Food and Drug Administration have demonstrated clear clinical benefits. The endocannabinoid system and pain. Brennan F, Carr DB, Cousins M. The role of opioids in pain management. Li HL, Lin H. An archaeological and historical account of cannabis in China. Touw M. The religious and medicinal uses of cannabis in China, India and Tibet. In a spontaneous canine OA model, CBD increased dogs’ mobility and reduced pain, while no side effects were observed, Gamble et al. demonstrated increased alkaline phosphatase during CBD treatment 81,86. In addition to surgically induced neuropathy, chronic pain can be triggered by chemical substance administration. Δ9-THC has stronger effects on pain reduction than CBD; nevertheless, side effects exclude its clinical use. Greene et al. demonstrated that chronic daily CBD administration enhanced the development of tolerance to Δ9-THC-induced anti-nociception, likely due to CBD-induced inhibition of Δ9-THC metabolism or due to antagonism of Δ9-THC’s effects after repeated treatment . Currently, both safety and efficacy data are lacking for the use of medical cannabis to treat chronic nonmalignant pain conditions. Neuropathic pain is another pain condition that has been investigated in prospective studies, but a lack of high-quality evidence renders cannabis treatment for this indication a grade C recommendation. Although 3 large and well-designed randomized controlled trials have investigated cannabis treatment of cancer-related pain, the evidence yields only a grade D recommendation. Despite increasing evidence of the efficacy of inhaled cannabis and cannabis extracts on treating neuropathic pain, additional randomized controlled trials with large sample sizes are needed to further assess the efficacy of medical cannabis for neuropathic pain. No other associations between cannabis use disorder and other anxiety disorders proved to be significant after adjustment for covariates. The five studies were all longitudinal, published between 1996 and 2013, and conducted in Australia, Colombia, the Netherlands, New Zealand, and the United States. Given the role of the endocannabinoid system in mood regulation, it is worthwhile for this report to explore the relationship between anxiety and cannabis. Anxiety disorders share features of excessive fear and anxiety, which induce psychological and physical symptoms that can cause significant distress or interfere with social, occupational, and other areas of functioning (APA, 2013). Studies have also found that people might be using fewer opioids for pain relief, possibly because more of them are using medical cannabis instead.1 During the 1800s, researchers in Europe and the U.S. published over 100 studies on medical cannabis.7 Later, legal restrictions reduced its medical use. The balance of benefits and harms from long-term use of cannabis for chronic pain is unclear. The patient populations with the best evidence supporting cannabis come from patients with neuropathic pain and the results may not generalize to those with musculoskeletal pain. "It's really challenging to tell somebody, 'I know you're in pain, but there's nothing I can do for you, and a lot of patients do not want to go on opioids,'" he says. UC Davis surgeon Richard Price thinks it's a reasonable option for his patients who are not getting an operation, though he'd like to see the findings from Europe replicated in the U.S., before he promotes cannabis more broadly. Currently there's only one cannabis-derived medication with FDA approval, the seizure treatment Epidiolex, and it doesn't contain any THC. On the other hand, he recalls the case of an older woman who tried cannabis for knee pain. The Farm Bill removed all hemp-derived products, including CBD, from the Controlled Substances Act, which criminalizes the possession of drugs. One of hundreds of components in marijuana, CBD does not cause a high by itself. However, these reports generally do not extend to regulated clinical trials for rheumatic diseases. Indeed, it is the largest medical request for the use of the drug. Arachidonic acid derived endocannabinoids are the normal physiological activators of the two cannabinoid receptors. These results point to the safe therapeutic potential of cannabinoids for alleviating pain.46 This effect was mediated by transient receptor potential cation channel (TRP) subfamily V1 (TRPV1) and TRP subfamily A1 (TRPA1), not CB1 and CB2.44 A follow-up study showed that CBD also reduces the secretion of IL-6, IL-8, and MMP3 from synovial fibroblasts from RA patients. Another study, using lipopolysaccharide-activated BV-2 microglial cells, reported that both THC and CBD decreased pro-inflammatory signaling activation by reducing the activation of the JAK/STAT pathway. Several studies have reported that CBD reduces the formation of reactive oxygen species and nitric oxide in various cell lines and animal models of inflammation. In addition, several studies have shown that cannabinoids downregulate cytokine and chemokine production and upregulate T-regulatory cells to suppress inflammatory responses.16,22 The third trial was a randomized, double-blind, placebo-controlled, crossover trial involving 20 adults in which both inhaled marijuana and oral THC were evaluated.One author (Webb C.) worked for 26 years in a high volume emergency department where he never witnessed a single visit for cannabis withdrawal symptoms, whereas dramatic symptoms from alcohol, benzodiazepine, and/or opioid withdrawal were a daily occurrence.There are some interactions between CBD and certain chemotherapy drugs, so those undergoing cancer treatment should inform their doctor of marijuana use, she says.Joining Releaf as a Consultant Neurologist in April 2024, Dr Michal Modestowicz brings more than a decade of experience in neurology plus two years within the medicinal cannabis industry to Releaf patients.The prevalence of medical cannabis use is steadily rising in the medical histories of individuals suffering from chronic pain.To begin the development of a cannabis use registry in Oregon.This can lead to a person getting too much THC, feeling effects for longer, and might cause symptoms of overdose.The team grouped products by THC-to-CBD ratios.Despite these limitations, the AHRQ review is consistent with international literature. The systematic review8 of the guidelines was generally well conducted. Critical appraisal of the included overviews, systematic review of guidelines, and guidelines are summarized below, and details for the overviews and systematic review of guidelines are presented in Appendix 3, Table 4; and details for the guidelines are presented in Appendix 3, Table 5 and Table 6. Outcomes considered in the overviews included pain reduction,11–14 quality of life,14 tolerability,13 withdrawal,11 adverse events,11–14 and serious adverse events.11,13 As such, using cannabis to ease anxiety can take some trial and error, and a medical professional should be consulted. The active ingredients in cannabis can produce two opposite effects, depending on the dose taken. What you need to know (and what we’re working to find out) about products containing cannabis or cannabis-derived compounds, including CBD. FDA regulation of cannabis and cannabis-derived products, including cannabidiol. These products include cannabis oils, gels, salves, creams, and patches. CBD's medical value was a hot topic for debate before being recognized in the medical field. More clinical trials should be done to prove CBD's significance clinically and statistically. Regulations of CBD worldwide differ from each other due to the insufficiency of solid evidence to establish its benefit versus the risks. CBD and tetrahydrocannabinol (THC), both from Cannabis plants with almost identical chemical structures, attach to the CB receptor, eliciting different effects like the psychoactivity seen on THC but less or none in CBD. Inclusion criteria were applied, and quality assessments were done, resulting in 12 publications eligible for the review. In an RCT, researchers compared the safety and effectiveness of orally administered Cannabis extract (2.5 mg THC and 1 mg CBD), THC (2.5 mg), or placebo for the treatment of cancer-related anorexia-cachexia. The authors concluded that dronabinol, compared with megestrol acetate, did little to promote appetite or weight gain in patients with advanced cancer. One-quarter of the patients reported a favorable antiemetic response to the cannabinoid therapies. Individuals reported a higher preference for cannabinoids than placebo or prochlorperazine. In essence, this means that CBD is legal if it comes from hemp, but not if it comes from cannabis (marijuana) — even though it is the exact same molecule.The main characteristics of all included studies are summarized in Fig.To complicate matters even further, no one really knew how marijuana interacted with many of these other medications.In addition to reporting on the systematic review by Marconi et al., the systematic review conducted by Moore et al. is also discussed.This study addressed the broad question of cannabis use and psychotic outcome and included meta-analysis results.An Israeli study found similar results, reporting that this association may be due more to sociodemographic and clinical factors than to cannabis use itself.There was no difference in the antiemetic effect of cannabinoids when compared with prochlorperazine.Most of the cannabis products in that study were oils containing CBD and/or THC. • Of those who ingested, most felt it more effective for pain relief than smoking. 