Chronic pain affects many people and can be challenging to manage with traditional treatments alone. As cannabis becomes more widely used for pain and inflammation, there are a few common questions and misconceptions about how it works, what it can realistically do, and how to use it safely.
Cannabis isn’t a one-size-fits-all solution. It interacts with the body’s endocannabinoid system to help regulate pain signals, inflammation, sleep, and stress, leading to gradual improvements in comfort and quality of life rather than complete pain relief.
In this Q&A, our lead medical professional, Dr. Bill McLay, breaks down common myths about cannabis for pain, explains how cannabinoids like THC and CBD influence inflammation, and offers practical guidance on product types, cannabinoid ratios, and dosing strategies. Whether you’re new to cannabis or looking to refine your current approach, this guide can help you set realistic expectations and make informed decisions as part of a broader pain-management plan.
What are the most common misconceptions patients have about using cannabis for pain?
A big misconception is that cannabis will “erase” pain completely. In reality, pain reduction is usually measured on a 0-10 scale, noting incremental improvements as time goes on. It’s also a myth that “natural” means risk-free, but side effects like dizziness, fatigue, and cognitive changes are common, especially with higher THC products.
How do you explain the role of the endocannabinoid system when discussing pain management with patients?
I usually describe the endocannabinoid system (ECS) as the body’s own “cannabis-like” signaling network that helps regulate pain, inflammation, mood, and sleep. It uses naturally produced chemicals (endocannabinoids) that bind to receptors (CB1 in the brain and nerves, CB2 in immune and inflammatory cells) to help “turn the volume up or down” on pain and inflammation. Cannabis-derived cannabinoids (like THC and CBD) can tap into this same system, which is why they may change how pain signals are processed and how sore or stiff tissues feel.
Are there specific terpenes you find impactful for pain relief?
Terpenes are aroma compounds in cannabis, and some may help with pain or inflammation. Reviews highlight Beta-myrcene for potential analgesic and muscle-relaxant effects, Beta-caryophyllene for CB2-mediated anti-inflammatory activity, and linalool for calming and possible pain-relieving effects in preclinical models. These effects are primarily shown in animal and cell studies, so I present them as “supporting actors,” not primary pain medications. In practice, patients often report that strains rich in Beta-myrcene or Beta-caryophyllene feel more body-relaxing or soothing, but effects differ for everyone.
What role does CBD play in pain relief?
For patients, I frame CBD as a potentially helpful “stabilizer” that may smooth out pain and stress rather than a one-dose miracle. CBD isn’t a quick fix for pain, but it may help by calming overactive nerves, reducing inflammation, and easing anxiety around pain. Mechanistically, it acts at many targets (like TRPV1, 5-HT1A, PPAR-γ, and sometimes CB1/CB2), which can reduce pro-inflammatory signaling and pain sensitivity.
A 2024 systematic review concluded that CBD shows promising analgesic and anti-inflammatory effects, especially for conditions like osteoarthritis and chronic pain. However, it emphasized that many studies are still small or early-stage.
Can you explain how cannabis may influence inflammation?
Both THC and CBD can interact with immune cells and signaling molecules that drive inflammation. Preclinical work shows that cannabinoids can lower levels of pro-inflammatory cytokines (such as TNF-α and IL-6) and reduce activation of inflammatory pathways, such as NF-κB, in various cell types. CBD has also been shown to reduce inflammatory mediator production and cell viability in rheumatoid arthritis synovial cells, suggesting direct anti-inflammatory effects in joint tissue. However, human data are still limited and mixed, so I stress that cannabis may help “tone down” inflammation for some patients but should be considered as one part of an overall anti-inflammatory plan.
Do specific cannabinoid ratios consistently yield better results for chronic pain?
So far, no single ratio has been shown to work for all chronic pain patients. In clinical trials, balanced or high-THC: CBD oral sprays (like nabiximols, roughly 1:1 THC: CBD) have shown small but statistically significant improvements in neuropathic and cancer-related pain compared with placebo.
