Navigating Cannabis Options for Chronic Pain

Dr. Reefer Navigating Cannabis Options for Chronic Pain

Using Medical Marijuana for Pain Relief

Why Strain, Dose, and Delivery Method Matter

There’s a long history of patients using cannabis to manage chronic pain, and modern research is finally catching up. Studies show cannabis can help with neuropathic pain, cancer-related pain, migraines, fibromyalgia, and spasticity from conditions like multiple sclerosis. The National Academies of Science even concluded that adults with chronic pain who used cannabis were more likely to experience meaningful pain reduction, though the effect was described as “modest.”

Pain relief is real — but what type of cannabis you use and how you use it makes a difference.

Why Cannabis Works for Pain

Cannabis is chemically complex. More than 560 unique compounds have been identified in the plant, including 60+ cannabinoids that interact with the body’s endocannabinoid system — the system responsible for regulating pain, mood, appetite, sleep, and inflammation.

The two best-known cannabinoids:

THC (Δ9-tetrahydrocannabinol)

  • Produces the “high”

  • Helps with pain, nausea, appetite

  • Useful for severe symptoms and chronic pain patients

CBD (Cannabidiol)

  • Non-intoxicating

  • Reduces inflammation and pain

  • Helps balance THC’s psychoactive effects

Both compounds work better together than alone — something called the entourage effect, where cannabinoids and terpenes reinforce each other’s benefits.

Species, Strains, and Why Names Don’t Mean Much

You’ve probably seen strain names like Purple Diesel, Blue Dream, OG Kush, etc. Dispensaries rely on them heavily, but scientifically, these names aren’t very reliable indicators of what’s actually in the product.

Most commercial strains fall into one of three chemotypes, typically grouped by:

  • High THC

  • High CBD

  • Balanced THC:CBD

As Dr. David Bearman, a physician with decades of cannabinoid experience, explains:

“Strain names are basically marketing. They don’t tell you what’s in the product. Patients should look at the label, not the name.”

And because cannabis isn’t FDA-regulated, what you get at one dispensary may not match what you get somewhere else — even if the name is the same.

How You Take Cannabis Makes a Big Difference

Different delivery methods absorb differently, kick in at different speeds, and last for different lengths of time.

Smoking or Vaping

  • Fast relief (minutes)

  • Easier to microdose

  • Effects don’t last as long

Edibles

  • Slow onset (30–90 minutes)

  • Stronger and longer-lasting

  • Easy to take too much if you’re not careful

Tinctures / Sublingual Oils

  • Good middle ground

  • More predictable dosing

  • Longer-lasting than smoking

Topicals

  • Helpful for joint or muscle pain

  • No psychoactive effects

  • Doesn’t treat internal pain

Capsules / Pharmaceutical THC

Medications like Marinol and Syndros (synthetic THC) are FDA-approved for nausea, appetite loss, and HIV-related weight loss. A 2013 study found dronabinol may produce longer-lasting pain relief than smoked cannabis — but many patients say real cannabis works better and has fewer side effects.

What Dose Works for Pain?

According to Dr. Bearman:

  • Start with a 1:1 ratio of THC:CBD

  • Begin at around 7.5 mg THC + 7.5 mg CBD, taken 3–4 times daily

  • For stronger pain relief, aim for 15 mg THC + 15 mg CBD

THC doses below 15 mg often don’t provide meaningful pain relief for moderate or severe pain. Everyone responds differently, so the goal is to start low, increase slowly, and find the smallest effective dose.

If psychoactive effects are a concern, CBD can help balance THC so patients feel relief without feeling high.

A Quick Word About Hemp

Hemp-based oils, extracts, gummies, and “CBD products” are everywhere online. But here’s the important part:

Hemp is not the same as medical marijuana.

Traditional definitions say:

  • Hemp = Cannabis sativa (low THC, high CBD)

  • Marijuana = Cannabis indica (higher THC)

But genetic research shows the differences aren’t that clean. Breeding has blurred the lines between the two. Hemp tends to produce very low THC and is used for fiber, food oils, and low-dose CBD — but it lacks the full cannabinoid profile needed for meaningful pain relief in many patients.

If you need strong or consistent pain control, hemp products usually won’t be enough.

Legal Notes and Product Testing

Medical cannabis is legal in most states, but federally it’s still classified as Schedule I, meaning it has “no accepted medical use” under federal law.

Testing requirements vary by state. Some states only check for contaminants; others require THC and CBD potency testing. For example:

  • California requires full pesticide, microbial, and potency testing.

  • Other states may have weaker or inconsistent standards.

This means the same strain name can have completely different cannabinoid levels depending on the grower or state.

Clinical Takeaway: Personalized Dosing Matters

Finding pain relief with cannabis usually requires:

  1. A personalized THC:CBD ratio

  2. A delivery method that matches your symptoms

  3. Slow, careful dose adjustments

  4. Guidance from a knowledgeable medical marijuana doctor

Cannabis won’t cure chronic pain overnight, but the right product and dose can make pain more manageable with fewer side effects than many pharmaceuticals.

Before starting medical cannabis — especially if you take other medications — make sure to speak with a licensed cannabis doctor.

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