Medical Cannabis May Work Less Well for People With Nociplastic Pain | Research

The takeaway

Among 1,213 medical cannabis patients with chronic pain, those with higher nociplastic pain scores reported less symptom relief and more side effects from cannabis, despite also substituting it for more medications.

Chronic pain patients, medical cannabis providers, and pain researchers

Higher nociplastic pain = less cannabis benefit + more side effects

What the researchers found

Higher nociplastic pain (NPP) scores were associated with less self-reported improvement in pain and overall health from medical cannabis, more cannabis side effects, and paradoxically, greater use of other medications including opioids and benzodiazepines, but also greater substitution of cannabis for those same medication classes.

Why it matters

Nociplastic pain, which arises from abnormal pain processing in the nervous system, affects conditions like fibromyalgia and is notoriously difficult to treat. Understanding that medical cannabis may be less effective for this pain subtype helps set realistic expectations and guide treatment decisions.

The numbers in context

1,213 participants. 59% female, mean age 49.4 years. Higher NPP quartiles associated with less improvement in pain, more side effects, higher concomitant opioid and benzodiazepine use, and substitution of cannabis for more medication classes.

How the study worked

Cross-sectional study of 1,213 medical cannabis users with chronic pain. The 2011 Fibromyalgia Survey Criteria was used as a surrogate for NPP severity. Participants were divided into quartiles and compared on medication use, cannabis use patterns, and symptom relief.

What this study cannot tell us

Cross-sectional design cannot determine causation. The FM Survey Criteria is a surrogate for NPP, not a direct measure. Self-reported outcomes may not reflect objective changes. The study cannot determine whether cannabis was truly less effective or whether these patients simply had more severe and treatment-resistant conditions.

How to read the evidence

Large cross-sectional study with a validated pain measure, though the cross-sectional design limits causal claims.

When this study was published

2024 study

The bigger picture

Not all chronic pain is the same. The finding that cannabis works differently depending on the underlying pain mechanism suggests a need for more personalized approaches to medical cannabis. One-size-fits-all recommendations may not serve patients well.

Questions still open

Is the lower efficacy in high-NPP patients because cannabis is genuinely less effective for nociplastic pain, or because these patients have more severe overall symptom burden? Would different cannabis formulations or doses work better for NPP?

Common questions

Does medical cannabis work for all types of chronic pain?

Not equally. This study found that patients with nociplastic pain (pain from abnormal nervous system processing, as in fibromyalgia) reported less benefit and more side effects from medical cannabis.

Why would patients who get less relief from cannabis still use more of it?

The researchers suggest it may reflect higher overall symptom burden and polypharmacy. These patients may be substituting cannabis for medications that also were not fully effective.

Read the original research

Relationship Between Nociplastic Pain Involvement and Medication Use, Symptom Relief, and Adverse Effects Among People Using Medical Cannabis for Chronic Pain.

The Clinical journal of pain, 40(1), 1-9

View on PubMed ↗Publisher’s paper ↗

Citation

Scott, J Ryan; Williams, David A; Harte, Steven E; Harris, Richard E; Litinas, Evangelos; Sisley, Suzanne; Clauw, Daniel J; Boehnke, Kevin F. (2024). Relationship Between Nociplastic Pain Involvement and Medication Use, Symptom Relief, and Adverse Effects Among People Using Medical Cannabis for Chronic Pain.. The Clinical journal of pain, 40(1), 1-9. https://doi.org/10.1097/AJP.0000000000001164