CBD Doesn’t Relieve Pain. THC Sometimes Does—and That’s Complicated

7 September 2024
by: Juicing For Health
in Lifestyle & Wellness

Last updated on

Millions of Americans reach for cannabis products when chronic pain strikes. Dispensary shelves overflow with CBD oils, gummies, and tinctures marketed as natural pain relievers. Consumers spend billions each year on these products, convinced they offer relief without the high associated with marijuana. But what if everything they believed about CBD and pain was wrong? A major new systematic review published in the Annals of Internal Medicine has upended conventional thinking about cannabis and chronic pain management. Led by Dr. Roger Chou and colleagues at Oregon Health & Science University, analyzed data from randomized controlled trials to determine which cannabinoid products actually work and which fall short of their promises. Their findings challenge assumptions that have driven a multibillion-dollar industry. Some products appear to work, at least modestly. Others seem to do nothing at all. And the ones that help come with trade-offs that patients need to understand before making decisions about their care. For anyone who has ever wondered whether cannabis products actually reduce pain or whether marketing has outpaced science, this research offers some answers. Those answers, however, are more complicated than most consumers might expect.

A Closer Look at What Researchers Found

Oregon Health & Science University researchers conducted a systematic evidence review published in the Annals of Internal Medicine. Their team analyzed 25 short-term, placebo-controlled randomized trials involving more than 2,300 adults living with chronic pain. Most participants, about 64 percent, suffered from neuropathic pain, the kind caused by nerve damage that often proves difficult to treat with standard medications. Researchers categorized cannabis products in several ways. First, they looked at ratios of tetrahydrocannabinol to cannabidiol, sorting products into high, comparable, and low THC-to-CBD categories. Second, they examined whether products were synthetic, purified, or extracted from plants. Third, they tracked how patients took these products, whether orally, through sprays applied inside the mouth, or topically on the skin. By organizing the data in these ways, researchers could compare apples to apples rather than lumping all cannabis products together. What emerged from their analysis painted a picture far different from what many consumers might assume based on dispensary marketing or anecdotal reports from friends and family members.

CBD Falls Flat on Pain Relief

Here is where the research delivers its most surprising verdict. Products with low THC and high CBD, including formulations containing CBD alone, showed almost no improvement in pain management. Despite their popularity and widespread availability, CBD products failed to move the needle on pain scores in controlled clinical trials. Dr. Roger Chou, senior adviser for the Pacific Northwest Evidence-based Practice Center at Oregon Health & Science University and lead author of the review, did not mince words about what the data showed. “This may be surprising to people. Conventional wisdom was that CBD was promising because it doesn’t have euphoric effects like THC, and it was thought to have medicinal properties. But, at least in our analysis, it didn’t have an effect on pain.” For millions of Americans who have turned to CBD products hoping for relief, these findings demand attention. CBD has been marketed as a cure for everything from anxiety to inflammation to chronic pain. Its lack of psychoactive effects made it appealing to people who wanted potential benefits without feeling high. Yet when researchers put CBD through rigorous clinical testing, the promised pain relief failed to materialize. Perhaps more troubling, CBD products did not even appear to cause fewer side effects in a way that might justify their use as a gentler alternative. While pure CBD formulations did not increase adverse events like dizziness or nausea, they also did not provide the therapeutic benefit that would make them worth taking in the first place.

THC Offers Real but Limited Relief

Products containing higher concentrations of THC told a different story. Cannabis formulations with high THC-to-CBD ratios and those with comparable amounts of both compounds did reduce pain severity in clinical trials. Oral synthetic or purified THC-only products and oromucosal extracted products with balanced THC and CBD both showed statistically meaningful improvements. But patients and physicians need to understand what “meaningful” actually means in practice. Pain reductions ranged from about half a point to just over one and a half points on a standard 10-point pain scale. For someone rating their pain at seven out of ten, THC-based products might bring that down to six or perhaps five and a half. Relief, yes, but hardly a transformation. Not all THC products performed equally, either. Among pure THC formulations, researchers found stark differences between two FDA-approved medications. Nabilone demonstrated a moderate reduction in pain severity, lowering scores by about 1.59 points compared to placebo. Dronabinol, by contrast, showed almost no effect, reducing pain by a mere 0.23 points on average. Both medications carry FDA approval, but not for pain. Nabilone and dronabinol are approved for treating nausea and vomiting caused by chemotherapy. Dronabinol also has approval for HIV wasting syndrome. Their use for chronic pain represents off-label prescribing, and this new research suggests that choice matters when it comes to which product a physician might recommend.

