Cannabis may ease certain types of chronic pain, including pain due to nerve damage and inflammation. Ways of taking cannabis include edibles, topical applications, and tablets to place under the tongue.

Today, chronic pain affects more people than cancer, heart disease, and diabetes combined. Chronic pain is one of the most common reasons adults seek medical care in the United States.

Most cannabis-based products do not have approval from the United States Food and Drug Administration (FDA), and more evidence is necessary to confirm their safety and effectiveness.

However, anecdotal evidence suggests that cannabis or its compounds may help relieve some types of pain.

There are distinct types or strains of cannabis available, which is also known as marijuana, and each may have slightly different effects on the user.

The term cannabis is preferable to marijuana, as the latter term has racist roots and connotations.

In this article, we look at the best cannabis strains for chronic pain relief.

A hand holding a notebook behind a cannabis plantShare on Pinterest
Duet Postscriptum/Stocksy United

The different types of cannabis plants include the following:

  • Cannabis indica
  • Cannabis sativa
  • hybrids

There is limited research available on the use of specific cannabis strains for pain and other symptoms. As a result, strain-specific recommendations are not medically proven.

The results of an online survey, comprising 95 participants, were featured in the Journal of Alternative and Complementary Medicine in 2014.

The researchers found that participants preferred indica strains for pain management, sedation, and sleep, while they would opt for sativa strains to improve energy and mood.

Regarding pain management, participants reported a statistically significant effect when using indica for:

It is, however, important to note that this study had several limitations. It was small in scale, anonymous, and asked people to self-report their symptoms. Respondents did not use the cannabis in a controlled setting, potentially resulting in differences in drug composition, dosage, and potency.

Another older study examined the use of organically grown sativa and indica strains in the treatment of several medical conditions. Just over half of the participants were using cannabis to treat HIV.

The study followed participants for 3 years and asked them about the effects of the drug on their condition during this time. The results indicated that indica strains are more likely to improve energy and appetite, while both sativa and indica strains can alleviate nausea to a similar degree.

Cannabis contains compounds that may relieve pain, nausea, and other symptoms. The components of cannabis that most studies focus on for pain relief are cannabidiol (CBD) and tetrahydrocannabinol (THC).

THC vs. CBD

THC resembles the cannabinoid chemicals that occur naturally in the body. When people ingest or inhale THC, it stimulates the brain’s cannabinoid receptors.

This activates the brain’s reward system and reduces pain levels. THC is a psychoactive compound as it binds to cannabinoid receptors and produces an elevated state of mind, known as a high.

CBD does not cause a high, although it may interact with pain receptors in the brain to exert pain-relieving and anti-inflammatory effects.

What the research says

In recent years, many studies have looked at the effects of cannabis on chronic pain. Some studies used parts of the cannabis plant, and some have used the entire plant, so more research is needed. Using parts of the cannabis plant (like CBD oil) helps study specific actions of that ingredient, but when the whole plant is used there is what is called an entourage effect, where the parts work together to have more effect.

A 2015 review of research on the use of cannabis and cannabinoids for various chronic pain conditions reports that several trials had positive results. The researchers suggest that cannabis or cannabinoids may be effective for treating some types of chronic pain, including neuropathy (nerve pain).

A research paper from 2016 found that cannabis use for cancer pain led to a reduction in opioid use (64%), improved quality of life (45%), and caused fewer medication side effects. It also led to participants using fewer medications.

Smaller studies have reported benefits for other types of chronic pain. For example:

  • Of about 17,000 people with cancer, 70 percent reportedly experienced an improvement in pain and general well-being after cannabis use.
  • People with chronic migraines experienced a decrease in migraine episodes after using the drug.

However, there is still a need for more research into the area of cannabis use for chronic pain, especially in the use of different strains, dosages, and methods of delivery.

An Australian study published in July 2018 concluded that cannabis use did not reduce the symptoms of pain or the need to use opioid medications. However, the findings were mostly based on reports from people who used the drug recreationally.

Using cannabis specifically for medicinal purposes might yield different results.

Is CBD legal?The 2018 Farm Bill removed hemp from the legal definition of marijuana in the Controlled Substances Act. This made some hemp-derived CBD products with less than 0.3% THC federally legal. However, CBD products containing more than 0.3% THC still fall under the legal definition of marijuana, making them federally illegal but legal under some state laws. Be sure to check state laws, especially when traveling. Also, keep in mind that the FDA has not approved nonprescription CBD products, and some products may be inaccurately labeled.