57% of focus group participants used several times daily. Primarily cannabis tea (smoking cannabis not permitted in Italy). Yet a trial of 80 people with PTSD showed that, compared with a placebo, cannabis had no significant effect on symptoms after three weeks. A 2021 study followed 150 people with PTSD for a year and found that those who used cannabis were about 2.5 times more likely to no longer meet criteria for the condition. A 2023 study of more than 8000 people prescribed opioids showed that those using cannabis approximately halved their opioid use after eight months. A 2020 study estimated that if US counties with a marijuana dispensary opened another storefront, they could decrease opioid-related deaths by 17 per cent. An infection of the spinal discs is called discitis, and it can cause a breakdown of the structure of discs, causing back pain. When the infection infiltrates spinal bone masses, a condition called osteomyelitis can occur, which weakens the bones, causing pain and discomfort. This is usually felt as pain just below the rib cage, radiating into the lower abdomen, groin, and back. A recent and authoritative systematic review, commissioned by the International Association for the Study of Pain, concluded that the current evidence ‘neither supports nor refutes claims of efficacy and safety for cannabinoids, cannabis, or cannabis-based medicines in the management of pain’ and that there is ‘the pressing need for studies to fill the research gap’,76 a conclusion supported by another recent systematic review.23 The Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists concluded that until higher-quality evidence is available, currently available cannabinoid products should only be prescribed as part of a registered clinical trial.77 There is little evidence of tolerance to the analgesic effects of cannabis-based medicines during extended use.32 Unlike with opioids, hyperalgesia to painful stimuli does not appear to occur with chronic use of cannabis,55 and analgesic effects can be retained, even when tolerance to psychotropic effects have developed.56 Heavy cannabis use in vulnerable individuals can increase the risk of psychosis and schizophrenia,24,57 and THC is contraindicated in individuals with a family history of mental health problems.58 Caution is also advised when prescribing THC to patients under the age of 25 years, and SAS-B prescribing data show that very few approvals for chronic pain involve patients in this age group (Figure 4). Regular monitoring of patients for adverse effects is recommended.54There is little evidence of tolerance to the analgesic effects of cannabis-based medicines during extended use.32 Unlike with opioids, hyperalgesia to painful stimuli does not appear to occur with chronic use of cannabis,55 and analgesic effects can be retained, even when tolerance to psychotropic effects have developed.56 Heavy cannabis use in vulnerable individuals can increase the risk of psychosis and schizophrenia,24,57 and THC is contraindicated in individuals with a family history of mental health problems.58 Caution is also advised when prescribing THC to patients under the age of 25 years, and SAS-B prescribing data show that very few approvals for chronic pain involve patients in this age group (Figure 4). The array of studies reviewed in these systematic reviews involved a heterogeneous mix of cannabinoids, routes of administration, doses, pain conditions treated and outcome measures, with studies also differing on whether cannabinoids were used alone or adjunctively with other medications. The approval rate for products to treat various chronic pain conditions is increasing dramatically. It is estimated that 600,000 Australians currently self-medicate with cannabis,6 with chronic pain a leading indication for such use. One in five Australian adults are estimated to live with chronic pain, costing the community over $140 billion per annum.1,2 Chronic pain is a frequent presentation in general practice and central to commonly treated conditions such as arthritis, fibromyalgia, cancer and diabetes. Suicidal behaviour is 2–3 times higher in patients with chronic pain, and approximately 40% of forced early workforce retirements are due to chronic pain. These effects were most noticeable in people with nerve-related pain, also known as neuropathic pain. The studies focused on pain that lingered for months or years, not short-term discomfort after injury or surgery. The review examined whether those differences matter for pain relief. Because medical marijuana lacks quality standards and FDA regulation, available products have shown significant inconsistencies, with one study revealing that only 17% of edible cannabis products were accurately labeled . As the medical marijuana landscape rapidly changes, it is imperative that healthcare providers stay up to date on available evidence regarding both the benefits and risks of use. Another reason that the reported pain relief is so significant is that cannabis has been proven effective for many forms of recalcitrant chronic pain. An early case–control study in New Zealand of marijuana use and lung cancer risk that included only 79 cancer-case subjects and 324 matched control subjects was published in 2008. Multiple case-controlled 60, 61 or cohort 62, 63 studies have shown no evidence of either lung or upper-airway cancer increase , especially after being controlled for tobacco use. There is obvious concern for cannabis smoking to increase lung cancer risk, as tobacco smoking is the major cause of lung cancer , and marijuana and tobacco smoke both contain many of the potent carcinogens . Looking at this from the point of cessation of cannabis smoking in cannabis-only smokers, there is an improvement of pre-existing respiratory symptoms of chronic bronchitis with symptoms in the quitters being reduced to levels similar to those in never-users . Future use will be determined by identifying formulations that provide sufficient pain relief while minimizing adverse effects. Cannabinoid use in the United States has been increasing as more states have legalized cannabis for medical and recreational uses. A high THC to CBD ratio in whole plant–based compounds showed the greatest likelihood of patient withdrawal from the study due to adverse effects. The incidence of severe adverse events resulting from CBD administration appears low based on review of these studies. Several comprehensive reviews have concluded that CBD has low toxicity, no psychotomimetic effects, very low abuse liability, and is well tolerated by adults 15, 48. There have generally been few randomized, placebo-controlled clinical trials to evaluate the therapeutic efficacy of CBD for most indications discussed and, in many instances, the data available from clinical trials or human laboratory studies were mixed with regards to the effectiveness of CBD versus placebo. Infectious Diseases If your doctor determines it might be a good option for you, they will discuss how you can use it to treat symptoms alongside your existing treatment plan. Medical cannabis products can contain primarily CBD, primarily THC, or a balance of the two. Cannabis is a flowering plant that produces chemicals called cannabinoids, which can be used to treat the symptoms of a number of conditions, including arthritis. The Moore et al (2007) review also included studies that showed an increased risk of psychotic spectrum disorder among cannabis users. Overall, studies consistently showed a relationship between cannabis use and the development of psychotic symptoms, though the magnitude of