Quick answer
Cannabis can reduce some types of pain. The evidence is strongest for chronic pain in adults and for multiple sclerosis spasticity. The evidence is mixed for acute pain. CBD alone has less evidence. The FDA has not approved cannabis or CBD for pain.
The Ultimate Guide to Cannabis for Alleviating Pain
What the evidence says
A 2017 report from the National Academies of Sciences, Engineering, and Medicine reviewed more than 10,000 studies. It found substantial evidence for three uses. One was chronic pain in adults. The report covered cancer pain, neuropathic pain, and fibromyalgia. Pain relief was modest. The other two uses were multiple sclerosis spasticity and chemotherapy-induced nausea.
- Chronic pain: substantial evidence for cannabis or cannabinoids.
- Multiple sclerosis spasticity: substantial evidence for oral cannabinoids.
- Chemotherapy-induced nausea: substantial evidence for oral cannabinoids.
- Acute pain: insufficient evidence.
FDA-approved cannabinoid medicines
The FDA has approved three cannabinoid drugs. None is approved for general pain.
- Epidiolex (CBD) for seizures in Lennox-Gastaut syndrome, Dravet syndrome, and tuberous sclerosis complex.
- Marinol and Syndros (dronabinol) for nausea and vomiting from chemotherapy, and for anorexia in AIDS.
- Cesamet (nabilone) for nausea and vomiting from chemotherapy.
No FDA-approved cannabis product lists pain as an indication.
CBD for pain
CBD is one cannabinoid. It does not cause a high. Research on CBD for pain is early. The National Center for Complementary and Integrative Health states that the strongest evidence for CBD is for certain epilepsy syndromes. More research is needed for pain. Some human studies show CBD may reduce pain from arthritis, neuropathy, or multiple sclerosis. Many trials are small. Doses range from 10 mg to 600 mg per day. Side effects include diarrhea, tiredness, and liver enzyme changes. CBD can interact with drugs like warfarin and clobazam.
Risks and side effects
THC causes impairment, anxiety, dry mouth, and increased heart rate. Cannabis smoke irritates lungs. High THC doses can cause paranoia or psychosis in some people. The CDC states that about 3 in 10 people who use marijuana have marijuana use disorder. Long-term use before age 18 may affect brain development. CBD can cause liver injury, drowsiness, and drug interactions. The FDA warns that CBD can harm the liver.
State law and product testing
Cannabis is illegal under federal law in the US. Many states allow medical or adult-use cannabis. Hemp is legal under federal law if it contains no more than 0.3% THC. The FDA still regulates CBD products. Labels often do not match content. Some products contain THC. Third-party lab tests show cannabinoid profile, pesticides, heavy metals, and solvents. Look for a batch number and a lab report.
What to discuss with a clinician
Ask about drug interactions, dose, and product type. Track pain scores and side effects. Do not replace proven treatments without medical advice. For chronic pain, CDC guidelines recommend nonopioid therapies first. For neuropathic pain, drugs like gabapentin, pregabalin, duloxetine, and amitriptyline have evidence. Cannabis may be an add-on for some patients. More research is needed.