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Cannabis-Based Treatment for Neuropathic Pain: A Meta-Analysis of Randomized Controlled Trials
Abstract   Peer reviewed

Cannabis-Based Treatment for Neuropathic Pain: A Meta-Analysis of Randomized Controlled Trials

Gregory Mitchell, Ari Kaganovsky, Giulia Carvalhal, Douglas Carneiro Barroso and Jafar Aljazeeri
The journal of pain, v 41(Supplement), 105953
Mar 2026
DOI: https://doi.org/10.1016/j.jpain.2025.105953

Abstract

Neuropathic pain remains a significant clinical challenge, with current pharmacologic therapies offering limited efficacy and frequent adverse effects. Cannabis-based treatments have gained attention as potential alternatives. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of cannabis-based therapies for neuropathic pain. We searched MEDLINE, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov through April 10, 2025, for randomized controlled trials (RCTs) comparing cannabis-based therapies with placebo in adults with neuropathic pain. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane RoB 2 tool. Pain outcomes were pooled using standardized mean differences (SMD), and adverse events using risk ratios (RR), both under random-effects models. The protocol was registered in PROSPERO (CRD420250610727). Twenty-two RCTs involving 1,467 participants were included. Cannabis-based therapies significantly reduced post-intervention pain scores compared with placebo (SMD −0.30; 95% CI −0.45 to −0.15; I² = 0%). No significant difference was observed in trials reporting pain as change from baseline (SMD −0.29; 95% CI −0.68 to 0.10; I² = 72%). Meta-regression showed no significant moderating effect of age, sex, or treatment duration. Cannabis use was associated with higher risk of adverse events including somnolence (RR 1.97), nausea (RR 1.80), diarrhea (RR 2.59), fatigue (RR 1.58), dizziness (RR 2.46), and dry mouth (RR 1.57), all p < 0.01. Cannabis-based therapies offer modest analgesic benefit and should be reserved as an adjunctive option for select patients with refractory symptoms, guided by a shared decision-making process that considers individual risks and preferences.

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