Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies
Open accessAbstract
This review examines evidence for the effectiveness of cannabinoids in chronic noncancer pain (CNCP) and addresses gaps in the literature by: considering differences in outcomes based on cannabinoid type and specific CNCP condition; including all study designs; and following IMMPACT guidelines. MEDLINE, Embase, PsycINFO, CENTRAL, and clinicaltrials.gov were searched in July 2017. Analyses were conducted using Revman 5.3 and Stata 15.0. A total of 91 publications containing 104 studies were eligible (n = 9958 participants), including 47 randomised controlled trials (RCTs) and 57 observational studies. Forty-eight studies examined neuropathic pain, 7 studies examined fibromyalgia, 1 rheumatoid arthritis, and 48 other CNCP (13 multiple sclerosis–related pain, 6 visceral pain, and 29 samples with mixed or undefined CNCP). Across RCTs, pooled event rates (PERs) for 30% reduction in pain were 29.0% (cannabinoids) vs 25.9% (placebo); significant effect for cannabinoids was found; number needed to treat to benefit was 24 (95% confidence interval [CI] 15-61); for 50% reduction in pain, PERs were 18.2% vs 14.4%; no significant difference was observed. Pooled change in pain intensity (standardised mean difference: −0.14, 95% CI −0.20 to −0.08) was equivalent to a 3 mm reduction on a 100 mm visual analogue scale greater than placebo groups. In RCTs, PERs for all-cause adverse events were 81.2% vs 66.2%; number needed to treat to harm: 6 (95% CI 5-8). There were no significant impacts on physical or emotional functioning, and low-quality evidence of improved sleep and patient global impression of change. Evidence for effectiveness of cannabinoids in CNCP is limited. Effects suggest that number needed to treat to benefit is high, and number needed to treat to harm is low, with limited impact on other domains. It seems unlikely that cannabinoids are highly effective medicines for CNCP.
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Cannabinoids can provide some relief of neuropathic and cancer-related pain, but their effects are small and tend to diminish over time, and they can have significant side effects.
“Can nabinoids can provide some relief of neuropathic and cancer- related pain, but their effects are small and tend to diminish over time, and they can have significant side effects 300 .”
From Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention (2023) · cites this paper as [300]
There is limited and inconsistent evidence that cannabinoids reduce chronic non-cancer pain by at least 30% but not more than 50%.
“There is limited and inconsistent evidence that cannabinoids reduce chronic non-cancer pain by at least 30% but not more than 50% [81].”
From Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits (2025) · cites this paper as [81]
A large number of patients need to be treated to achieve a clinical benefit with cannabinoids for chronic pain.
“A large number of patients need to be treated to achieve a clinical benefit [81] and they are costly for patients [88].”
From Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits (2025) · cites this paper as [81]
Effects are larger in small studies using cannabinoids.
“Small study sizes are of particular concern as it has been previously demonstrated that effects are larger in small studies using cannabinoids [2, 168].”
From Medical cannabinoids: a pharmacology-based systematic review and meta-analysis for all relevant medical indications. (2022) · cites this paper as [168]
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Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits
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“There is limited and inconsistent evidence that cannabinoids reduce chronic non-cancer pain by at least 30% but not more than 50% [81].”
Self-citationSchlag, A. K., O'Sullivan, S. E., Zafar, R. R., & Nutt, D. J. (2021) · Neuropharmacology · doi:10.1016/j.neuropharm.2021.108586 · Cited by 82 · see citing works
Bell, A. D., MacCallum, C., Margolese, S., Walsh, Z., Wright, P., Daeninck, P. J., Mandarino, E., Lacasse, G., Kaur Deol, J., de Freitas, L., et al. (2024) · Cannabis & Cannabinoid Research · doi:10.1089/can.2021.0156 · Cited by 78 · see citing works
“Three reviews included only systematic reviews, 28,29,30 three contained primary research, 31–33 and one included other systematic reviews, in addition to primary research.”
BackgroundSpanagel, R., & Bilbao, A. (2021) · Neuropharmacology · doi:10.1016/j.neuropharm.2021.108680 · Cited by 43 · see citing works
- Authors
- Stockings, E., Campbell, G., Hall, W. D., Nielsen, S., Zagic, D., Rahman, R., Murnion, B., Farrell, M., Weier, M., & Degenhardt, L.
- Affiliations
- UNSW Sydney (AU)
- The University of Queensland (AU)
- The University of Sydney (AU)
- Corresponding author
- Stockings, Emily
- ORCID
- Venue
- Pain
- Published
- 2018-05-25
- Volume
- 159
- Issue
- 10
- Pages
- 1932-1954
- ISSN
- 0304-3959 (ISSN-L)
- 1872-6623
- OpenAlex
- W2807290966
- Cited by
- 460
- References
- 83
- Citations by year
- 2026: 20 · 2025: 33 · 2024: 56 · 2023: 50 · 2022: 68 · 2021: 80 · 2020: 77 · 2019: 61 · 2018: 13
- FWCI
- 6.74
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- cc-by-nc-nd
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- UNSWorks (UNSW Sydney) (submittedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- cannabinoids, chronic non-cancer pain, neuropathic pain, fibromyalgia, rheumatoid arthritis, visceral pain, pain intensity, adverse events, number needed to treat, number needed to harm, sleep
- MeSH terms
- Cannabinoids, Cannabis, Clinical Trials as Topic, Humans, Databases, Factual, Observation, Chronic Pain
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