Assessing the Efficacy of Cannabinoid Compositions for Treating 3 Classes of Chronic Pain: A Real-World Evidence Study

Purpose: Cannabis has been determined to be effective at treating chronic pain, although research on the effects of specific cannabinoids, especially for different mechanisms of chronic pain, is limited. This study examined therapeutic efficacy for combinations of intoxicating and nonintoxicating cannabinoids for symptoms of 3 different types of chronic pain conditions. Methods: We recruited adult California residents diagnosed with fibromyalgia (n = 64), rheumatoid arthritis (n = 25), and osteoarthritis of the knee and/or hip (n = 75). Participants in each group were randomly assigned to receive a 12-week supply of oral capsules with 3 different cannabinoid compositions: product 1—12.5 mg cannabidiol (CBD) and 12.5 mg tetrahydrocannabinol (n = 45); product 2—10 mg tetrahydrocannabinolic acid, 10 mg cannabidiolic acid (CBDa), 5 mg cannabigerol, and 3 mg cannabichromene (n = 57); and product 3—10 mg CBD and 10 mg CBDa (n = 62). Participants completed validated self-report questionnaires assessing pain characteristics, mental health and cognitive functioning, and physical functioning at baseline and 12-week timepoints. Findings: Of 276 individuals recruited, 168 (60.9%) completed all survey questionnaires. Four individuals who completed the questionnaires but discontinued study product use were removed from the dataset. Per-protocol analyses identified significant improvements across all symptoms except cognitive function abilities. Effects ranged from small to large; most did not differ in magnitude across product or type of chronic pain. Products differed in effectiveness for sleep disturbance, and participants taking product 2 reported reductions in neuropathic pain intensity. Implications: These findings suggest that various cannabinoid combinations may have beneficial effects across 3 different types of chronic pain. Nonintoxicating cannabinoids such as CBD and CBDa may provide relief from pain and related symptoms and may be utilized when cannabis intoxication is undesirable or problematic.