Cannabis products that primarily contain cannabidiol (CBD) bring little relief to people with chronic pain, while products high in tetrahydrocannabinol (THC) slightly reduce pain severity but come with stronger side effects, according to a meta-analysis published yesterday in the Annals of Internal Medicine.Why It’s Important
Nearly half of people who use products containing CBD report using them for pain, yet evidence that they are effective is lacking. Meanwhile, last week, President Donald Trump signed an executive order downgrading cannabis from a Schedule I to a Schedule III drug, the same category as ketamine. The order also requires federal agencies to “improve access to hemp-derived cannabinoid products,” noting that Americans use medical marijuana to seek relief from chronic pain.
By the Numbers
- Researchers analyzed 25 randomized, placebo-controlled trials involving 2,303 individuals who used cannabis products for one to six months; 64% of participants reported using the products to address neuropathic pain.
- On a zero-to-10-point pain scale, nabilone, a synthetic THC analogue, reduced short-term pain severity by an average of 1.59 points. Dronabinol, another purified THC product, had a negligible effect on pain.
- Nabiximols, a spray containing comparable THC and CBD levels, reduced short-term pain by an average of 0.54 points.
- Products that consisted primarily of CBD were associated with no or trivial reductions in short-term pain severity.
- Products high in THC were associated with an increased risk of adverse events, including dizziness, sedation, and nausea.
The Other Side
The reported details of the cannabis products were inconsistent; thus, there was insufficient information to analyze factors such as formulation and administration route. Additionally, the trials did not address other potential harms of cannabis products, including psychosis and cannabis use disorder.
What’s Next
“Novel pharmaceuticals for chronic pain are desperately needed, and cannabinoids may offer an innovative path forward,” wrote the author of an accompanying commentary. “However, the rapidly evolving marketplace and increase in use require a shift in focus from understanding whether a single cannabinoid preparation is safe and effective to understanding under what conditions cannabis-based products can be used safely, whether they confer meaningful benefit, and how risks can be minimized.”
Related Information
Source
Roger Chou et al. Cannabis-based products for chronic pain: an updated systematic review. Ann Intern Med. Published December 22, 2025. doi: 10.7326/ANNALS-25-03152
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