Some studies suggest that cannabinoids—compounds in cannabis, or marijuana, such as CBD (cannabidiol) and tetrahydrocannabinol (THC)—can be an effective alternative to opioids in managing pain, including neuropathic pain. But cannabinoids can be associated with significant adverse effects, including sedation, euphoria, cognitive dysfunction, and paranoia. “Right now, the evidence seems to say that CBD offers marginal relief with clear side effects, so I'd be cautious about using it,” says Brian Callaghan, MD, FAAN, professor of neurology at the University of Michigan Health System in Ann Arbor.

One study presented at an American Headache Society meeting in June 2023 showed that a THC/CBD mix, taken as four puffs of vaporized flower, was effective in treating acute migraine. The dosage relieved or eliminated pain in some patients and resolved the most bothersome symptoms, such as nausea and sensitivity to light and sound, two hours after an attack.

“These results look promising, but this is not what we would recommend for everybody,” says lead author Nathaniel M. Schuster, MD, associate professor of anesthesiology at the UC San Diego Center for Pain Medicine. “We looked at cannabinoids as a one-time acute treatment, not to prevent a migraine and not for daily use. Cannabinoids are potentially addictive, and we still don't know a lot about them.” Dr. Schuster also noted that the THC dosages in the study were much lower than those typically used recreationally.

There are some positives for cannabinoids, says Jennifer W. McVige, MD, a specialist in adult and pediatric headache at the Dent Neurologic Institute in Amherst, NY. “They do not suppress respiration, like opioids and benzodiazepines can. And they don't affect the gut like NSAIDs, so you don't have stomach side effects. Overuse can cause a hypersensitivity reaction with cyclic vomiting, but that is rare. There is a place for it in pain management, but setting up rigorous trials is difficult to do under current laws.” Overall, more research, although challenging to conduct, may show how and if cannabinoids can help people with chronic pain.

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Researchers Aim to Understand Chronic Pain and How It Can Be Managed