The effects of cannabinoids on chronic pain, particularly neuropathic pain

Several NCCIH-funded studies are investigating the potential pain-relieving properties and mechanisms of action of substances in cannabis, including minor cannabinoids (those other than THC) and terpenes (substances in cannabis that give the plant its strain-specific properties such as aroma and taste). The goal of these studies is to strengthen the evidence regarding cannabis components and whether they have potential roles in pain management.

NCCIH is also supporting other studies on cannabis and cannabinoids, including:

An observational study of the effects of edible cannabis and its constituents on pain, inflammation, and thinking in people with chronic low-back pain.
Studies to develop techniques to synthesize cannabinoids in yeast (which would cost less than obtaining them from the cannabis plant).
Research to evaluate the relationship between cannabis smoking and type 2 diabetes.

Don’t use cannabis or cannabinoids to postpone seeing a health care provider about a medical problem.

Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions.

Research has been done on the effects of cannabis or cannabinoids on chronic pain, particularly neuropathic pain (pain associated with nerve injury or damage).
A 2018 review looked at 47 studies (4,743 participants) of cannabis or cannabinoids for various types of chronic pain other than cancer pain and found evidence of a small benefit. Twenty-nine percent of people taking cannabis/cannabinoids had a 30 percent reduction in their pain whereas 26 percent of those taking a placebo (an inactive substance) did. The difference may be too small to be meaningful to patients. Adverse events (side effects) were more common among people taking cannabis/cannabinoids than those taking placebos.
A 2018 review of 16 studies of cannabis-based medicines for neuropathic pain, most of which tested a cannabinoid preparation called nabiximols (brand name Sativex; a mouth spray containing both THC and CBD that is approved in some countries but not in the United States), found low- to moderate-quality evidence that these medicines produced better pain relief than placebos did. However, the data could not be considered reliable because the studies included small numbers of people and may have been biased. People taking cannabis-based medicines were more likely than those taking placebos to drop out of studies because of side effects.
A 2015 review of 28 studies (2,454 participants) of cannabinoids in which chronic pain was assessed found the studies generally showed improvements in pain measures in people taking cannabinoids, but these did not reach statistical significance in most of the studies. However, the average number of patients who reported at least a 30 percent reduction in pain was greater with cannabinoids than with placebo.

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