Recent guidelines note that higher-THC products may slightly improve pain scores but also increase side effects such as dizziness and cognitive impairment. In practice, I explain that ratios are highly individual: many patients do well starting with low-THC, higher-CBD or balanced products and then slowly adjusting based on pain relief, function, and tolerability.
How do you help patients evaluate whether they need fast-acting relief or long-duration relief?
I start by asking them to map their pain: Is it fairly constant all day, or does it spike at specific times (like after work or at night)? For short, sudden flares or breakthrough pain, faster-onset options (like inhaled products) may be appropriate, with careful attention to dose and safety. For steady, all-day pain or nighttime pain, longer-acting oral products (tinctures, troches, oral formulations) can provide a more stable baseline, sometimes with a small fast-acting dose layered on top for spikes. I also tie the choice to their daily routines, work, driving, and caregiving, so that the timing and form of cannabis minimize impairment and maximize function.
How do you talk about cannabis as part of a broader approach to managing pain and inflammation, rather than a stand-alone solution?
I emphasize that chronic pain is best treated with a toolbox, not a single tool, and cannabis is just one option in that toolbox. Evidence suggests cannabinoids can provide additional pain relief, but not usually enough on their own to fully control severe chronic pain. We talk about combining cannabis with physical therapy, movement, sleep optimization, stress reduction, and in some cases, other medications, while also watching for interactions and over-sedation. I also highlight that self-care (activity pacing, weight management, mental health support) can make any cannabis regimen work better.
How do you help patients set realistic expectations for pain relief?
We discuss patient-specific goals from better sleep to improved ability to function (walk, work, enjoy family). I also discuss common side effects, costs, and the possibility that we may try cannabis for a defined period and change strength or dosage form if it does not work initially.
What are some memorable outcomes or trends you’ve seen over the past few years with chronic pain patients?
Clinically and in observational research, many patients report improved sleep, mood, and quality of life once they find a regimen that works for them, even when pain scores only drop a little. Some cohort studies suggest reductions in opioid use among chronic pain patients after starting medical cannabis, though the evidence is low-certainty and not consistent across all groups. Overall, the trend toward using cannabis as a complementary option is growing, with careful monitoring and coordination, rather than as a single cure-all.
How do lifestyle factors—diet, stress, exercise—interact with cannabis’ effects on inflammation?
Diet, stress, and physical activity all influence inflammatory pathways and may interact with how well the ECS and cannabinoids work. The ECS is involved in energy balance, stress responses, and immune regulation, so a highly inflammatory lifestyle (poor diet, chronic stress, little movement) can fight against what cannabis is trying to do. CBD and other cannabinoids can reduce inflammatory signaling. Still, their impact may be more meaningful when combined with anti-inflammatory habits like a balanced diet, regular exercise, good sleep, and stress-management strategies. I tell patients that cannabis can be a helpful assist, but lifestyle is still the foundation for calming chronic inflammation.
What products or strains in our current lineup can help with pain relief?
30:1 Huny Troches are a great place to start for most. Balanced 1:1 ratio tinctures are also a good starting point for those trying to find their optimal dose, as it is easy to start low and slowly increase until desired results are seen. For more severe pain or those with higher tolerance, high-THC troches are a great option. For breakthrough pain, vape cartridges and flower are a great option. Some strain recommendations include:
- Animal Mints
- Blue Nerds
- Dosidos
- Garlic Drip
- London Pound Cake
- Melted Strawberries
The Bottom Line
Cannabis can be a valuable part of a chronic pain management plan, but it works best when approached thoughtfully and realistically. For many, the biggest benefits are measured with meaningful improvements in sleep, mood, daily function, and overall quality of life. Work with your healthcare provider to find what works for you, stay open to gradual adjustments, and explore cannabis safely as a tool in a comprehensive approach to living better with chronic pain.
