Cannabis products with THC showed small pain improvements with significant side effects, while CBD alone did not help
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.
Quick Facts
What This Study 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).
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- CBD alone produced no pain benefit, while THC products increased dizziness risk 3.6x
- Evidence Grade:
- Comprehensive living review with moderate strength of evidence, updated through April 2025.
- Study Age:
- Published 2025, updated through April 2025
- Original Title:
- Cannabinoids as a Potential Alternative to Opioids in the Management of Various Pain Subtypes: Benefits, Limitations, and Risks.
- Published In:
- Pain and therapy, 12(2), 355-375 (2025)
- Authors:
- Chou, Roger(2), Ahmed, Azrah Y.(2), 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
- Database ID:
- RTHC-06220
Evidence Hierarchy
Combines results from multiple studies to find an overall pattern.
What do these levels mean? →Frequently Asked Questions
Does cannabis help with pain?
THC-containing products produced small reductions mostly for neuropathic pain. CBD alone showed no benefit.
What are the side effects?
THC products caused large increases in dizziness (3.6x) and sedation (5x), and moderate nausea increases. These are significant relative to the small pain benefit.
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Cite This Study
https://rethinkthc.com/research/RTHC-06220APA
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
MLA
Chou, Roger, et al. "Cannabinoids as a Potential Alternative to Opioids in the Management of Various Pain Subtypes: Benefits, Limitations, and Risks.." Pain and therapy, 2025. https://doi.org/10.23970/AHRQEPCCER250UPDATE2025
RethinkTHC
RethinkTHC Research Database. "Cannabinoids as a Potential Alternative to Opioids in the Ma..." RTHC-06220. Retrieved from https://rethinkthc.com/research/chou-2025-cannabinoids-as-a-potential
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.