Side Effects Cloud Any Benefits

Here lies the catch that anyone considering THC for pain must weigh. Products that worked also caused problems. Across trials, high and comparable THC formulations were linked to moderate and sometimes large increases in adverse events. Patients reported dizziness, sedation, and nausea at rates much higher than those taking placebos. For someone already struggling with chronic pain that limits their ability to work, drive, or care for family members, adding dizziness and sedation to their daily experience might not represent a worthwhile trade. A half-point reduction in pain means little if it comes with feeling foggy or nauseated throughout the day. Researchers noted these side effects occurred even during short-term use. Trials included in the review lasted between one and six months. What happens when patients use THC-based products for years remains unknown because long-term studies simply do not exist in sufficient numbers to conclude.

Why Cannabis Research Stays Complicated

Anyone hoping for simple answers about cannabis and pain will find frustration in the details. Unlike pharmaceutical medications manufactured under strict quality controls, cannabis products vary wildly depending on their source, preparation, and formulation. Dr. Chou explained why comparing cannabis studies proves so challenging. “It’s complicated because cannabis products are complicated,” he said. “It’s not like taking a standardized dose of ibuprofen, for example. Cannabis is derived from a plant and has multiple chemicals in addition to THC and CBD that may have additional properties depending on where it’s grown, how it’s cultivated and ultimately prepared for sale.”   Cannabis plants contain dozens of cannabinoids beyond THC and CBD, along with terpenes and other compounds that may influence how products affect the body. Two products with identical THC percentages on their labels might produce different effects based on these other ingredients. A patient who finds relief with one dispensary’s product might get different results from another brand, even if the numbers on the packaging look similar. Researchers in this review tried to account for some of that variability by categorizing products carefully. But they still found themselves limited by the information available in published trials. Many studies failed to provide complete details about the exact products tested, making it harder to draw precise conclusions about what works and what does not.

Medical Community Remains Split

Physicians themselves cannot agree on whether cannabis belongs in the pain management toolkit. Professional organizations have issued conflicting guidance that reflects genuine uncertainty about the evidence. Recently, the American College of Physicians declined to recommend inhaled cannabis for non-cancer pain. Yet a previous expert panel took a different view, issuing a soft recommendation that cannabis might help people with chronic cancer or non-cancer pain when standard treatments had failed to provide adequate relief. Neither position is unreasonable given the current state of evidence. Doctors who worry about side effects and the modest size of benefits can point to data supporting their caution. Physicians who believe desperate patients deserve access to any potentially helpful option can also find support in the research. What both camps agree on is that better evidence would help resolve these disagreements.

What Consumers Should Know

For patients wondering whether to try cannabis products for chronic pain, this research offers several takeaways worth considering. First, CBD products marketed for pain relief have not proven effective in clinical trials. Whatever benefits individual users believe they experience, controlled studies comparing CBD to a placebo have not found meaningful differences in pain scores. Spending money on CBD for pain management may not be money well spent based on current evidence. Second, THC-based products do appear to reduce pain, but improvements are modest, and side effects are real. Patients should have honest conversations with their physicians about whether the potential benefits justify the risks, especially given that dizziness, sedation, and nausea occur at elevated rates. Third, not all THC products work equally. Among available options, nabilone has shown stronger effects than dronabinol in reducing pain. Patients and doctors should consider this variation when making treatment decisions. Dr. Chou framed his team’s mission in terms of helping people make informed choices rather than telling them what to do. “CBD-based products are widely available in dispensaries. Many people use these products, and they think they help. Our goal is to provide some scientific basis to help people make their decisions,” said Dr. Chou.

Big Gaps Remain in What We Know

Researchers closed their review by acknowledging how much remains unknown. Long-term outcomes have not been studied adequately. Scientists still need to understand why different THC products produce different results. Perhaps most important for everyday consumers, researchers need to determine whether findings from clinical trials translate to products actually available at dispensaries. Products sold in licensed cannabis stores may differ from those tested in research settings. Variations in growing conditions, extraction methods, and quality control could mean that dispensary products perform better or worse than their clinical trial counterparts. Without studies directly comparing these real-world products, patients cannot know for certain whether the research applies to what they are buying. For now, the evidence suggests a sobering reality. Cannabis is neither the miracle pain cure that enthusiasts claim nor the dangerous substance that opponents warn against. It occupies a messier middle ground where some products might help some people a little bit, while others appear to do nothing at all, and side effects remain a genuine concern. Patients deserve to know these facts before they spend money and risk-averse effects on products that may or may not deliver the relief they seek. Science has not yet provided all the answers about cannabis and pain. But it has provided enough information for people to make more informed choices than marketing alone would allow.

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