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Cannabinoids in Neuropathic Pain: Trials and Insights

By April 23, 2025No Comments

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Review
. 2025 Apr 22.

doi: 10.1007/s00210-025-04134-7. Online ahead of print.

Cannabinoids in neuropathic pain treatment: pharmacological insights and clinical outcomes from recent trials

Mohammad Gayoor Khan 1, Sajid Hussain Altaf Hussain 2, Faris F Aba Alkhayl 3, Marya Ahsan 4, Hayder Ridha-Salman 5
Affiliations 

Abstract

Neuropathic pain, a complex and often devastating condition, poses significant challenges for its effective management. Despite promising research on various cannabis formulations and delivery methods for neuropathic pain, significant gaps remain in our knowledge. While inhaled cannabis shows analgesic effects and alternative delivery methods may improve bioavailability, oral formulations have yielded mixed results, often limited by small sample sizes and placebo effects. Therefore, further research is essential to optimize cannabis formulations, identify responder profiles to tailor treatments effectively, and, most critically, confirm the long-term safety and efficacy of cannabis-based therapies in managing NP.

This review article aims to provide a comprehensive analysis of the therapeutic potential of cannabis-based medicines, with a particular focus on cannabinoids. This review, though not systematic, examines 11 clinical studies, specifically Randomised Clinical Trials) published from 2014 to 2024, highlighting the efficacy of numerous cannabis formulations, in alleviating neuropathic pain. Key findings show that cannabinoids can reduce pain perception, improve patient quality of life, and mitigate other symptoms associated with neuropathic pain.

The synergistic effects of tetrahydrocannabinol and cannabidiol are discussed, emphasizing their ability to enhance analgesic effects, while potentially reducing the psychoactive side effects of tetrahydrocannabinol. This review emphasizes the importance of the personalized approach to improve therapeutic outcomes. Limitations of the existing research focusing on cannabis for neuropathic pain are limited by heterogeneity, lack of standardization, small sample sizes, and reliance on subjective outcomes, impacting the reliability and generalizability of findings. However, this exhaustive review aims to inform clinicians and researchers about the evolving role of cannabis in contemporary pain management strategies, illustrating the diverse pharmacological profiles of cannabinoids and their potential as adjunct therapies for neuropathic pain management.

Keywords: Cannabinol, Cannabis, Neuropathic pain, Peripheral neuropathy, RCTs

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

References

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Publication types

Summary and Context

This comprehensive review synthesizes clinical trial data from the past decade to examine the role of cannabinoids in managing neuropathic pain. The findings support the growing body of evidence suggesting that cannabis-based therapies, particularly those combining THC and CBD-can provide meaningful symptom relief for some patients. Inhaled formulations have shown the most consistent analgesic effects, while oral alternatives remain limited by variability and inconsistent outcomes.

The review emphasizes the importance of personalized care, noting that therapeutic response may vary widely depending on formulation, dosage, and patient profile. While the overall safety and tolerability of cannabinoid-based interventions are promising, further research is needed to improve delivery methods, identify treatment responders, and confirm long-term outcomes.

This analysis reinforces the potential of cannabinoids as adjuncts or alternatives to conventional therapies for neuropathic pain. However, it also highlights the need for standardized clinical protocols, larger sample sizes, and a more nuanced understanding of the endocannabinoid system’s role in chronic pain modulation.

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