risk is uncertain. Further, a meta-analysis of 2 prospective community studies demonstrated an association between cannabis use and new-onset mania symptoms among those without a diagnosis of bipolar disorder (pooled OR 2.97; 95% CI, 1.80 to 4.90) with low heterogeneity between studies. The review found that only specific pharmaceutical-grade cannabinoid products approved by the U.S. According to first author Dr. Michael Hsu of UCLA Health, many people assume cannabis provides reliable medical benefits, yet recent research does not fully support those assumptions. Interest in cannabis and related compounds such as CBD has steadily increased, and a 2018 survey found that 27% of adults in the U.S. and Canada had used them for concerns like pain, anxiety and sleep. Over 120 of these studies were given priority based on sample size, recency, relevance and the range of health conditions they addressed. A study published in JAMA examined more than 2,500 scientific papers released from January 2010 through September 2025, including randomized clinical trials, meta-analyses and clinical guidelines. Another important consideration is whether cannabis is legal where you live. Whether or not to use cannabis for sleep is a highly personal decision. Health experts also recommend people avoid using cannabis while pregnant or breastfeeding. Cannabidiol (CBD) interacts with the endocannabinoid system in a similar way to THC, without the intoxicating effects. Incorporating marijuana into your lifestyle has several benefits, whether it’s THC or CBD. The authors acted independently, and Santé Cannabis had no role in the analysis of the study, nor the writing of the manuscript or decision to publish. The authors had no role in the conduct of the study and collection of data. This is a retrospective, observational study which took place at Santé Cannabis; therefore, the design and conduct of the study was executed by Santé Cannabis clinic staff. Further, a cross-sectional study by Aviram et al. of 145 patients reported that 61% of patients treated with cannabinoids had greater than a 50% reduction in their monthly migraine attack frequency with a decrease in migraine medication (opioid and triptan) consumption and disability. The level of evidence for the treatment of migraine with cannabis is poor and primarily comes from observational studies. A small randomized controlled trial and multiple observational studies offered limited evidence for the efficacy of cannabis treatment of headache 66,67,68,69,70,71,72. The American Society of Pain and Neuroscience has reviewed the evidence regarding the use of cannabis for fibromyalgia treatment. He has published a number of papers detailing lab experiments looking at endocannabinoids as well as THC, and written a review looking at the potential of cannabinoids for treating bowel cancer. In the past, Cancer Research UK has funded research into cannabinoids, notably the work of Professor Chris Paraskeva in Bristol investigating the properties of cannabinoids as part of his research into the prevention and treatment of bowel cancer. Researchers are looking into Sativex as a treatment for cancer related symptoms and for certain types of cancer. The National Institute for Health and Care Excellence (NICE) has listed conditions where it believes medically prescribed cannabis products might be helpful. In a randomized placebo-controlled, double-blinded study conducted on a spontaneouscanine model of osteoarthritis, Verrico et al found that CBD significantly decreased painand increased mobility in a dose-dependent fashion among animals.61 Unfortunately, opioid therapy and other conventional analgesicmodalities don’t show complete relief of pain in many patients. Cancer pain affects the quality of patients’ life and represents a major economic burdenacross the world. Among all 1,366 patients included in the review, cannabinoids were found to be more effective than the conventional antiemetics prochlorperazine, metoclopramide, chlorpromazine, thiethylperazine, haloperidol, domperidone, and alizapride. Numerous clinical trials and meta-analyses have shown that dronabinol and nabilone are effective in the treatment of N/V induced by chemotherapy.36-39 The National Comprehensive Cancer Network Guidelines recommend cannabinoids as breakthrough treatment for chemotherapy-related N/V. Despite advances in pharmacological and nonpharmacological management, nausea and vomiting (N/V) remain distressing side effects for patients with cancer and their families. Another Israeli group postulated that the anti-inflammatory and immunosuppressive effects of CBD might make it a valuable adjunct in the treatment of acute graft-versus-host disease (GVHD) in patients who have undergone allogeneic hematopoietic stem cell transplant. No ongoing clinical trials of Cannabis as a treatment for cancer in humans were identified in a PubMed search. There was no difference between THC/CBD spray and placebo in unpublished trials (three studies with 437 participants). There was a difference between THC/CBD spray and placebo in published trials (six studies with 935 participants). THC/CBD spray was not superior to placebo in unpublished trials (three studies with 437 participants). THC/CBD spray was superior to placebo in published trials (three studies with 655 participants). Cannabis‐based medicines in intermediate‐term studies were not superior to placebo (five studies with 1109 participants). Studies of the pathophysiology of cannabis smoke have shown related large airway epithelial damage, edema, erythema, and increased secretions with goblet cell hyperplasia, loss of ciliated epithelium, and squamous metaplasia on biopsy. In a cross-sectional study of 7716 US adults from the National Health And Nutrition Examination Study cohort, Kempker showed no effect on FEV1/FVC up to 20 joint-years, but in those with greater than 20 joint-years there was a 2.1-fold risk for FEV1/FVC ratio 23]. This has been confirmed , but is less than salbutamol, and is lost over time with the effects of combustion when smoked. Overall, while there may be some bronchodilator effects, they are likely negated by the paradoxical bronchospasm that also occurs with inhalation of combusted materials . Materials include a table summarizing results regarding CBD’s action in pain research and a CSV table containing CBD’s pharmacological data. These results provide hope for successful CBD use in the clinic in the future; however, more studies are required for precise elucidation of CBD’s mechanisms of action. Compared to Δ9-THC, CBD has fewer unwanted side effects, and they are milder. These targets were often not replicated throughout various models, suggesting the hypothesis of state-dependent effects of CBD. Medicinal cannabis use for CNCP (in palliative care, epilepsy, CINV, MS and chronic painThere was insufficient evidence from a smaller number of methodologically limited studies about the effects of cannabis on testicular or transitional cell cancer.Cancer pain results from inflammation, invasion of bone or other pain-sensitive structures, or nerve injury.Despite what these sources may claim, it’s impossible to tell whether these patients have been ‘cured’ by cannabis or not.About 40% of them reported that the number of monthly migraine headaches they had was cut in half.When we say a substance (like THC) has a biphasic effect, it means that it can produce two opposite effects — depending on the dose of the substance taken.The present study found associations between CBD use and improvements in patient’s arthritis symptoms and reductions in other medications.This classification also affects the ability of clinicians to prescribe cannabis and CBPs to their patients. Prevalence of chronic pain and high-impact chronic pain among adults–United States, 2016. While there are numerous areas of potential therapeutic development of products acting on the ECS intended to treat pain- and non–pain-related conditions, it is vital to recognize that the overall place in therapy for almost all of these products (pharmaceutical, botanical, or otherwise) is still widely unknown, and there is a growing need for more clinical safety and efficacy data since comprehensive information in these areas is still deficient.13 As knowledge expands, it is critical that pharmacists are prepared to answer the questions and concerns of healthcare professionals and patients alike. For example, the findings from a 2019 study published in the Journal of Psychoactive Drugs, which evaluated data from 1,000 individuals taking legalized cannabis in one state, found