Traditional chronic pain metrics don't tell the whole story of cannabis' effectiveness

This paper examined patient evidence about the overall effectiveness of cannabis medicine for relief from chronic pain beyond traditional metrics such as pain severity and pain interference. It was published in August 2025 in the journal Experimental and Clinical Psychopharmacology. The authors are researchers at Johns Hopkins University, Arizona State University, and La Trobe University in Australia.

The authors investigate the current state of assessment tools used for the interpretation of the effectiveness of medicines for chronic pain. 

In the authors' words:

many individuals perceive cannabis as beneficial not because it directly reduces pain, but because it alters their psychological responses to it and improves other important outcomes, such as role and social functioning, sleep quality, and opioid substitution, which are largely overlooked in clinical trials of cannabis for chronic pain.

cannabis helps them cope with their conditions by enhancing their ability to manage and tolerate any given level of discomfort

 

They contend that the traditional measures of pain are insufficient to assess the overall effectiveness of cannabinoid medicine for ALL chronic pain symptoms and effects. The impact of chronic pain on patient quality of life extends well beyond actual pain levels to include disrupted sleep and social functioning ability. Few will argue that sleep quality is not an important part of good health, so this conclusion seems to have merit.

Other meaningful outcomes not usually considered in most randomized controlled trials are:

• pain catastrophizing (feeling helpless and unable to function)
• pain acceptance (participating in life activities despite pain)

There seems to be significant evidence that cannabinoid medicine can, at the very least, help distract patients from their underlying pain, and successfully participate in normal life events, despite their pain.

Some of the methods proposed to evaluate these additional, more subjective outcomes are:

• Q-methodology, which combines qualitative insights with quantitative analysis to rank people’s priorities
•  36-item Short Form (SF-36) Survey (Mchorney et al., 1993)
• Pittsburgh Sleep Quality Index (PSQI; Buysse et al., 1989)
• Pain Catastrophizing Scale (PCS: Sullivan et al., 1995)
• Chronic Pain Acceptance Questionnaire (CPAQ; Vowles et al., 2008)

 

Even if there is a type of placebo effect on some patients, the fact remains that if they perceive a benefit, they can likely improve their daily quality of life. If the benefit is only a placebo effect, it will not last for extended periods of time (which is the definition of "chronic"). Anything that allows chronic pain patients to feel better in any way about their condition and symptoms is a good thing in our opinion.

The authors concluded:

we cannot simply dismiss the experiences of thousands of people who report meaningful benefits from using cannabis for managing their pain.

Ultimately, broadening our understanding in this way can mitigate existing confusion, foster nuanced clinical decision-making, strengthen patient advocacy, and promote personalized treatment strategies.  

The full text pdf article is here at APA PsycNet.

Source:

Mun CJ, Thrul J, Epstein DH. Looking beyond traditional pain outcomes to better evaluate cannabis's true potential and limitations in chronic pain management. Exp Clin Psychopharmacol. 2025 Aug 21. doi: 10.1037/pha0000795. Epub ahead of print. PMID: 40839511.