The majority of Americans reside in a state where the medicinal use of cannabis for chronic pain relief is legal . A 2023 study on cannabis for non-cancer-related pain found that 22% of participants actively used cannabis for chronic pain management, 8% disclosed past cannabis usage, and 70% had never utilized cannabis. Overall, the study noted that cannabis use is more likely among people with more severe pain and more pain conditions. When it comes to cancer pain, another 2023 study found that 70% of patient participants reported subjective improvement in pain . Cannabis is undeniably becoming a popular treatment option for chronic pain, especially with the growing desire to curb the use of addictive opioids. But is it the right option for you?
Does Cannabis Relieve Pain?
There are a huge number of conditions that can lead to chronic pain. Among them are cancer-pain, musculoskeletal pain, and neuropathic pain. These types of pain come from diseases and disorders like tumors, arthritis, nerve damage and neurodegenerative disorders, and injuries. In addition to the many types of pain disorders, there are also a number of pathways in the body that are responsible for the different types of pain we feel. Since the endocannabinoid system plays a role in regulating many of these pathways, it is thought that cannabinoids like cannabidiol (CBD) and tetrahydrocannabinol (THC) may offer broad relief to many chronic pain conditions . However, utilizing cannabinoids as a medicine is challenging because individual responses can vary and the dose and formulation of cannabinoids that is ideal for one person may not be ideal for another.
Medical Cannabis for Chronic Pain
A 2023 review of fifteen studies found pain reduction ranging from 42% to 66% with CBD alone and CBD with THC . Likewise, another 2023 paper notes that the analgesic properties of CBD may help alleviate symptoms of chronic musculoskeletal pain such as high levels of clinical pain, poor quality of sleep, inflammation, psychological factors, and sensitization of the nervous system .
In addition to CBD and THC for chronic pain, the cannabis terpene beta-caryophyllene is also a molecule of interest . Terpenes are non-intoxicating molecules that give plants distinct scents and flavors. In the case of caryophyllene, researchers have found that it also activates cannabinoid receptor 2 (CB2) more strongly than CBD which may translate into anti-inflammatory and analgesic benefits. Likewise, the terpene myrcene is recognized as a sedative and may also have muscle-relaxant properties and pinene has demonstrated anti-inflammatory properties.
THC is the cannabinoid responsible for the intoxicating high that accompanies marijuana use . It works primarily on cannabinoid receptor 1 (CB1) but also exerts a smaller activating force on CB2. Both THC and CBD are similar in structure to endocannabinoids that are naturally produced by the body. That is why they can act on the same pathways and exert similar effects. One study even observed that THC possessed 20 times the anti-inflammatory power of aspirin and twice that of hydrocortisone. While cannabinoids undoubtedly possess properties that can relieve pain, their practical use is not so straightforward.
Best Cannabis Strains for Chronic Pain
In medicinal cannabis, physicians work with patients to help them titrate the best cannabinoid dosage for them, and adjust the dose as tolerance and symptoms change . Titration is the process of gradually increasing a dosage over time until the optimal therapeutic dose is achieved with minimal disruptive side effects. “Cannabinoid Based Medicine (CBM) Dosing and Titration Protocols” for routine and conservative dosing recommend that medical cannabis users start with a CBD-dominant medical cannabis product. Patients will gradually increase their dosage until relief is felt. If symptom relief is not achieved, and the CBD dose is more than 40 mg per day, physicians may recommend adding THC. CBM protocols recommend starting THC doses at just 1-2 mg.
Since both CBD and THC may benefit pain relief, it is important to consider starting with non-intoxicating CBD products before diving into high-THC marijuana. However, your doctor is ultimately the only person qualified to determine what is appropriate for your specific health concerns. If they have deemed it appropriate to use marijuana, here are some strains that have gained fame for their ability to ease pain.