that among the 65% of individuals taking cannabis for pain, 80% found it was very or tremendously helpful.36 This led to 82% of these individuals being able to reduce, or halt, taking OTC pain medications and 88% being able to halt taking opioids.35 While medical cannabis presents many possibilities, the plant itself is extremely controversial, with questions over its legality, overall addictiveness, and effectiveness.22 Surveys report that an estimated 85% of Americans support legalizing medical cannabis.22 As of April 2019, medical cannabis was legal in 34 states, many of which necessitate patient registry or identification cards for the purchase and use of the substance for specific, diagnosed medical conditions.16 These conditions differ by state and continue to change. Medical visits related to cannabis use rose more than 27-fold among adults 65 and older between 2008 and 2021. Increasing numbers of older adults are using cannabis over recent years. Whenever possible, people who use CBD products should check the certificate of analysis (which summarizes independent tests of potency and contaminant levels) before buying these products. While CBD is generally safe and doesn’t have next-day effects, it can interact with certain medications. Small benefits occurred with oral synthetic products higher in THC and plant-derived THC/CBD sprays. Long-term follow-up was only available in 10 patients, so it is uncertain how many patients ultimately abstained from use and how often this resolved the symptoms. All patients were younger than 50 years old and 95% had used at least once weekly; 68% of the patients had used cannabis for over 2 years. Most cannabis cigarette samples provided by the participants had Aspergillus species detected in culture, and there was passage of fungal spores demonstrated through most of the samples. There were distinct differences between participants who used cannabis solely for medical reasons and those who used it for both medical and recreational purposes. Most of the researchers work for Leafwell, which helps patients get medical marijuana cards in states where it is legal. “By focusing on Nav1.8 as a therapeutic target, the study paves the way for the development of innovative, cannabinoid-based pain treatments.” Since then cannabinoids were found to act on various cancer cell lines, through various mechanisms.252,253 Cannabinoids were also found to be suppressors of angiogenesis and tumor invasion.254 Our knowledge on the anticancer activity of cannabinoids is rapidly expanding; hence only results of recent research on this topic are presented here. The antiproliferative action of cannabinoids on cancer cells was first noticed in the 1970s. This expression pattern supports a specific role for the CB1 receptor in controlling IOP.241 When delivered topically to cat eyes with osmotic minipumps, whole marijuana extract, THC and other plant cannabinoids reduced IOP, while cannabichromene was inactive. CBD causes antipsychotic effects.203 It was found to be a safe and well-tolerated alternative treatment for schizophrenia.204 (See, however, also ref 205). Neuropsychological results in THC-intoxicated normal volunteers exhibit strong similarities with data acquired from patients suffering from productive schizophrenic psychoses, as regards disturbances in internal regulation of perceptual processes.195 In a recent study, it was found that anandamide levels are enhanced in firstepisode schizophrenic patients, and that THC downregulates anandamide signaling.196 This observation possibly means that THC lowers endogenous production of anandamide, which may actually be a defense mechanism - presumably comparable to the known observation that administration of corticosteroids blocks corticosteroid synthesis. Sleep Aids: Know the Types, Benefits, & Risks Within weeks, her joint stiffness eased, and she cut back on painkillers. Years of NSAIDs left her with stomach pain, and steroids felt like a risky trade-off. This has sparked a surge of interest in natural alternatives, with cannabis stepping into the spotlight. The World Health Organization (WHO) estimates that chronic inflammatory diseases contribute to over 60% of deaths worldwide (WHO, 2020). Unlike acute inflammation, a short-term, healing response to cuts or infections, chronic inflammation lingers, often unnoticed, wreaking havoc over time. Using a case-control design of 410 patients with first episode psychosis and 370 population controls, Di Forti et al. (2015) showed that first-episode psychosis patients were more likely to have lifetime cannabis use, more likely to use cannabis every day, and to mostly use high- potency cannabis as compared to the controls. Similar research conclusions were reached in a longitudinal study by Valmaggia et al. (2014), where they examined the association between lifetime cannabis use and the development of psychosis. In addition, this group of studies collectively adjusted for approximately 60 different potential confounders, including other substance use, personality traits, sociodemographic markers, intellectual ability, and other mental health problems. The authors also noted that individual studies excluded psychotic symptoms that arose solely from drug use by using scales to measure drug intoxication. The authors noted that some individual studies adjusted for psychotic symptoms at previous assessments or baseline and excluded people with psychotic symptoms or diagnosis at baseline to help clarify the temporal order of events. Preclinical research suggests that emetic circuitry is tonically controlled by endocannabinoids. In addition, both plant-derived and endogenous cannabinoids have been studied for anti-inflammatory effects. ICAM-1 expression in tumor cells has been reported to be negatively correlated with cancer metastasis. An in vitro study of the effect of CBD on programmed cell death in breast cancer cell lines found that CBD induced programmed cell death, independent of the CB1, CB2, or vanilloid receptors. At the federal level, marijuana is still considered a Schedule I substance under the Controlled Substances Act and is not approved for medical use. Nine of the states have medical programs that allow you to use only CBD or low-THC products for medical conditions that qualify for the program. Of those states, 38 allow medical marijuana through comprehensive programs, while 14 states have a comprehensive medical-only program. In the new study, the researchers measured the electrical current in rodent sensory neurons and how the current changed when CBD, CBG, and CBN were introduced.Smoking cannabis or taking it in the form of tea often provides an inconsistent dose, which may make it difficult for patients to monitor their intake.Brennan F, Carr DB, Cousins M. The role of opioids in pain management.Finally, this study was an observational one, so our findings could not rule out the potential impact of factors such as the placebo effect.Patients with anxiety, depression, insomnia, or chronic pain diagnoses also showed improvements in condition-specific symptoms over 12 months.Studies on rodent subjects, for example, found that blocking activation of the CB1 receptor leads to increased depressive symptoms.Data from 2016 has shown that 77% of UK people surveyed (who smoke weed) reported normally mixing it with tobacco.Specific populations of patients may be more vulnerable to adverse effects of cannabis-based medications. Most studies were small, few reported outcomes beyond 2 to 3 weeks, and none reported long-term outcomes. Participants had central or peripheral neuropathic pain related to various health conditions. The risk of bias from this trial is unclear, as it was underpowered and participants who withdrew from the trial may have returned to taking other medications before returning for formal study withdrawal visit. This review differed in that it intentionally re-analyzed data excluding unpublished studies (most of which were industry-funded). Findings are inconsistent for effect of cannabis-based medicines in patients with fibromyalgia, musculoskeletal pain, Crohn’s disease, and MS. Based on four overviews11–14 (with overlapping systematic reviews), one systematic review of guidelines,8 there is some suggestion of benefit with cannabis-based medicines for neuropathic pain. The studies were generally of short term varying between 4 days to 14 weeks (when reported) and long-term effects are not known. Though there were fewer studies on cancer pain compared to non-cancer pain, their impact on the results was uncertain. Chronic back pain can