Medical cannabis refers to the whole, unprocessed plant or its extracts.

Medical cannabis only has approval from the U.S. Food and Drug Administration (FDA) as a safe or effective treatment for two rare and severe forms of epilepsy, known as Lennox-Gastaut syndrome (LGS) and Dravet syndrome. Both conditions involve seizures that other drugs have not been able to control.

The name of the drug is Epidiolex. It contains a purified form of CBD, and the FDA gave approval in June 2018.

It was also approved for the treatment of seizures associated with tuberous sclerosis (TSC) in 2020.

The FDA has also approved medications containing synthetic THC cannabinoids called dronabinol (Marinol or Syndros) and nabilone (Cesamet). These drugs reduce nausea in people undergoing cancer treatments and increase appetite in people living with HIV.

The FDA has not yet approved the use of any cannabis drugs for pain relief.

Synthetic cannabis is also the name given to drugs such as K2 or Spice. The National Institute on Drug Abuse (NIDA) points out that these are not cannabis, they are not safe, and they are not recommended for any purpose. The adverse effects of these drugs can be fatal.

Synthetic cannabis attempts to duplicate the effects of the ingredients in the plant.There is a theory that the entire plant has a more profound effect, with the different ingredients working together to have an entourage effect.

Cannabis use can cause some side effects, including:

Learn more about the benefits and risks of cannabis.

Cannabis is available in several different forms, including:

Oil

It is possible to extract cannabis oil from cannabis using ethanol.

People usually take cannabis oil orally and should only need small quantities to experience benefits.

CBD is another type of cannabis-based oil that is increasingly popular among people with chronic pain.

Topical treatments

People can apply topical treatments, such as lotions, balms, and salves, containing cannabinoids to the skin to relieve pain and inflammation.

Transdermal patches that contain cannabinoids are also available.

Edibles

Edibles are one of the most popular ways to use cannabis. Edibles involve infusing food, such as cookies, brownies, and candies, with the drug.

Cannabis edibles offer an easy way to take cannabis, but the effects of edibles can be difficult to predict.

Sublingual cannabis

Sublingual administration involves placing a drug under the tongue. The drug enters the bloodstream faster using this method, so it will work more quickly.

Opioids are powerful medications that relieve pain by acting on the nervous system. They are highly addictive, and withdrawal symptoms are not uncommon.

In 2021, opioids accounted for 75% of all drug overdose deaths, and 3 million American citizens have had or currently have opioid use disorder.

Is cannabis better than opioids?

Medical cannabis may offer an alternative to addictive opioids. When researchers surveyed almost 3,000 medical cannabis users, they found that 30 percent had used opioids in the last 6 months.

Of those respondents, 81 percent agreed or strongly agreed that cannabis was more effective alone than in combination with opioids.

In addition, 97 percent said they agreed or strongly agreed that they could decrease their opioid usage when taking cannabis.

Below are some frequently asked questions about cannabis and chronic pain.

How much cannabis should a person take for pain?

Older research suggests that 10 milligrams of THC, which is a compound found in cannabis, offers the same pain relief as a 60 milligram dose of codeine. Similarly, 20 milligrams of THC works as well as 120 milligrams of codeine. However, more research is needed on this topic.

How do you deal with severe chronic pain?

There is no singular approach that is appropriate for the treatment of severe chronic pain. However, analgesics such as NSAIDs, acetaminophen, and aspirin may be useful. Medications such as opioids and antiepileptic drugs are also an option. Some studies suggest cannabis can be helpful in treating neuropathic pain, but more research is needed.

Several studies report the benefits of cannabis use for chronic pain.

According to some research, it is as effective as opioids, which are among the most potent pain-relieving drugs.

The side effects of cannabis use are usually minimal, especially in comparison with opioid side effects. However, due to a lack of regulation for most cannabis-based therapies, the exact composition and quality of a product cannot be guaranteed.

This evidence indicates that cannabis may be beneficial for chronic pain relief.

There are several strains of cannabis available, so even if one strain does not reduce symptoms, another may. Typically, it is best for people to keep their dosage low, especially if they are new to using cannabis.

Those who wish to use medical cannabis should discuss the risks and benefits in more detail with their doctor and ensure they obtain their medications legally and from a reputable outlet.