Chronic pain is one of the toughest problems in modern medicine. More than 100 million Americans live with it, and it drains over half a trillion dollars every year in treatment costs and lost productivity. With numbers like that, it’s no wonder patients and doctors alike are searching for better solutions. Cannabis has become a headline contender, but does it truly work—or just promise relief without delivering the goods?

The Agency for Healthcare Research and Quality (AHRQ), a federal agency tasked with evaluating medical evidence, has been running a “living systematic review” to answer exactly that question. Unlike traditional reviews that go out of date the moment new studies are published, this one is continuously updated as fresh research comes in. The latest update landed in summer 2025, and it paints a nuanced picture of cannabis for chronic pain: some real benefits, some disappointing misses, and side effects that can’t be ignored.

What the Review Found

AHRQ focused on cannabis products based on their THC-to-CBD ratios. Balanced formulations, with roughly equal parts THC and CBD, showed small but meaningful improvements in pain and overall function. Patients were able to manage their conditions a little better—but there was a price. Dizziness, sedation, and nausea were common, with dizziness standing out as a frequent and sometimes debilitating side effect.

High-THC products, whether synthetic or derived from the plant, also offered modest pain relief. The catch was that side effects were even more pronounced. People reported significant sedation and nausea, and dizziness again made a strong appearance. The evidence was less robust in this group, but the pattern was clear: more THC didn’t necessarily mean better relief, just a higher risk of being knocked sideways by side effects.

CBD-dominant products told a different story. Despite their popularity and reputation as a gentler option, they didn’t consistently improve pain or function in patients with chronic pain. In fact, when THC was present even in small amounts, nausea sometimes crept in without delivering meaningful gains in relief. For patients banking on CBD alone, the evidence just doesn’t support it as a reliable pain treatment—at least not yet.

The 2025 Update

The latest review incorporated six new studies, three randomized clinical trials and three observational studies. These included a trial comparing topical hemp seed oil to standard diclofenac gel for knee osteoarthritis, another looking at a topical blend of THC, CBD, and CBN for diabetic neuropathy, and a head-to-head trial pitting inhaled cannabis against oxycodone, or both, in patients with fibromyalgia. While these additions expanded the evidence base to 29 randomized trials and 15 observational studies, none of them shifted the core conclusions. Balanced cannabis formulations still look like the most promising option, high-THC products remain a mixed bag, and CBD alone continues to underwhelm.

The Bigger Picture

Perhaps the most striking aspect of the review is what remains unknown. There is still no solid evidence on whether cannabis reduces the need for opioids in the long term, or on whether it carries significant risks of psychosis, cognitive decline, or cannabis use disorder when used for chronic pain. Other plant-based treatments like kratom, which some have touted as alternatives, also suffer from a lack of meaningful research. In other words, we’re still looking at a field with as many questions as answers.

For now, the message is straightforward. Cannabis can help with chronic pain, but the benefits are modest and depend heavily on the THC-to-CBD balance. Side effects like dizziness, sedation, and nausea are not rare annoyances but predictable outcomes that patients and clinicians need to weigh. CBD alone is unlikely to offer the relief many people are hoping for.

The Agency for Healthcare Research and Quality will continue updating its living review as more studies appear. Until then, the best path forward is cautious optimism: cannabis has potential, but it’s not a magic bullet, and the fine print matters.