vary in terms of intensity, from mild to moderate or severe.Data sharing is not applicable to this article as no new datasets were generated or analyzed during the current study.Moreover, study samples had to have included at least several participants with chronic musculoskeletal or non-cancer pain.The cannabinoidsrelated compounds exert their effects by the diverse and versatile mechanisms of action thatinclude both the neuronal and inflammatory pathways.In addition, both cannabinoids inhibited IL-1α-induced proteoglycan breakdown and collagen degradation.This is not intended to be an inclusive list, but rather to give a brief survey of the types of conditions for which medical marijuana can provide relief.Scientists and researchers are looking for alternative means to address chronic pain using more substantial evidence from clinical trials and observational studies.One participant addressed cognitive functioning and reported a perceived increase in cognitive functioning with the medical cannabis product.I asked Dr. Hill his thoughts on evidence-based guidance to physicians regarding cannabis products. CannaMD is proud to serve as a trusted resource for medical marijuana research and news. “The biologically hypothesized rationale for cannabinoid administration is whole-body exposure to exogenous cannabinoids to turn on pain inhibition.” These receptors are the same receptors targeted by cannabinoids, or chemical compounds, in marijuana. When body tissue is damaged, your cells produce endocannabinoids – a very unique type of neurotransmitter – that regulate inflammation and pain sensation through interaction with cannabinoid receptors. Surprisingly, a significant number of cannabis and pain management reports have still been published. In individual countries, prevalence rates have been reported as 3.3% in Austria (Gustorff 2008), 6.9% in France (Bouhassira 2008), and up to 8% in the UK (Torrance 2006). For postherpetic neuralgia, for example, studies demonstrate a large loss of quality of life and substantial costs (Scott 2006; Van Hoek 2009). Many people with neuropathic pain conditions are significantly disabled with moderate or severe pain for many years. Neuropathic pain is usually divided according to the cause of nerve injury. What Is Disease Progression in AS? The resultsof some “fair” quality studies were likely to be valid, while others may couldhave been only possibly valid. The “fair” quality category was broad, andstudies with this rating varied in their strengths and weaknesses. The study may be missing information, making it difficult to assesslimitations and potential problems. These studies did not meet all the criteria for a ratingof good quality, but no flaw or combination of flaws was deemed likely to causemajor bias. Stress may also cause SUD slips and relapse in patients who are in treatment for opioid and other substance use disorders. Added text about the findings from a multicenter survey on perceptions, prevalence, and patterns of Cannabis use among 13,180 patients with various cancers treated at 12 National Cancer Institute-designated cancer centers (cited Ellison et al. as reference 4). The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. Limitations noted by the authors that may be confounders in this analysis include the observational nature of the study, the relatively small sample size, and the high heterogeneity of the participants. Chronic pain affects millions worldwide, and for those seeking alternatives to traditional medications, cannabis has emerged as a potential solution. Researchers at the University of Sydney followed over 2,350 patients from across Australia who ingested cannabis oils containing both THC and CBD. No, Worldwide Cancer Research have not yet funded any research about cannabis and cancer. The five studies included in the meta-analysis of heavy cannabis use and suicidal ideation were published between 1997 and 2013 and conducted in Canada, New Zealand, Norway, and the United States (two studies) in male and female populations of all age groups. The six studies included in the meta-analysis of any cannabis use and suicide ideation were published between 1997 and 2014 and conducted in Canada, New Zealand, Norway, and the United States (four studies) in populations of male and female young adults or adolescents. Two systematic reviews were identified that assessed the association between cannabis use and suicidal ideation, attempts, and suicide (Borges et al., 2016; Moore et al., 2007). CONCLUSION 12-5 There is moderate evidence of a statistical association between cannabis use and a small increased risk for the development of depressive disorders. In the largest RCT, 246 patients with peripheral neuropathic pain self-titrated nabiximols up to a maximum allowable dose of 24 sprays/day or received a placebo.41 Those who completed the study (79 nabiximols and 94 placebo) and responded positively to the intervention demonstrated a significant decrease in pain (OR 1.97, 95% CI 1.05 to 3.70). Odds of achieving ≥ 30% pain reduction with cannabis compared to placebo in trials of patients with neuropathic pain. Studies generally did not find clinically significant differences on continuous pain scales between groups, but a higher proportion of intervention patients experienced clinically significant pain relief at up to several months of follow-up. Thirteen trials examined the effects of cannabis-based preparations on neuropathic pain (Table 3). The authors of these clinical trials reported that cannabinoids (nabilone or Sativex®) led to a significant decrease in some aspects of pain in patients with fibromyalgia (Skrabek et al., 2008) or rheumatoid arthritis (Blake et al., 2006). Thus, available evidence on the effectiveness of MC against CMP and other chronic non-cancer pain remains limited and the results of systematic reviews are somewhat inconclusive. The review includes patients’ demographic characteristics, patterns of MC use, perceived positive and negative effects, use of alcohol or other drugs, reported barriers to CM use, and funding sources of the studies. Although the effectiveness of medical cannabis (MC) for CMP still lacks solid evidence, several patients suffering from it are exploring this therapeutic option with their physicians. Still, Hasin says, it “can have a lot of other consequences to both physical and psychological health.” Cannabis certainly isn’t dangerous in the same way as opioids are, Deborah Hasin, an epidemiologist who has researched cannabis, told Landau in a March 2024 story. One complication is that certain types of pain are especially susceptible to the placebo response. Although somewhat dated, a concise and useful review of outcomes is provided by the TGA’s Clinical guidance for the use of medicinal cannabis in the treatment of chronic non-cancer pain (December 2017).24 This analysis concluded that medicinal cannabis products were superior to placebo in producing a 30% reduction in pain scores and a 50% reduction in pain intensity ratings. The aim of this article is to briefly review the scientific evidence related to medicinal cannabis for the treatment of chronic pain and update physicians on relevant issues and optimal prescribing practices. To discover the benefits and adverse effects perceived by medical cannabis users, especially with regards to chronic pain. To determine current prevalence of medical cannabis in chronic non-cancer pain; estimate the dose size and frequency of cannabis use; describe main symptoms for which relief was sought. Is CBD a Safe and Effective Sleep Aid? Although most participants who addressed mental health spoke of the benefits, one participant stated not experiencing mental health benefits or pain relief. It medical cannabis takes the edge off plenty where I feel human again.” 