CBD+THC tincture at a 2.5:1 ratio is effective for chronic neck and back pain

This study tested the effectiveness of one specific cannabinoid product for reducing chronic neck and back pain. It was published in the 2023 edition of the journal Medical Cannabis and Cannabinoids.

It was a small study of 28 chronic neck and/or back pain patients with symptoms persisting for a median of about 10 years. All patients failed to achieve pain reduction from standard OTC (over the counter, non-prescription) medications, and stopped taking any other medications for the duration of the trial. The median age was 63.3 (range: 31.3 to 74.7), and half were female. It was conducted between October 2021 and June 2022. 

The product they tested was called Cybis® 10:25 (10mg THC, 25mg CBD, and 1mg Linalool per mL). The study was not blinded, but "open-label", so the patients knew what product they were taking. It was taken oromucosally (via tincture drops under the tongue usually).

From the manufacturer's press release:

This formulation is specifically formulated for chronic pain patients.

Full spectrum profile with Linalool the dominant terpene, alongside bisabolol and betacaryophellene providing potential benefits of the entourage effects. Linalool has shown to reduce anxiety through human clinical trials.

The participants took increasing amounts of the oil over a period of 28 days. The following charts show pretty clearly that the dose of 1.5 mL (twice a day) was most effective. That is the equivalent of 30mg THC and 75mg CBD total per day delivered via tincture. They used the Numerical Pain Rating Scale (NPRS) and Brief Pain Inventory Short Form (BPI-SF) assessment standards for measurement (od = once per day, bd = twice per day).
Change from baseline in NPRS (a); NPRS in those with no rescue medication use (b); BPI Now (c); BPI Average (d). * Significant difference from baseline pain score. For panels A and B, line at −2 represents the minimum clinically important difference in NPRS score.


The 1.5mL dose administered twice daily reduced pain symptoms between 2 and 3 absolute points on a 10 point scale. All other doses achieved less absolute pain reduction. This relationship is linear dose-dependent, meaning 'more was better' within these parameters.

One interesting part of this study is that they took 13 blood samples over 24 hours after the first single dose of 0.5mL to determine cannabinoid content in the participants blood (pharmacokinetics / bioavailability). Their samples showed "significant interpatient variability" which is consistent with most other studies on bioavailability. We aren't sure why, but everyone processes and metabolizes cannabinoids with different efficiency. That's a big reason why the phrase, "Start LOW and GO SLOW" is so important when choosing a starting dose.

In the authors' words:

There were dose-dependent improvements in numerical pain rating scores (p < 0.001)

clinically significant reductions in pain at 1.0 mL bd and 1.5 mL bd doses (28.8% and 34.1% reductions, respectively, p < 0.001)

Depressive symptoms and stress had dose-dependent reductions (p = 0.0182, p < 0.01, respectively). 


The authors' conclusion:

In patients with chronic neck/back pain, CBD and Δ9-THC are well tolerated and doses of 1.0 mL bd and 1.5 mL bd showed clinically significant reductions in pain compared to baseline pain scores.


The full text article is here at Karger.com.



Paul Glare, Richard Chye, Mark Bloch, Mark Arya, Andrew Moore, John Montgomery; Tolerability and Efficacy of a 10:25 Preparation of Δ9-Tetrahydrocannabinol and Cannabidiol for Treatment of Chronic Back or Neck Pain: A Multiple-Dose Escalation Study. Med Cannabis Cannabinoids 20 December 2023; 6 (1): 66–76. https://doi.org/10.1159/000531232