A 2025 systematic review of randomized controlled trials finds that medical cannabis may reduce orthopaedic pain compared to placebo, but the evidence is generally low quality and almost never tested against standard painkillers. Clinicians cannot yet rely on this data to guide prescribing, and patients should understand that “promising” does not mean “proven.”

Orthopaedic pain is one of the most common reasons patients seek medical cannabis certification, and musculoskeletal conditions represent an enormous share of opioid prescribing. As regulators, payers, and professional societies increasingly demand evidence-based justification for cannabis recommendations, the quality of the underlying data matters enormously. Clinicians need to know whether the growing patient interest in cannabinoid analgesia for arthritis, spinal pain, and post-surgical recovery is supported by trial-level evidence or is outrunning the science. This review addresses that question head-on.

The opioid crisis has driven urgent interest in non-opioid analgesic options, and medical cannabis is among the most frequently discussed alternatives. Cannabinoids interact with endocannabinoid and inflammatory pathways that are mechanistically relevant to musculoskeletal pain, providing biological plausibility for their use in conditions ranging from osteoarthritis and rheumatoid arthritis to degenerative disc disease and postsurgical recovery. This 2025 systematic review set out to evaluate the randomized controlled trial evidence specifically for orthopaedic pain by searching PubMed and Cochrane, restricting inclusion to RCTs, and applying both GRADE and Cochrane Risk of Bias assessments to the included studies.

The authors’ own conclusion is notably restrained: they describe the available high-quality evidence as minimal. Where positive analgesic effects were identified, they emerged almost exclusively in comparisons against placebo or no treatment, rather than against standard-of-care analgesics such as NSAIDs or opioids. The safety profile was characterized as mild-to-moderate adverse effects, a finding broadly consistent with the larger cannabinoid literature, but the review explicitly notes that long-term safety data remain insufficient. No meta-analysis was conducted, so pooled effect sizes and measures of statistical heterogeneity are unavailable. The authors call for more rigorous, adequately powered RCTs with active comparator arms, standardized dosing protocols, and longer follow-up periods before clinical guidelines can be meaningfully informed.

I appreciate the discipline of restricting this review to RCTs and applying formal quality grading. That is exactly the kind of rigor the cannabinoid literature needs, and it is telling that the authors themselves concluded the evidence is minimal. The gap between what patients experience in the clinic and what the trial data can confirm remains wide. Beating placebo is a necessary first step, not a finish line, and the near-total absence of head-to-head comparisons against NSAIDs or acetaminophen makes it impossible to say where cannabis actually fits in a pain management algorithm.

In practice, I see orthopaedic pain patients daily who have already failed or cannot tolerate conventional analgesics, and for those individuals, a carefully titrated cannabinoid trial is often reasonable. But I frame it honestly: we are working with clinical experience, mechanistic plausibility, and a favorable short-term safety profile, not with the kind of robust comparative data that would make this a first-line recommendation. I always pair cannabis with physical therapy, functional goals, and ongoing reassessment rather than treating it as a standalone solution.

This review sits at an informative but early point in the research arc for cannabinoid analgesia in orthopaedic settings. The broader chronic pain literature, including the 2018 Stockings et al. systematic review and the 2017 National Academies report, has consistently found moderate-quality evidence supporting cannabinoids for general chronic pain, but the orthopaedic subgroup has remained poorly characterized. This review confirms that gap rather than closing it. Clinicians should interpret the findings as confirming biological plausibility and early signal, not as sufficient evidence to position medical cannabis as a replacement for established orthopaedic analgesics.

From a pharmacological standpoint, clinicians considering cannabinoid adjuncts in orthopaedic patients should remain attentive to potential interactions with perioperative medications, anticoagulants, and centrally acting analgesics. THC-dominant products carry sedation and psychomotor risks relevant to post-surgical rehabilitation timelines, while CBD may affect CYP450-mediated drug metabolism. The most actionable takeaway from this review is not to prescribe differently today, but to document outcomes carefully in patients already using medical cannabis for orthopaedic pain, contributing to the practice-based evidence that formal trials have not yet provided.