56 years, female A participant suggested medical cannabis helped reduce suicidal ideation and made her feel ‘human again’. One participant believed that medical cannabis helped with his diabetes management. Cannabis and Gastrointestinal Diseases By bridging high-quality clinical data with human-centered guidance, Cannabis for Chronic Pain Relief offers a practical and compassionate roadmap for those working with cannabis in the chronic pain setting. The status of approval of cannabis‐based medicines and reimbursement by health insurance companies for chronic pain differs from country to country (Ablin 2016; Krcevski‐Skvarc 2018). Some current clinical guidelines and systematic reviews consider cannabis‐based medicines as third‐ or fourth‐line therapy for chronic neuropathic pain syndromes if established therapies (e.g. anticonvulsants, antidepressants) have failed (Moulin 2014; Petzke 2016). Cannabis and Emerging Viral Diseases THC/CBD oromucosal spray (nine studies with 1433 participants) was superior to placebo. THC/CBD oromucosal spray (eight studies with 1436 participants) was not different to placebo. Dronabinol (two studies with 264 participants) was not different to placebo. THC/CBD oromucosal spray (nine studies with 1408 participants) was superior to placebo. THC/CBD oromucosal spray (six studies with 1092 participants) was superior to placebo. Most tested the ability of cannabinoids to relieve chronic pain in people with cancer or acute pain following surgery or injury. In this study, 21 patients with chronic pain were administered vaporized Cannabis along with sustained-release morphine or oxycodone for 5 days. An observational study assessed the effectiveness of nabilone in patients with advanced cancer who were experiencing pain and other symptoms (anorexia, depression, and anxiety). The included studies also varied greatly in terms of objectives, methodology, and participants’ populations, with 13 studies out of 49 (27%) having less than 100 participants. Moreover, people who are attending these centers may not use cannabis exclusively for medical reasons. For 41% of participants, they have been recruited at MC dispensaries, MC associations, or MC advocacy groups, including four studies performed in countries without a legal framework for access to MC (Swift et al., 2005; Coomber et al., 2003; Lintzeris et al., 2018; Pedersen et al., 2016). However, this review has several limitations, related principally to methodological weaknesses in an important proportion of the included studies. By blocking this process, NSAIDs reduce painful swelling. Fibromyalgia is a typical example.13 Other conditions that can cause central pain include stroke, multiple sclerosis, tumors, epilepsy, brain or spinal cord injuries, and Parkinson’s disease. Central pain develops when the central nervous system is not working properly and amplifies pain signals from the body.1,14 This type of pain can exist even without a clear physical cause. Patients often describe this pain as burning, stabbing, or tingling, and they may feel numbness or “pins and needles.” Neuropathic pain occurs when sensory or spinal nerves are damaged, causing them to send incorrect pain signals to the brain.14 For example, in diabetic neuropathy, foot pain comes from damaged nerves rather than injured tissue. In this study, the most commonly reported cannabis side effects included dry mouth (43%), fatigue (23%), and a lack of motivation (15%). The study identified several factors that increased the likelihood of a patient trialling cannabis for their chronic MSK pain. The number of medical cannabis patients has increased exponentially over the past 18 months, and that trend continues to strengthen. The authors found no convincing, unbiased, high-quality evidence suggesting that nabilone is of value in treating people with fibromyalgia. A large proportion of studies were observational, and there were very few level I randomized control studies in the core orthopedic topics. This difference, however, is considered barely clinically significant.25,26 Furthermore, it appears that CBD enhances the anticonvulsant effects of drugs in major seizures and reduces their effects in minor seizures.185,186 Hence, CBD was suggested as a drug for the treatment of children with pharmacoresistant epilepsy.187 The application of the CB1 receptor antagonistsSR141716A or AM251 to “epileptic” neurons caused the development of continuous epileptiform activity, resembling electrographic status epilepticus. Together these results show that cannabinoids have significant neuroprotective effects in this model of ALS, and suggest that these beneficial effects may be mediated by nonCB1 receptor mechanisms.172 THC was also found to delay the progression of disease.173,174 Treatment with AM1241, a CB2-selective agonist, was effective at slowing signs of disease progression, when administered after onset of signs in an ALS mouse model. In addition, its strong antioxidative and neuroprotective effects may prolong neuronal cell survival.171 Indeed, treatment of postsymptomatic, 90-day-old SOD1G93A mice (a model of ALS) with WIN 55,212-2, significantly delayed disease progression. "Since starting my treatment plan with Releaf, I’m genuinely shocked at how well it has worked." Albeit powerful at targeting pain, many would argue they have been overly prescribed, and they are often alarmingly hard to come off. Our expert clinical team and compliance specialists provide valuable insights to ensure accuracy when required. There have been anti-tumor effects of cannabinoids in animal and cell culture 58, 59 models. Bronchial biopsies have demonstrated that marijuana users show not only manifest airway inflammation but also histopathological and/or molecular changes indicative of precancerous bronchial activity 50, 51. In a 2-year follow-up study from Kaiser Permanente of 452 daily marijuana-only smokers and 450 non-smokers, there was a significant increase in outpatient visits for respiratory illnesses among the marijuana smokers (RR, 1.19; 95% CI 1.01–1.41) . In the smokers of marijuana alone, tobacco alone, or marijuana plus tobacco, the prevalence of chronic cough (18–24%), sputum production (20–26%), wheezing for at least 3 weeks/year (25–37%), and at least two prolonged episodes of acute bronchitis during the previous 3 years (10–14%) were significantly higher than in the non-smokers. If you’re considering using medical marijuana, check your state regulations. The only medical marijuana product approved by the FDA is a prescription oil called Epidiolex to treat epilepsy. One study of 84 CBD products found that more than a quarter contained more CBD than was on the label, and some products even contained THC. It’s also unclear exactly how cannabinoids prevent prostate cancer cells from getting bigger or dividing. There are no studies looking at how cannabinoids work in humans, so we don't know if they would work the same way in people. Othernon-serious side effects varied among studies and are listed in Table 1. AEs were reported in all studies, and most were categorized as non-serious. Additionalneuropsychological performance measurements were attempted, but wereinconclusive given the range of disabilities throughout the studyparticipants. The number of puffsneeded-to-treat to achieve a clinically significant reduction (30% or more) ofpain intensity during the 8 hour period was determined to be four. State Legalization of Medical Cannabis Emotional functioning, role functioning, and social functioning do not improve with use of non-inhaled medical cannabis or cannabinoids compared with placebo treatment. Non-inhaled medical cannabis or cannabinoids slightly improve pain levels, with a number needed to treat of 10 (95% CI, 7 to 20) to decrease average pain by 1 cm more on a 10-cm visual analog scale compared with placebo. Non-inhaled medical cannabis or cannabinoid products contain cannabis extract or combinations of cannabinoids, usually THC and CBD. The study authors reported that, during long‐term follow‐up, pain intensities remained at a low level (range 2.5 to 3.8 of a 0 to 10 scale). On the other hand, our analyses do not support the conclusions of the Special Interest Group on Neuropathic Pain (NeuPSIG) of the International Association for the Study of Pain that cannabis‐based medicines are not effective in chronic neuropathic pain (Finnerup 2015). The differences to our rather cautious conclusions on the efficacy, tolerability and safety of cannabis‐based medicines in chronic neuropathic pain can be explained as follows. Andreae 2015 performed an individual participant data analysis of 178 participants from five studies of inhaled cannabis. On the other hand, it may be unethical to ignore potentially important information from small studies or to randomise more participants if a meta‐analysis including small, existing studies provided conclusive evidence. That’s not to say cannabis can’t help with chronic pain, nausea, appetite and more—it’s just that we don’t yet have the research to know for sure. And indeed there is evidence that cannabis can help with pain from cancer, and the U.S. Cannabis is an extremely safe and effective medication for many patients with chronic pain. We did not find any articles comparing rates of CUD in chronic pain or PTSD populations to other populations. The amount of prior cannabis use