A living systematic review found THC:CBD sprays and high-THC products produced small pain reductions (mostly neuropathic), while CBD alone showed no benefit, and all THC products increased dizziness, sedation, and nausea.
Pain specialists, medical cannabis clinicians, policy makers
CBD alone produced no pain benefit, while THC products increased dizziness risk 3.6x
What the researchers found
THC:CBD oral spray: small pain decrease (MD -0.54/10); high THC: small decrease (MD -0.78/10); CBD alone: no benefit (moderate SOE); THC products caused large dizziness increase (RR 3.57) and sedation increase (RR 5.04).
Why it matters
This is the most current synthesis of cannabis for pain, showing benefits are small and limited to THC products while CBD alone does not help.
The numbers in context
29 RCTs, N=2,579; THC:CBD spray MD -0.54 (95% CI -0.95 to -0.19); high THC MD -0.78 (-1.59 to -0.08); CBD alone MD 0.40 (no benefit); dizziness RR 3.57; sedation RR 5.04.
How the study worked
Living systematic review; 29 RCTs (N=2,579) and 15 observational studies (N=49,453); databases searched through April 2025; meta-analyses grouped by THC:CBD ratio and product type.
What this study cannot tell us
Most studies short-term (1-6 months); 48% neuropathic pain; no evidence for psychosis, CUD, or cognitive harms; insufficient evidence for whole-plant cannabis.
How to read the evidence
Comprehensive living review with moderate strength of evidence, updated through April 2025.
When this study was published
Published 2025, updated through April 2025
The bigger picture
Despite widespread belief in cannabis for pain, evidence shows modest THC-driven benefits weighed against substantial side effects, with no support for CBD-only products.
Questions still open
- Is a 0.5-0.8 point reduction clinically meaningful? Would longer trials show tolerance? Can side effects be managed to make small benefits worthwhile?
Common questions
Does cannabis help with pain?
What are the side effects?
Read the original research
Cannabinoids as a Potential Alternative to Opioids in the Management of Various Pain Subtypes: Benefits, Limitations, and Risks.
Pain and therapy, 12(2), 355-375
Citation
Chou, Roger; Ahmed, Azrah Y.; Dana, Tracy; Morasco, Benjamin J.; Bougatsos, Christina; Fu, Rongwei; Williams, Leah; Ang, Samuel P; Sidharthan, Shawn; Lai, Wilson; Hussain, Nasir; Patel, Kiran V; Gulati, Amitabh; Henry, Onyeaka; Kaye, Alan D; Orhurhu, Vwaire. (2025). Cannabinoids as a Potential Alternative to Opioids in the Management of Various Pain Subtypes: Benefits, Limitations, and Risks.. Pain and therapy, 12(2), 355-375. https://doi.org/10.23970/AHRQEPCCER250UPDATE2025
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