Four small trials suggest cannabinoids may reduce diabetic nerve pain, but the evidence is too limited for firm conclusions

Three of four RCTs reported statistically significant reductions in neuropathic pain with cannabinoid interventions compared to placebo. Vaporized or sublingual THC at approximately 16-18 mg/day was associated with clinically meaningful pain relief. One trial did not show superiority over placebo.

Systematic review searching PubMed, Google Scholar, Cochrane Library, and Scopus. Screened 15,377 records, assessed 35 full-text articles for eligibility, and included 4 RCTs in qualitative synthesis. Only studies conducted specifically in participants with diabetes and painful peripheral neuropathy were eligible.

Diabetic peripheral neuropathy affects up to 50% of people with diabetes and is notoriously difficult to treat. Despite growing interest in cannabinoids for neuropathic pain, evidence specific to diabetic neuropathy is remarkably sparse.

The fact that only four small trials exist despite decades of cannabinoid research highlights how little specific evidence exists for this common and debilitating condition. The preliminary dose range of 16-18 mg/day THC provides a starting point for future trials.

Only four small, heterogeneous RCTs were available. Variability in formulations and comparators limits comparability. Risk of bias concerns across studies. The identified dose range should be viewed as hypothesis-generating, not as a recommendation.