reported in these studies also varied greatly, ranging from an average of weekly use to an average of using cannabis multiple times per day. The long-term effects of cannabis use on cognitive functioning are less clear, and the systematic review by Schreiner and colleagues suggests that cannabis use might not result in long-term cognitive impairment. Therefore, the strength of evidence for residual effects of cannabis use is rated as moderate. They reported that in this subgroup of studies examining long-term effects, there was not a statistically significant effect on global cognitive functioning, nor on any of the 8 reported cognitive domains.93 There may be differences in effect of different cannabis‐based medicines in different types of neuropathic pain. The treatment should be supervised by a pain specialist. The Special Interest Group on Neuropathic Pain (NeuPSIG) for the pharmacotherapy of neuropathic pain gave a weak recommendation against the use of cannabis‐based medicines (Finnerup 2015). Since relatively few participants achieve a worthwhile response with cannabis‐based medicines, decisions to use these medicines may require stopping rules to avoid the unnecessary exposure to harms in the absence of benefit. It might be expected that, at best, a few people with neuropathic pain will benefit from long‐term use of cannabis‐based medicines. Cannabis has a sizeable negative stigma surrounding it, and the patients open to trying CBD may have been more open to positive changes. Second, because the surveys were long, it could have deterred patients from returning for future visits. The surveys themselves were a limitation of this study for two reasons, the first being that they were exceedingly long, leading to survey fatigue taking minutes to complete. These participants dropping out may have been exacerbated by the lack of financial incentives to complete the surveys. Another limitation of the study was that each study visit saw people drop out of the study, which could have impacted our results. The studies also found that frequency of use correlated with the likelihood of a psychotic outcome. Cannabis use was slightly more common among individuals who died from suicide who used non-overdose methods (11.6%) than among those who died from suicide related to overdose methods (9.2%) in general population studies. Suicide ideation was noted to be increased among heavy cannabis users, though this was of borderline significance (OR 2.53; 95% CI, 1.00 to 6.39). Conversely, the pooled estimate may be inflated if cannabis users who choose to drive while intoxicated have a higher baseline risk independent of cannabis use, compared with cannabis users who choose not to drive after use.79 Results were consistent in the 2 larger and methodologically stronger studies, but response rates were very low which may exacerbate issues with recall bias. Endogenous cannabinoids, such as anandamide and 2-arachidonoylglycerol, are secreted in times of stress and are known to have many different downstream effects, which include regulation of mood, appetite, and nociception.6 Similarly, the key chemical components of cannabis, namely tetrahydrocannabinol (THC) and cannabidiol (CBD), act on the cannabinoid 1 and 2 receptors to produce antinociceptive effects.6–8 This suggests a genuine improvement in physical and mental health and day-to-day function, which is critical for patients with chronic illnesses,” says Arkell. The study used a standardized questionnaire frequently used in research to measure health-related quality of life in people with chronic health conditions, as described in past research. Your symptom relief and side effects depend on which type of medical marijuana you use. The U.S. Food and Drug Administration (FDA) has not approved the use of cannabis as a treatment for any medical condition. The absence of significant improvement for patients with mild symptoms at baseline may be explained by a smaller margin for symptom improvement. The ECS could be more deficient in patients with moderate/severe symptoms compared to mild symptoms leading to increased improvement in the first group. From Table 2, moderate or severe scores at baseline were most common for pain (205 patients, 73.5%) and poor wellbeing (202 patients, 72.4%). This suggests statistical improvement recorded at FUP1 is still present at FUP2 in all symptoms independently from treatment adjustment at FUP1. Some products may offer small benefits for certain patients, but those gains often come with trade-offs. As prescriptions fall short, many people turn to cannabis-based products, hoping for relief. To date, the consumer CBD market has far outpaced science, and well-designed, appropriately controlled, clinical trials and human laboratory studies are needed to definitively support or refute CBD’s therapeutic utility for many disease states. As one of the most accessible healthcare providers, pharmacists have a pivotal role in educating patients and prescribers about medical cannabis, including the current regulations and clinical studies exploring the potential uses of medical cannabis in chronic pain. In addition, results reported at the American Academy of Neurology 2019 Annual Meeting revealed that in a preliminary study, investigators at the Dent Neurologic Institute in Buffalo, New York, found that the cannabis provided elderly patients with relief from chronic pain, sleep disorders, and anxiety related to diseases such as amyotrophic lateral sclerosis, Parkinson disease, neuropathy, spinal cord damage, and multiple sclerosis.6 Their findings show that medical cannabis is well tolerated in people aged 75 years and older and may improve symptoms such as chronic pain and anxiety.6 Two recent systematic reviews examined the efficacy of cannabis and cannabinoids for the treatment of chronic pain,14,15 and reported mixed findings for the management of various chronic pain symptoms related to conditions such as MS, fibromyalgia, peripheral and central neuropathy, human immunodeficiency virus (HIV), rheumatoid arthritis, and cancer. Given the confusion between the terms cannabis, cannabinoids, and cannabis for medical purposes, we will refer to the term “medical cannabis” (MC) in this review, in order to describe cannabis products (plant-based products or pharmaceutical products) used for CMP or other non-cancer chronic pain. Several studies have suggested that medical cannabis can help alleviate pain. Furthermore, most of the reported side effects in our study were mild (84%), which echoes the findings in clinical trials and cross-sectional studies. Gulbransen et al. found improvements in quality of life, pain, depression, and sleep quality in 400 patients with non-cancer-related chronic pain. Research involving CBD for arthritis pain is lacking; however, there have been clinical studies involving CBD and chronic pain. Current Clinical Trials The modern use of cannabis as pain relief has been denoted in its use by Queen Victoria in dysmenorrhea 2,3. It has been explored for its potential therapeutic applications in addressing various conditions, such as depression, anxiety, sleep disorders, neurological disorders, and chronic low back pain, which affect a significant portion of the population. “Our study suggests that CBD products may be able to relieve anxiety in the moment for adults who use them, and possibly longer-term, in a way that is meaningful and doesn’t necessarily produce the same risks or harms of THC or prescription medications,” said Bidwell. But the cannabis groups saw greater reductions in perceived anxiety than the non-cannabis group, and those using CBD-dominant products showed the most improvement of all. Nine studies were at high risk of bias for study size. Three review authors independently extracted data of study characteristics and outcomes of efficacy, tolerability and safety, examined issues of study quality, and assessed risk of bias. To learn more about cannabis and cancer, tune in to this episode of Cancer Straight Talk from MSK. For some assurance, she recommends patients look for products that have been quality-checked by places like ConsumerLab or the U.S. Now that cannabis is legal in New York and several other states, patients can go through a certifying provider, like Dr. Raghunathan. Although a systematic review reported no differences in musculoskeletal pain relief according to the type of cannabinoid tested,12 a subsequent systematic review46 reported that the highest quality evidence indicated that nabiximols was superior to other cannabinoids. The efficacy of cannabis treatment