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An updated Cochrane review has concluded that there remains no clear evidence that cannabis-based medicinal products relieve chronic pain.
The review, entitled ‘Cannabis‐based medicines for chronic neuropathic pain in adults‘, published in the Cochrane Database of Systematic Reviews on 19 January 2026, looked for evidence that patients reported pain relief levels of 50% or greater.
Following the analysis of 21 studies with a total of 2,187 participants, the authors of the review revealed that there was no clear evidence for an effect on pain relief of at least 50% in three types of medicines: THC‐dominant medicines versus placebo; THC/cannabidiol (CBD)‐balanced medicines versus placebo; and CBD‐dominant medicines versus placebo.
“Six studies included participants with central neuropathic pain (multiple sclerosis, spinal cord injury); 13 studies included participants with peripheral neuropathic pain (plexus injury, peripheral neuropathy of different aetiologies, trigeminal neuropathy); and two studies included participants with both central and peripheral neuropathic pain,” the authors said.
However, the authors added that the available evidence was “limited in both methodological rigour and clinical relevance”, while some studies did not report on participants’ previous cannabis use.
The studies that did report on participants past use of cannabis did not distinguish between recreational and medical cannabis use, the authors said.
The authors also found that 14 of the studies were “at high risk of bias because they were small” and only 4 studies lasted for at least 12 weeks, whereas the European Medicines Agency recommends that study duration for chronic neuropathic pain trials should be at least 12 weeks after a stable dose is achieved.
People living with neuropathic pain can use a range of descriptors to describe their symptoms; however, “none of the neuropathic pain scales available covers all potential descriptors of neuropathic pain”, the authors added.
The study findings echo Scottish Intercollegiate Guidelines Network (SIGN) draft guidance, published in February 2025, which did not recommend the routine use of medical cannabis in the management of chronic non-malignant pain, owing to “very limited evidence of clinically significant improvements in pain”.
“High-quality RCTs [randomised controlled trials] with appropriate duration of follow up are needed to identify clinically relevant harms and benefits of medicinal cannabis in the treatment of chronic pain,” the SIGN guidance said.
A previous Cochrane review, published in 2018, also reported “a lack of good evidence that any cannabis-derived product works for any chronic neuropathic pain”.
Commenting on the review, Heather Wallace, chief executive of charity Pain Concern, said: “Many of us are caught up in the need to deprescribe opioids, so, although we’d love an effective medication for neuropathic pain, we acknowledge the call for research. We’d like people with neuropathic pain included in designing good quality research, and those who want to try cannabis able to participate in research.
“We know that some people will try it anyway. It’s important that they can have an open, realistic, non judgemental conversation with their doctor. Expecting pain relief of at least 50% may be unrealistic —medications and interventions may be help somewhat, but neuropathic pain is best treated by an holistic approach. People need support and information to find out what works for them and what they can do to help themselves.”
