Updated Review: Does Cannabis Actually Help Chronic Pain?

Systematic review searching Ovid MEDLINE, PsycINFO, Embase, Cochrane Library, and Scopus through July 2025. Included only randomized placebo-controlled trials of cannabinoids for chronic pain lasting 1–6 months. Cannabinoids were categorized by THC-to-CBD ratio, source (synthetic, purified, extracted), and administration method. Risk of bias and strength of evidence were independently reviewed by two assessors.

Cannabis is increasingly used and recommended for chronic pain, but the evidence base has been unclear. This review — published in the Annals of Internal Medicine, one of the most selective medical journals — provides the most current synthesis available and draws a clearer line between which cannabinoid types show benefit and which do not.

This review reinforces a growing pattern in cannabinoid research: the type of cannabinoid product matters enormously. Nabilone (a synthetic THC analog) outperformed plant-derived THC, while CBD-dominant products showed no pain benefit in controlled trials. For the millions of people using cannabis products for pain based on anecdotal evidence, the clinical trial data tell a more nuanced story — one where specific formulations matter and side effects are part of the equation. This connects to the broader Cochrane neuropathic pain review (RTHC-00225) which reached similar conclusions about modest benefit and significant harms.

Most trials were short-term (1–6 months), so long-term efficacy and safety remain unknown. The 64% neuropathic pain concentration means results may not generalize well to other chronic pain types. Many trials had moderate risk of bias. Cannabis product formulations varied across studies, making direct comparisons imperfect.