Efficacy and Safety of Cannabinoid-Based Interventions for Low Back Pain and Migraine: A Systematic Review of Randomized Controlled Trials.

Authors

Claudete da Costa-Oliveira, Magnólia de Jesus Castro, Luiza Aparecida Luna Silvério, Maria Fernanda Barros de Oliveira Brandão, Ygor Jessé Ramos, Priscila Gava Mazzola

Published in

Cannabis and cannabinoid research. Pages 25785125261490003. Sep 22, 2026. Epub Sep 22, 2026.

Abstract

Low back pain, migraine, and other headache disorders are major contributors to disability, and interest in cannabinoid-based interventions has increased despite uncertainty regarding their indication-specific therapeutic value. This systematic review evaluated the efficacy and safety of isolated cannabinoids, synthetic cannabinoids, vaporized Cannabis products, and standardized Cannabis extracts for low back pain, migraine, and medication-overuse headache.
Electronic databases, trial registries, and supplementary sources were searched for double-blind randomized clinical trials in adults. Eligible studies were assessed using Risk of Bias 2, synthesized narratively according to synthesis without meta-analysis guidance, and rated for certainty using Grading of Recommendations Assessment, Development, and Evaluation (PROSPERO registration: 582772).
Five randomized controlled trials involving 1,072 participants met the inclusion criteria. In acute low back pain, a single 400-mg oral dose of isolated cannabidiol was not superior to placebo. In acute migraine, vaporized tetrahydrocannabinol (THC) plus cannabidiol (CBD) improved 2-h pain relief, pain freedom, and freedom from the most bothersome symptom, with sustained benefits observed for selected outcomes through 24-48 h, compared with placebo, whereas a CBD-dominant formulation showed no clear benefit. In medication-overuse headache and chronic musculoskeletal pain, nabilone showed favorable but very uncertain signals for pain-related outcomes and analgesic consumption. In chronic low back pain, a phase III trial showed that the standardized full-spectrum Cannabis extract VER-01 improved pain intensity, disability, sleep quality, and patient-reported outcomes compared with placebo. THC-containing inhaled formulations were associated with more psychoactive adverse effects and possible functional unblinding.
Current randomized evidence does not support a class-wide effect of cannabinoid-based therapies for low back pain or headache disorders. Efficacy appears to depend on indication, formulation, route of administration, and cannabinoid composition. Moderate-certainty evidence supports vaporized THC + CBD for acute migraine outcomes, including 2-h efficacy and sustained response for selected outcomes through 24-48 h and VER-01 for chronic low back pain; evidence for single-dose oral cannabidiol and nabilone remains very uncertain. Larger independently replicated trials using analytically standardized formulations, harmonized outcomes, active-placebo strategies when THC is present, and additional studies evaluating repeated use across multiple migraine attacks and longer-term safety are needed.

PMID:
42773786
Bibliographic data and abstract were imported from PubMed on 23 Sep 2026.

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