pain and MS.” 
Cannabinoids in the management of difficult to treat pain. (2008)
  • THC has twenty times the anti-inflammatory potency of aspirin and twice that of hydrocortisone, but in contrast to all nonsteroidal anti-infl ammatory drugs (NSAIDs), demonstrates no cyclo-oxygenase (COX) inhibition at physiological concentrations.”
  • “Cannabinoids may offer significant “side benefits” beyond analgesia. These include anti-emetic [reduce nausea] effects, well established with THC, but additionally demonstrated for CBD, the ability of THC and CBD to produce apoptosis [cellular suicide] in malignant [diseased] cells and inhibit cancer-induced angiogenesis, as well as the neuroprotective antioxidant properties, and improvements in symptomatic insomnia.”
  • Conclusion of study: “Given their multi-modality effects upon various nociceptive pathways, their adjunctive side benefits, the efficacy and safety profiles to date of specific preparations in advanced clinical trials, and the complementary mechanisms and advantages of their combination with opioid therapy, the future for cannabinoid therapeutics appears very bright, indeed.”
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. (2010) 
  • “The results of this study show that the THC:CBD extract is an efficacious adjunctive treatment for cancer-related pain in patients who are not achieving an adequate analgesic response to opioids.”
Initial experiences with medicinal extracts of cannabis for chronic pain: Results from 34 ‘N of 1’ studies (2004)
  • “THC and THC : CBD were effective in relieving pain and improving sleep in a small group of patients.”
  • “Prior to the study we had expected to find that the THC : CBD mixture would be optimal, that we would see more side-effects with THC, and that CBD alone would be almost ineffective. Whilst there was a preference for THC:CBD, the differences were not as marked as we anticipated. The lack of effect of CBD by itself may just reflect either the narrow range of pain problems studied and ⁄ or the need for a substantially higher dose of CBD.”
Nabiximols for opioid-treated cancer patients with poorly-controlled chronic pain: a randomized, placebo-controlled, graded-dose trial. (2012)
An open-label extension study to investigate the long-term safety and tolerability of THC/CBD oromucosal spray and oromucosal THC spray in patients with terminal cancer-related pain refractory to strong opioid analgesics. (2012)
  •  “In summary, the findings show that some patients will continue to obtain relief of cancer-related pain with longterm use of THC/CBD spray, without increasing their dose of this or other pain-relieving medications over time, suggesting that the adjuvant use of THC/CBD spray in cancer-related pain could provide substantial benefit to patients.”
Cannabinoid-based drugs as anti-inflammatory therapeutics. (2005)
  • “From these findings and other data, it seems that cannabinoids have several mechanisms of action for the attenuation of symptoms and disease progression of multiple sclerosis and other neurodegenerative diseases. These mechanisms might include the inhibition of TH1-cell responses in the CNS… and the suppression of neuroimmune mediators of neuropathic pain that are locally released.”
Cannabidiol attenuates cardiac dysfunction, oxidative stress, fibrosis, and inflammatory and cell death signaling pathways in diabetic cardiomyopathy. (2010)
  • “Remarkably, CBD attenuated myocardial dysfunction, cardiac fibrosis, oxidative/nitrative stress, inflammation, cell death, and interrelated signaling pathways.” 
Cannabis, pain, and sleep: lessons from therapeutic clinical trials of Sativex®, a cannabis‐based medicine. (2007)
  • “Experience to date with Sativex in numerous Phase I–III studies in 2000 subjects with 1000 patient years of exposure demonstrate marked improvement in subjective sleep parameters in patients with a wide variety of pain conditions including multiple sclerosis, peripheral neuropathic pain, intractable cancer pain, and rheumatoid arthritis, with an acceptable adverse event profile.”