A 1:1 THC:CBD Cannabis Extract Significantly Reduced Chronic Pain in German Patients | Research

The takeaway

In 64 chronic pain patients in Germany, a THC25:CBD25 hybrid cannabis extract reduced average pain scores from 5.5 to 3.4 on a 10-point scale, with even larger improvements in cannabis-naïve patients (5.9 to 2.4).

Pain medicine specialists, primary care physicians, chronic pain patients, and medical cannabis prescribers.

What the researchers found

Mean pain intensity (NRS) decreased from 5.46 to 3.37 in the full population (n=64) and from 5.92 to 2.37 in cannabis-naïve patients (n=35). Pain interference also decreased substantially in both groups. Physical and mental health quality of life improved, and both patients and physicians reported high satisfaction.

Why it matters

Real-world evidence from clinical practice showing meaningful pain reduction with a balanced THC:CBD extract adds to the growing case for cannabis as a chronic pain treatment option, especially the impressive results in cannabis-naïve patients.

The numbers in context

64 patients (ITT), 35 cannabis-naïve. Pain NRS: 5.46 → 3.37 (ITT), 5.92 → 2.37 (naïve). Pain interference: 5.39 → 3.38 (ITT), 5.68 → 2.54 (naïve). Both physical and mental health SF-12 scores improved. High patient and physician satisfaction.

How the study worked

ESCAPE: observational study of 64 patients (50% female) with chronic pain in Germany receiving Cannamedical Hybrid Cannabis Extract THC25:CBD25 across four clinical visits. Pain assessed by Brief Pain Inventory (NRS and interference), quality of life by SF-12. Cannabis-naïve patients analyzed as a pre-specified subgroup.

What this study cannot tell us

Observational, no control group or blinding — cannot separate treatment effects from placebo, regression to mean, or natural course. Moderate sample size. Product-specific results may not generalize. Potential selection bias in physician-referred patients.

How to read the evidence

Observational real-world study with validated pain measures and pre-specified subgroup analysis, but no control group or blinding.

When this study was published

Published 2025.

The bigger picture

The substantially greater improvement in cannabis-naïve patients (60% pain reduction vs 38% overall) suggests that first-time cannabis users may benefit most, possibly due to lack of tolerance. This has practical implications for prescribing decisions.

Questions still open

Would a randomized controlled trial confirm these results? Is the balanced THC:CBD ratio important, or would THC-dominant or CBD-dominant extracts work as well? Why do cannabis-naïve patients respond so much better?

Common questions

Does cannabis work better for people who've never tried it?

In this study, cannabis-naïve patients had a 60% pain reduction compared to 38% overall. This may reflect lower tolerance, stronger placebo response, or genuine first-use benefit. More research is needed to confirm this pattern.

What does a 1:1 THC:CBD ratio mean?

The extract contained equal parts THC and CBD (25% each). The balanced ratio is thought to provide pain relief from THC while CBD may reduce THC side effects and add its own anti-inflammatory benefits.

Read the original research

How to ESCAPE from Pain? An Observational Study on Improving Pain and Quality of Life with the Cannamedical® Hybrid Cannabis Extract.

Advances in therapy, 42(9), 4367-4389

View on PubMed ↗Publisher’s paper ↗

Citation

Wagner, Yvonne; Samel, Ines; Probst, Kristina; Schollenberger, Lukas; Ruckes, Christian; Nadstawek, Joachim. (2025). How to ESCAPE from Pain? An Observational Study on Improving Pain and Quality of Life with the Cannamedical® Hybrid Cannabis Extract.. Advances in therapy, 42(9), 4367-4389. https://doi.org/10.1007/s12325-025-03262-z