Cannabis for Pain Management in Rheumatology

‘Cannabis has a long history of being used for pain management,’ says Physician Editor Bharat Kumar, MD, MME, FACP, FAAAAI, RhMSUS. ‘What does it mean for rheumatology patients moving forward? Read our article for one answer to this question.’

As cannabis becomes more widely legalized, both in the U.S. and internationally, its use for pain management in chronic conditions has expanded rapidly. For people with rheumatic and musculoskeletal diseases (RMDs), cannabis presents an intriguing option due to its analgesic and anti-inflammatory effects.

Chronic pain and inflammation are hallmark symptoms of such rheumatic conditions as rheumatoid arthritis (RA), osteoarthritis, fibromyalgia and lupus, and conventional treatments often fall short of providing complete relief.^1,2 Consequently, patients are turning to cannabis, either independently or with the hope of guidance from their rheumatologists.^3,4 However, as patients and providers navigate this evolving landscape, challenges related to knowledge gaps, physician comfort and evidence-based guidelines must be addressed.⁵

Patient-Driven Use

Rheumatology patients frequently report that cannabis offers relief not only for pain but also for secondary symptoms, including sleep disruption and anxiety, improving their quality of life with the additional benefit of reducing medications such as antidepressants, non-steroidal anti-inflammatory drugs (NSAIDs) and benzodiazepines.⁴

Fibromyalgia, characterized by widespread pain and notoriously resistant to conventional treatments, is one condition for which cannabis use has grown among patients.⁶ Patients with RA report reduced joint pain and improved mobility with cannabis, although scientific evidence remains limited and further research is needed to solidify these observations.⁷

Patients typically express interest in both THC and CBD, the two primary cannabinoids of more than 100, in the cannabis plant.⁸ These compounds interact with the body’s endocannabinoid system, which regulates pain perception, inflammation and immune responses.⁹ Although THC can provide potent pain relief and has anti-inflammatory effects, it is also psychoactive, which can be a barrier for some patients. CBD, on the other hand, offers anti-inflammatory benefits without psychoactivity, appealing to those who prefer symptom relief without altered cognition. It should be noted that CBD alone provides less pain relief than THC alone or when THC is combined with CBD.^10,11

Other minor cannabinoids, such as CBG, CBC, CBN and THCV, have been growing in popularity for sleep, pain and inflammation; however, these cannabinoids are not well studied.

Knowledge Gaps

A recent international survey of rheumatologists and allied health providers highlights the variations in knowledge, attitudes and practices around cannabis. Conducted November 2023 to April 2024, this cross-sectional survey included 215 respondents, of whom 86% were rheumatologists. The results reveal a community divided in comfort and confidence when discussing cannabis with patients.¹²