What is the best medical cannabis for nerve pain?
No single cannabis product is best for nerve pain. The product with the most clinical trial evidence is a THC:CBD oromucosal spray called nabiximols (Sativex). Each spray delivers 2.7 mg THC and 2.5 mg CBD. Nabiximols is approved in several countries for multiple sclerosis spasticity. It is not sold in the US. In US legal markets, the closest match is a vaporized flower or oral oil with THC at 5% to 10% plus CBD in a 1:1 to 4:1 THC:CBD ratio. Start with 2.5 mg THC. Wait 2 hours. Raise the dose in small steps.
What the evidence supports
- Nabiximols: A 2018 Cochrane review of 16 studies found low-quality evidence of a small reduction in neuropathic pain. About 1 in 6 patients reported 30% or more pain relief.
- Smoked cannabis: A 2010 trial by Ware and colleagues used 9.4% THC flower in patients with neuropathic pain. It reduced pain intensity by about 0.4 points on a 10-point scale versus placebo.
- CBD alone: Human trials for nerve pain are small. Evidence is weaker than for THC-containing products.
Ratios and forms
US dispensaries sell flower, vape cartridges, tinctures, capsules, and topicals. For nerve pain, inhaled flower or oral oil give the most predictable effects. Topicals have no human trial data for neuropathic pain.
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- Balanced 1:1 THC:CBD: 5 mg THC plus 5 mg CBD per dose. A common starting point for patients who want less intoxication.
- THC-dominant 4:1: 10 mg THC plus 2.5 mg CBD. Higher risk of anxiety and impaired coordination.
- CBD-dominant 1:20: 1 mg THC plus 20 mg CBD. Limited evidence for nerve pain. No intoxication at low THC.
Strains and labels
Strain names do not predict chemistry. Ask for a batch certificate of analysis. Look for total THC, total CBD, and terpene content. Terpenes such as myrcene, beta-caryophyllene, and linalool appear in nerve pain research, but human trials are absent. Treat terpene claims as unproven.
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Cautions
Cannabis can cause dizziness, dry mouth, and impaired memory. It can worsen anxiety at high THC doses. Do not drive after use. Cannabis may interact with warfarin, clobazam, and other drugs processed by CYP2C9 and CYP3A4. Tell your clinician about all cannabis use. US federal law classifies cannabis as Schedule I. State programs set their own rules.
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Bottom line
Choose a product with THC plus CBD, not CBD alone. Vaporize flower at 180°C to 200°C or use oral oil. Start with 2.5 mg THC. Increase by 2.5 mg every 2 to 3 days until pain relief or side effects. Keep a log of dose, product, and effect. Bring the log to your clinician.