Patients With Chronic Musculoskeletal Pain Often Turn to Cannabis
A 2024 study of patients seeking orthopedic care in Toronto found that cannabis use for chronic musculoskeletal pain was common—and that many users believed it helped. The findings, however, reflect patient perceptions rather than evidence that cannabis works better than standard pain treatments.
Published in the Journal of Cannabis Research, the study surveyed 629 adults with chronic muscle, tendon, bone or joint pain who attended a first-time consultation at the Orthopaedic Clinic at Toronto Western Hospital. The survey data were collected between November 2018 and April 2019, around the time Canada legalized recreational cannabis.
Of the participants, 144—23%—said they were currently using or had previously used cannabis specifically to manage their musculoskeletal pain. Among these users, 63.7% described cannabis as “very” or “somewhat” effective, while another 26.6% rated it as “slightly” effective. Fifty-seven percent said cannabis seemed more effective than prescription pain medication, and about 40% reported reducing their use of other analgesics after starting cannabis.
These results are notable, but they do not show that cannabis caused pain relief or that it outperformed conventional medicines. Participants were reporting their own experiences, without a control group or objective clinical assessments. People who chose cannabis may also differ from non-users in pain severity, treatment history, expectations or other health factors.
CBD was the most commonly reported formulation
Among cannabis users, cannabidiol, or CBD, was the most frequently identified cannabinoid, reported by 39%. Twenty percent said they used a hybrid product, while 23% did not know the product’s cannabinoid composition. Oils were the most common method of administration, followed by smoking and vaporizing.
The lack of knowledge about product composition is important because cannabis products can differ substantially in their concentrations of CBD, tetrahydrocannabinol (THC) and other compounds. Dose, route of administration and THC content may all affect both potential benefits and adverse effects.
Side effects and other reported benefits
Dry mouth was the most frequently reported side effect, affecting 43% of users. Fatigue was reported by 23%, and 15% reported a lack of motivation. Thirty-nine percent said they had experienced none of the listed cannabis-related side effects.
Some participants also reported using cannabis for symptoms associated with chronic pain. Sleep disturbances were the most commonly cited, at 44%, followed by anxiety at 26% and headaches at 18%. These figures describe what participants believed cannabis helped—not confirmed treatment effects for sleep, anxiety or headache.
Among participants who had never used cannabis for their pain, 65% expressed interest in trying it. The most frequently reported barriers were limited knowledge about cannabis formulations, how to use it, how to obtain it and the available evidence. Stigma was also identified as a concern, although the researchers noted that knowledge gaps appeared to be more prominent barriers in this group.
Previous cannabis use was the strongest predictor
A history of recreational cannabis use was strongly associated with using cannabis for musculoskeletal pain. Participants with that history had approximately 12.7 times the odds of reporting therapeutic use compared with those without it. Cannabis use was also associated with factors such as longer-lasting pain, opioid use, previous pain-clinic visits, depression, spine pain and pain affecting multiple body areas.
The pattern may indicate that people with more persistent or difficult-to-treat pain are more likely to seek alternatives. It does not establish that cannabis is especially effective for these patients.
The study’s limitations are substantial. It was a cross-sectional survey conducted at a single Canadian orthopedic clinic, relied on self-reported information and used a questionnaire that had not been formally validated. It also included English-speaking adults attending a first consultation, so the results may not apply to all people with chronic musculoskeletal pain.
Current clinical evidence remains mixed. A review and position paper on medical cannabis for orthopedic patients concluded that cannabinoids may provide a small reduction in chronic pain, but the improvement often falls below thresholds considered clinically meaningful, and adverse effects are more common with prolonged treatment. Health Canada’s guidance for health professionals likewise describes the clinical evidence for arthritis and other musculoskeletal conditions as limited.
The Toronto findings therefore point to widespread interest and positive patient experiences, not definitive proof of efficacy. Randomized, placebo-controlled trials are still needed to determine which cannabinoid preparations, doses and delivery methods—if any—provide meaningful benefits for chronic musculoskeletal pain, and for which patients.
