A physician-focused review found that while most evidence supports cannabis for pain management, no head-to-head comparison exists between different cannabis preparations, leaving the optimal treatment approach unanswered.
Physicians prescribing cannabis for pain, pain specialists, and patients choosing between cannabis products.
Zero head-to-head comparisons between cannabis preparations for pain
What the researchers found
Most reviews concluded cannabis plays a significant role in pain management. Systematic studies do not support an "entourage effect" of other cannabis plant constituents for pain. CBD is the only cannabinoid that does not cause intoxication and is not a controlled substance. No head-to-head comparison exists between different cannabis cultivars, between pure cannabinoids, or between pure cannabinoids and extracts.
Why it matters
Physicians must choose between very different cannabis products with no comparative evidence. The finding that the "entourage effect" lacks systematic support for pain challenges a major marketing claim.
The numbers in context
Products range from defined cultivars (varying THC:CBD ratios) to pure cannabinoids (THC, CBD) to standardized mixtures (nabiximols, 1:1 THC:CBD). Zero head-to-head comparisons published.
How the study worked
Review examining cannabis and cannabinoid preparations for chronic pain from the physician perspective, covering available preparations (cultivars, extracts, nabiximols, pure CBD/THC), evidence base, and clinical knowledge gaps.
What this study cannot tell us
Narrative review without systematic methodology. Conflicting opinions in the literature acknowledged. Pain is heterogeneous, making generalized recommendations difficult.
How to read the evidence
Physician-focused review synthesizing existing evidence but noting the absence of comparative clinical trials.
When this study was published
Published in 2022.
The bigger picture
Despite thousands of years of cannabis use for pain and growing modern legalization, the most basic clinical question, which preparation works best, remains unanswered.
Questions still open
- Why have no head-to-head trials been conducted? Would standardized cannabis preparations enable better clinical comparisons?
Common questions
Which form of cannabis works best for pain?
Does the entourage effect help with pain?
Read the original research
The Role of Cannabis, Cannabidiol and Other Cannabinoids in Chronic Pain. The Perspective of Physicians.
Journal of neuroimmune pharmacology : the official journal of the Society on NeuroImmune Pharmacology, 17(1-2), 318-333
Citation
Köstenberger, Markus; Nahler, Gerhard; Jones, Trevor M; Neuwersch, Stefan; Likar, Rudolf. (2022). The Role of Cannabis, Cannabidiol and Other Cannabinoids in Chronic Pain. The Perspective of Physicians.. Journal of neuroimmune pharmacology : the official journal of the Society on NeuroImmune Pharmacology, 17(1-2), 318-333. https://doi.org/10.1007/s11481-021-10010-x
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