Afghani, also known as Afghan or Afghanistan, represents a pure indica cannabis strain with origins in the Hindu Kush mountain range along the Afghanistan-Pakistan border. As a landrace strain, it has naturally evolved over numerous generations, adapting to the local environment. This particular strain is renowned for its robust sedative properties, making it a favored option among medical marijuana patients seeking relief from pain and insomnia. The buds of the Afghani landrace strain are compact and covered in resinous trichomes, providing a sticky texture and a distinctive, strong aroma. The flavor profile is characterized by earthy, pungent, and woody notes, complemented by subtle hints of sweetness and spice, attributed to dominant terpenes such as terpinolene, myrcene, and pinene. While the THC content in Afghani can vary, it typically falls within the range of 15-20%, making it a potent strain known for inducing a powerful body high. Users often describe the experience as profoundly relaxing, with some reporting feelings of euphoria and happiness. However, caution is advised against daytime use due to its sedative effects.
- Mazar I Sharif
Mazar I Sharif, also known as Mazar, stands out as one of the cannabis strains with the highest linalool content. Not only is it unique for having linalool as its dominant terpene, but it also boasts elevated levels of caryophyllene and myrcene. Originating from Northern Afghanistan, this indica cannabis strain features a flavor profile characterized by herbal spice, with distinct notes of tobacco and sage. Mazar is recognized for its relatively low THC levels, averaging around 13%, coupled with a noteworthy CBD content. While its distinctive terpene and cannabinoid profile makes Mazar I Sharif particularly suitable for medical cannabis patients, it is somewhat uncommon in dispensaries. Those fortunate enough to experience the Mazar I Sharif strain often describe it as an excellent choice for achieving physical relaxation. However, caution is advised as some individuals encountering a more THC-potent phenotype of Mazar caution that its effects can be immobilizing and strongly narcotic. If given the opportunity to try the Mazar I Sharif strain, it is recommended to verify the THC content to anticipate the specific phenotype’s characteristics.
- King Louis XII
King Louis XIII, also known as “King Louis” or “Louis XIII Kush,” is an indica cannabis strain crafted by combining OG Kush and LA Confidential. The THC levels of this strain can vary significantly, ranging from 20% to an impressive 29%, depending on the cultivator. King Louis XIII is distinguished by its dense buds, emitting a strong fragrance of pine and earthy musk. The primary terpenes responsible for its aroma are myrcene, limonene, and caryophyllene, contributing woody and spicy undertones to its taste profile. Renowned for its rapid and potent effects, this strain induces profound physical relaxation and an elevated mood. Due to its potency and quick onset, King Louis XIII is most suitable for evening consumption to ensure its sedative properties do not interfere with daily activities. Widely embraced in the medical marijuana community, this strain has garnered immense popularity for its efficacy in alleviating pain, insomnia, and stress.
Blueberry, a renowned cannabis strain celebrated for its genuine blueberry flavor, has achieved legendary status. This indica, a recipient of the Cannabis Cup, is the result of crossing Purple Thai with Thai. With an average THC content of around 17% and 1% CBG, Blueberry offers a relaxing and euphoric experience, though it carries sedative properties. Its delightful sweet blueberry taste is truly a sensory delight. Beyond recreational enjoyment, medical marijuana patients favor this tried-and-true strain for its effectiveness in relieving pain and stress. The terpene profile of Blueberry is dominated by myrcene, caryophyllene, and pinene. Originating in the 1970s, American breeder DJ Short developed this strain, intertwining genetics from exotic landrace strains. Since then, Blueberry has become a staple in cannabis seed banks.
- Granddaddy Purple
Whether you refer to it as Grand Daddy Purp, Granddaddy Purple Kush, Granddaddy Purps, or simply GDP, the Granddaddy Purple cannabis strain has earned widespread acclaim. This indica, born from the fusion of Mendocino Purps, Skunk, and Afghanistan, rose to prominence circa 2003. Despite its seemingly moderate THC potency of around 17%, Granddaddy Purple delivers potent effects, seamlessly blending cerebral euphoria with profound body relaxation. Recognized for its dreamy high in recreational circles, medicinal users find relief from pain, insomnia, increased appetite, and muscle spasms. The purple-tinged buds of Granddaddy Purple release a delightful mix of sweet and floral flavors, reminiscent of grapes, berries, and flowers. Dominated by myrcene, pinene, and caryophyllene, its terpene profile adds to the strain’s distinctive characteristics.
