Medical Cannabis & Chronic Pain

What is Chronic Pain?

Chronic pain is a debilitating medical condition that causes considerable discomfort, agony and suffering to people living with it. It is estimated that up to 3.4 million Australians are living with chronic pain. In many cases, chronic pain persists longer than the average time expected for an injury to heal or for the pain to subside.

Chronic pain is defined as a physical pain that has continued over three months. Chronic pain can be subjective, in that every person has a different experience of pain. This can make it difficult for doctors to diagnose, however patients suffering from chronic pain generally experience moderate to high levels of pain daily for months or years at a time.

What Causes Chronic Pain?

There are various causes that trigger chronic pain, however not all of them are necessarily immediately apparent. Chronic pain can be caused directly, or as a result of other medical conditions. The most common are:

  • Physical injury
  • Surgery
  • Arthritis
  • Cancer
  • Lower back pain
  • Knee or ankle pain
  • Period pain
  • Endometriosis
  • Migraines
  • Nerve or neuropathic pain
  • Fibromyalgia

Acute pain, such as from an injury, is usually short lived. This type of pain is a reaction to tissue damage and usually fades after the injury has healed, Chronic pain is far more complicated as it may develop in less obvious ways. One such example is when a physical injury has healed but changes to the nerves in that area cause the nervous system to continue sending pain signals to your brain.

Depending on the type of chronic pain, a doctor can diagnose the condition in several ways, including:

  • Physical exam
  • Neurological exam
  • Psychological evaluation
  • Patient self-assessment
  • Bloodwork
  • X-Ray
  • CT scan
  • MRI scan
  • EMG tests

What are Chronic Pain Symptoms?

Chronic pain is physically and emotionally taxing and can leave you irritable, easily angered, and in severe cases, depressed. Pain is closely linked to quality of life and psychological wellbeing. Symptoms of chronic pain include:

  • Unpleasant sensations
  • Muscle weakness and stiffness
  • Irritability
  • Aches and tension
  • Sleep disturbance
  • Inability to concentrate
  • Reduction in energy
  • Forgetfulness
  • Anxiety or panic attacks
  • Depression

Some people try to take medication into their own hands, which can be dangerous, such as using alcohol or opioids outside of supervised medical advice. This carries many risks including side effects, addiction and/or overdose. It is always advised that you seek professional medical advice before using any medication.

Medical Cannabis & Chronic Pain

Patients who experience chronic pain are often prescribed opioids and/or non-steroidal anti-inflammatory drugs (NSAIDs), which accompany other treatments such as physical therapy, surgery, acupuncture, and/or chiropractic therapy. While these treatments may be effective for some patients, it is also true that patients who are treated with medical cannabis are more likely to experience a clinically significant reduction in pain symptoms.

Medical Cannabis and Chronic Pain Conditions

Patients in Australia are prescribed medical cannabis to treat a range of chronic pain related conditions including:

  • Arthritis
  • Cancer pain
  • Fibromyalgia
  • Neuropathy
  • Pain from multiple sclerosis
  • Post-surgical pain
  • Chronic back pain

In many cases, patients are able to reduce or discontinue use of pharmaceutical medications, including NSAIDs and opiates. Anecdotal clinical evidence suggests that when pain is controlled, sleep is better, anxiety is reduced, and functioning at home and at work is vastly improved. Some patients might only use one medical cannabis product to achieve pain relief, while others might use a combination of medical cannabis products.

There are numerous published surveys of outcomes from medical cannabis patients suffering from chronic pain which show significant efficacy for treatment of pain.

  • A 2016 online survey of 1,429 medical cannabis users in 18 countries (77.8 percent from the US, 61 percent with chronic pain) reported 86 percent had improvement in symptoms, with 25 percent substituting cannabis for opiates.
  • A 2018 report from the Israeli Cannabis Clinical Research Institute and the Institute for Drug Research reviewed the use of medical cannabis in 901 elderly patients (over sixty-five years old) spanning a period of almost three years. They found 93.7 percent of respondents reported improvement in their condition, with a pain reduction from a median of “8 out of 10” to “4 out of 10.” After six months, 18.1 percent were able to discontinue or reduce their use of opioid-based medications.

A 2020 retrospective cohort study from a cannabis medical practice in California followed 180 patients with chronic lower back pain from one to eleven years, finding 50.8 percent were able to stop all opioid use. Of the twenty-nine patients who did not stop opioids, nine were able to reduce opioid use, three had no change, and seventeen increased their usage. Of all the patients, 48 percent subjectively felt cannabis helped them mitigate their opioid intake.

How does medical cannabis interact with opioids?

Research has shown that if you are already taking opioids to treat chronic pain then taking medical cannabis may be able to assist with reducing or removing altogether the undesirable side effects caused by opioids, including constipation, shallow breathing, and sleepiness. 

In a clinical trial at the University of California, 21 participants with chronic pain who were on morphine or oxycodone were given inhaled cannabis. Results showed the addition of cannabis did not increase the levels of opiates in the bloodstream (thereby no increase in the risk of overdose), but pain was significantly reduced. The researchers concluded that the combination of medical cannabis and opioids may allow for opioid treatment at lower doses with fewer side effects.

Multiple studies from the Journal of Medical ResearchNational Academies of Sciences, Engineering, and MedicineJournal of Pharmacology and Experimental Therapeutics and Pharmacology Biochemistry and Behaviour involving animals show that cannabinoids enhance the pain-reducing effects of opioids, and vice versa.


Another recent study looking at the combination of gabapentin, a commonly used pharmaceutical for neuropathic pain, revealed the combination in mice of this drug with THC showed synergistic enhancement of pain relief.

Treating Chronic Pain with Medical Cannabis

Patients experiencing pain caused by inflammatory conditions may find relief from a range of phytocannabinoids (e.g. THC, CBD, CBG, CBN, etc.), while patients with nerve-based pain (neuropathy) may benefit more from CBD focused therapy.

Medical Cannabis and Chronic Pain Advice

You should always speak to your doctor first about any medical cannabis treatment options that might be available to treat your chronic pain. Depending on the severity of your pain and condition, doctors will usually adopt a “start low and go slow” approach (known as titration) to steadily increase the dosage of medical cannabis until a desired level of pain relief is reached.

Plant-based medicines may help with:

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