In my younger days, there was a group of pain experts that used opioids as their linchpin. Then studies came our showing only 1/2 can tolerate them and only 1/4 will stay on them. Opioid abuse reared its head. Pain reduction was not great except among a subgroup of responders.
Sadly, they fared better then many of the other agents (gapapentinoids, antidepressants fare poorly in back pains/scaiticas which account for over 1/2 pain patients).
Cannabinoids came under fire early in an issue of PAIN years ago (need to treat 25 to get one good case) and was ignored. Now a recent metanalysis found benefits were:
“Cannabinoids reduced chronic pain and improved quality of sleep, but the effect sizes are of questionable importance. Cannabinoids had no effects on acute pain or cancer pain and increased the risks of non-serious adverse events. The harmful effects of cannabinoids for pain seem to outweigh the potential benefits.
My experience with cannabinoids showed that titration took so long that patients really didn’t notice much benefit and were often unwilling to buy a second batch as a result. Now it looks like it really doesn’t do much significant difference.
I live by the philosophy of threes: – You need to do three things at once to obtain any meaningful results. – meds, exercise, massage/Tai chi and so forth. Maybe not abandon but couple with two other treatments to expect anything.
I’ve had to deal with some chronic pain and found botulinum injection, massage and regular gym use is making a difference. Any one, by itself, would have done little.
Barakji J, Korang SK, Feinberg J, Maagaard M, Mathiesen O, Gluud C, Jakobsen JC. Cannabinoids versus placebo for pain: A systematic review with meta-analysis and Trial Sequential Analysis.
PLoS One. 2023 Jan 30;18(1):e0267420.
https://pubmed.ncbi.nlm.nih.gov/36716312/