Medical Cannabis for Chronic Pain: What the Evidence and the Law Say

Medical cannabis reduced pain by 0.43-0.70 points on the NRS scale (0-10) versus placebo across studies. Serious adverse events were rare. Common side effects included dizziness, drowsiness, dry mouth, and nausea. The risk of cannabis use disorder was approximately 29% per DSM-5 criteria. Absolute contraindications include unstable cardiovascular disease, psychosis, bipolar disorder, and pregnancy.

Narrative review of available literature on medical cannabis for chronic pain, covering efficacy, safety, contraindications, drug interactions, dosing, and medico-legal considerations in the Italian regulatory context.

As medical cannabis prescriptions increase globally, pain therapists need a comprehensive understanding of what the evidence actually shows. The modest pain reduction alongside a substantial addiction risk frames a realistic benefit-risk conversation for patients.

The gap between patient expectations and evidence-based outcomes is wide in medical cannabis for pain. A mean pain reduction of less than one point on a 10-point scale is statistically significant but clinically modest. Combined with the 29% CUD risk, this underscores the need for realistic patient counseling.

Narrative review without systematic methodology. The 29% CUD risk figure may overestimate risk in medically supervised use. Medico-legal considerations are specific to Italian law. Pain reduction averages mask individual variation in response. Does not cover all cannabis formulations or routes.