of migraine is further substantiated by a cross-sectional study of 145 patients,38 of whom 61% reported at least a 50% decrease in monthly migraine frequency after initiating cannabis treatment. A small randomized controlled trial33 and several observational studies34–42 reported limited evidence for the efficacy of cannabis treatment of headache. (III) Were there any differences in reported symptoms based on the type of arthritis?Given the variability in cannabinoid formulations and dosing, prescribers should remain informed on emerging clinical evidence and evolving regulatory guidelines to integrate cannabinoids responsibly into pain management strategies.It should also be noted that in some of the studies reviewed above, the analyzed patient populations were undergoing treatment for bipolar disorder, adding an additional layer of limitations to the research findings.On the other hand,critics see that the legalization will increase cannabis use affecting health and safety,reducing the educational achievement of teens, and increasing crime.120 Food and Drug Administration (FDA) has approvedonly a cannabis-derived drug (Epidiolex (cannabidiol)) and three synthetic cannabis (Marinoland Syndros (dronabinol) and Cesamet (nabilone)).However, a few studies are showing the benefits of CBD not only for chronic pain but also for sleep improvement and quality of life.The U.S. Centers for Disease Control and Prevention (CDC) reported nearly 450,000 opioid-related deaths in the past decade.Cannabis contains several bioactive compounds that are of pharmaceutical interest for the study of pain and other disorders .Preparations, such as marijuana, hashish, and dagga, have been used in medicine for millenia.1 Investigations into the chemistry of Cannabis began in the mid-19th century, following a major trend in chemical research at the time, which centered on the quest for active natural products. RD was 0.05 (95% CI ‐0.00 to 0.11) (P value 0.07) (seven studies with 737 participants. Dronabinol (two studies with 264 participants) was not different to placebo. Only one study compared nabilone with dihydrocodeine (DHC) in 73 participants (Frank 2008). Five per cent of participants in both groups reported a psychiatric adverse event. None of the participants in the THC/CBD group reported adverse events of the nervous system. One study was judged as “good”24 and three as “fair” quality.21-23 Concerns regarding biasin the three “fair” quality studies were related to high attrition,23 unclear randomization and treatment concealment,21 and the observational design (Supplemental Table S3).22 Included were all concurrent comparativestudies (randomized and nonrandomized) comparing medical cannabinoid use, anydose, and any administration to any non-cannabinoid treatment. We included studies ofadults undergoing spinal surgery (acute pain), those with chronic low back orneck pain (chronic defined as ≥12 weeks), and those with chronic neuropathicpain following a spinal cord injury. In each study, there was aquantifiable advantage of cannabis therapy for alleviating back pain. In addition, some research points to the possibility that long term use of cannabis can lead to worsening symptoms of depression. Given the research above, there is a good chance that using cannabinoids to activate your endocannabinoid system can help to temporarily alleviate depression symptoms. However, the same study found that high doses had an opposite effect a biphasic response which is often seen in cannabis.. Unfortunately, the drug had to be pulled from the market because many of the patients using it developed depressive and anxiety symptoms. Seeing there’s not much data on the matter, you can use the limited clinical data there is on CBD from the study on social anxiety, with a starting dose of 10mg per kilogram per day. These recommendations do not apply to use of inhaled medical cannabis or recreational cannabis, which have not been formally studied. Cannabis, or marijuana, is the source for tetrahydrocannabinol (THC) and cannabidiol (CBD), which with other cannabis derivatives are termed cannabinoids. To address these gaps, further studies are needed that assess both the therapeutic benefits and potential adverse effects of cannabis. Instead, most studies have focused on comparing cannabis to placebo, making it challenging to draw definitive conclusions about its superiority or viability as an alternative to existing forms of pain relief. Additionally, there is a scarcity of studies, particularly RCTs, comparing the efficacy of cannabis to other active analgesic treatments. Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain: 2023 Update For much of the five millennia of the documented use of cannabis, the mechanisms of action of cannabinoids were largely unknown. THC has been shown to have appetite stimulating and anti-nausea effects, and it is the main cannabinoid responsible for the psychoactive effects of cannabis 17–19. Cannabis contains several bioactive compounds that are of pharmaceutical interest for the study of pain and other disorders . In ancient China, cannabis was used to treat gout, malaria, digestive disorders, and menstrual pain . CBD itself does not produce typical behavioral cannabimimetic effects and was thought not to be responsible for psychotropic effects of cannabis. Although there are many cannabinoids present in cannabis, Δ9tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD) are the two components found in the highest concentrations. WebMD does not provide medical advice, diagnosis or treatment. That makes it hard to know whether your medical treatment or therapy is helping. The 'Summary of findings' table includes the primary outcomes and the secondary outcomes of participant‐reported pain relief of 30% or greater, and nervous system disorders and psychiatric disorders as specific adverse events. In circumstances where there were no data reported for an outcome, we planned to report the level of evidence as very low quality (Guyatt 2013b). The GRADE approach uses five considerations (study limitations, consistency of effect, imprecision, indirectness and publication bias) to assess the quality of the body of evidence for each outcome. We dealt with clinical heterogeneity by combining studies that examined similar conditions. Where rates of pain relief of 30% and of 50% or greater were not reported or provided on request, we calculated them from means and SDs using a validated imputation method (Furukawa 2005). These laws allow many people with chronic pain to obtain cannabis lawfully in their state. Patients with anxiety, depression, insomnia, or chronic pain diagnoses also showed improvements in condition-specific symptoms over 12 months. People with chronic health conditions reported improvements in fatigue, pain, and sleep. THC also has anti-inflammatory properties, and one study showed that the topical treatment of THC in mice with dinitrofluorobenzene (DNFB)-mediated allergic contact dermatitis effectively reduced immune cell infiltration and decreased allergic ear swelling . Exploring cannabinoids as a substitute for opioids in pain management requires a thorough understanding of the complex interactions between cannabinoids and the ECS and their specific impacts on pain pathways. While THC is psychotropic, CBD, another phytocannabinoid present in the Cannabis sativa plant, is non-psychotropic and has witnessed widespread acceptance for the symptomatic treatment of various medical conditions. All the retrieved articles were thoroughly examined by the authors to determine the reliability of the data reported in the articles and their suitability for the review topic, and the authors independently extracted the information. For this comprehensive review of the therapeutic potential of cannabinoids and current and future applications, a rigorous and methodical approach was taken in selecting and assessing the literature. Long-term cannabis users' IQs declined by 5.5 points on average from childhood, and there were deficits in learning and processing speed compared to people that did not use cannabis. Recent research published in The American Journal of Psychiatry closely followed nearly 1,000 individuals in New Zealand from age 3 to age 45 to understand the impact of cannabis use on brain function. While public perception that cannabis is a harmless substance is growing, the long-term benefits and risks of cannabis use remain unclear. Medical marijuana laws reduce prescription medication use in Medicare Part D. Health Aff (Millwood). Cantlupe J. Medical marijuana goes mainstream.