What the 2024 pain meta-analyses actually tell us
Systematic reviews on cannabis and chronic pain have a habit of reaching quite different conclusions from what look like similar datasets. Working out why means getting into the detail of inclusion criteria, outcome measures, and how researchers deal with heterogeneity.
The 2024 Cochrane review update on cannabinoids for chronic neuropathic pain included 36 trials and found moderate-certainty evidence for a small improvement in pain intensity, alongside meaningful rates of adverse events. The authors were appropriately cautious about effect sizes and how far the findings translate to real-world clinical populations.
The heterogeneity problem
What most of the mainstream commentary missed is how different the trial populations actually are. Studies range from patients with HIV-associated neuropathy to fibromyalgia to post-surgical pain. The cannabis products used range from oral THC:CBD combinations to smoked flower to synthetic cannabinoids. Such different methodologies and treatments are difficult to compare and correlate to real world treatment.
In my own practice, I do not treat "chronic pain" as a single category. I treat individual patients with specific pain conditions, specific histories of what has and has not worked before, and specific goals for their lives. Systematic reviews are useful as a background signal, but they cannot do that work for you.
More to come on this in a longer piece I am working on.
Comments & discussion
I welcome discussion on everything I write here. Medicine is rarely black and white, and botanical medicine shows even greater variance than most fields. I am genuinely open to other opinions and perspectives, and I read every comment.
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