Mango, also known as Mango OG, was developed through the crossbreeding of Afghani with KC 33. This indica-dominant hybrid induces euphoric, relaxing, and uplifting effects that unfold gradually. Although its THC content typically falls below 20%, users should exercise patience due to its “creeper” effect, which may lead to sedation if more is consumed hastily. Despite this caution, Mango has much to offer. Its genetic origins are rumored to trace back to an unidentified hippie breeder in the 60s, but the contemporary version took shape around 1991. Since its inception, the Mango strain has been cherished for its generously-sized, fruity tropical buds bursting with mango flavor, complemented by notes of citrus and earth. Dominated by myrcene, pinene, and caryophyllene, its terpene profile contributes to its distinct qualities. Mango proves to be a suitable cannabis strain for users of all experience levels, but it is advisable to try it in the evening initially before exploring daytime use.
- Purple Kush
Purple Kush stands as a timeless kush variant of cannabis, featuring densely packed, frosty buds. While its aroma is sour and pungent, the taste is delightfully clean, offering a luscious and sweet experience. Utilizing a dry herb vape allows for the full expression of Purple Kush’s bright, floral, and citrusy flavor. The predominant terpenes in Purple Kush are myrcene, pinene, and caryophyllene. Following consumption, users may encounter a classic kush high, characterized by profound relaxation of both the mind and body.
The lineage of Purple Kush can be traced back to a cross between Hindu Kush and Purple Afghani, closely connecting it to the landrace genetics of the Hindu Kush Mountain Range. Esteemed among indica enthusiasts, Purple Kush is revered for its ability to alleviate pain and anxiety, promote sleep, and induce deep body relaxation. However, its potency warrants caution, especially for less-experienced cannabis users. While accessible to all, beginners are advised to start with small amounts to gauge their tolerance.
- Bell, A. D., MacCallum, C., Margolese, S., Walsh, Z., Wright, P., Daeninck, P. J., … & External Review Panel. (2023). Clinical Practice Guidelines for Cannabis and Cannabinoid-Based Medicines in the Management of Chronic Pain and Co-Occurring Conditions. Cannabis and Cannabinoid Research. https://www.liebertpub.com/doi/pdf/10.1089/can.2021.0156
- Bicket, M. C., Stone, E. M., & McGinty, E. B. (2023). Association of cannabis use with patient-reported pain measures among adults with chronic pain in US states with medical cannabis programs. Regional Anesthesia & Pain Medicine. https://rapm.bmj.com/content/early/2023/11/03/rapm-2023-104833.abstract
- Mohammed, S. Y. M., Leis, K., Mercado, R. E., Castillo, M. M. S., Miranda, K. J., & Carandang, R. R. (2023). Effectiveness of Cannabidiol to Manage Chronic Pain: A Systematic Review. Pain Management Nursing. https://www.sciencedirect.com/science/article/abs/pii/S1524904223001935
- Petersen, K. K. S., Rice, A. S., & Arendt-Nielsen, L. (2023). The use of cannabidiol (CBD) as an analgesic component. The Lancet Regional Health–Europe, 35. https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(23)00210-7/fulltext
- Russo, E. B. (2008). Cannabinoids in the management of difficult to treat pain. Therapeutics and clinical risk management, 4(1), 245-259.https://www.tandfonline.com/doi/pdf/10.2147/tcrm.s1928
- Russo, E. B. (2011). Taming THC: potential cannabis synergy and phytocannabinoid‐terpenoid entourage effects. British journal of pharmacology, 163(7), 1344-1364. https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/j.1476-5381.2011.01238.x
- Sharon, H., Agbaria, Y., Brill, S., de Santiago, J., & Hochberg, U. (2023). Medical cannabis for refractory cancer-related pain in a specialised clinical service: a cross-sectional study. BMJ Supportive & Palliative Care. https://spcare.bmj.com/content/early/2023/11/15/spcare-2023-004421.abstract