Efficacy and Safety of Cannabinoid-Based Interventions for Low Back Pain and Migraine: A Systematic Review of Randomized Controlled Trials
Abstract
Introduction: 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.
Methods: 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).
Results: 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…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,072 participants or records.
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