Research study · Biomedicines · 2026
Long-Term Inhaled Cannabis Therapy for Chronic Low Back Pain: A Five-Year Retrospective Analysis of Prospectively Collected Patient-Reported Outcomes in 241 Treatment-Refractory Patients
Verified on PubMed Oxford CEBM Level 1B: Randomized Controlled Trial
A 2026 randomized controlled trial in Biomedicines tested cannabis in low back pain. The study found that pain and daily function improved over the five years, and many people stopped taking their stronger prescription medicines. This study shows that people with hard-to-treat back pain who used smoked medical cannabis often reported lasting improvement and were.
In plain language
Study overview
This study followed 241 adults with long-standing lower back pain that had not improved with usual treatments such as prescription painkillers, nerve medicines, antidepressants, anti-inflammatory tablets and physiotherapy. Each person started a medical cannabis treatment that was mostly smoked, and their progress was tracked once a year for five years.
Findings
The study found that pain and daily function improved over the five years, and many people stopped taking their stronger prescription medicines. The study had no comparison group that did not receive cannabis, so it cannot prove the cannabis caused these changes.
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The deeper readScientific analysis
Background/Objectives: Chronic low back pain (CLBP) affects approximately 20% of the global population and is a leading cause of years lived with disability. Long-term, real-world evidence for inhaled cannabis in patients refractory to conventional multimodal therapy remains scarce. We assessed the five-year efficacy and safety of inhaled cannabis in CLBP patients who had documented failure of at least 1 year of opioid analgesics, anticonvulsants, antidepressants, NSAIDs, and physiotherapy, with each patient serving as their own historical control. Methods: We analyzed prospectively collected clinical data from 241 consecutive adults with treatment-refractory CLBP (mean age 49.3 years; 37.8% female; mean pain duration 15.1 years) initiated on inhaled medical cannabis (predominantly smoking, THC 4-22%, CBD 2-22%) in a single-center tertiary orthopedic clinic between 2020 and 2025 (Hasharon Hospital, Rabin Medical Center, Israel). Year-0 outcomes were compared with outcomes at Years 1-5 on cannabis. Primary outcomes were the Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), and Brief Pain Inventory severity/interference. The primary analysis was a mixed model for repeated measures with multiple imputation for missing data. Results: Of 241 patients, 238 (98.8%) provided Year-5 data and 224 (92.9%) remained on cannabis at Year 5; only five patients (2.1%) discontinued for adverse events or inefficacy. All four primary PROMs improved markedly and durably (NRS -5.36; ODI -17.68; BPI severity -6.73; BPI interference -3.41; all p < 10^-20). Concomitant opioid use fell from 100% to 4.6% at Year 5. Across 1205 patient-years of cannabis exposure, 99.8% of adverse events were mild. BioWell gas-discharge-visualization parameters discriminated pain only at chance level. Conclusions: In this observational cohort, inhaled cannabis was associated with large, sustained improvements in pain, disability and pain interference, with near-total displacement of opioids, NSAIDs, antidepressants and gabapentinoids. These associations cannot be interpreted causally without a concurrent randomized control arm.
The paper
Citation
Robinson D, Khatib M, Lavon E, Kafri N, Rashed WA, Murad H, et al. Long-Term Inhaled Cannabis Therapy for Chronic Low Back Pain: A Five-Year Retrospective Analysis of Prospectively Collected Patient-Reported Outcomes in 241 Treatment-Refractory Patients. Biomedicines (2026). PubMed 42351683 · DOI
Limitations the authors noted
Single-arm observational design without a concurrent control arm; causal inference not possible. Regression to the mean and expectancy/self-selection effects cannot be excluded. Open-label, self-titrated therapy with unblinded patient-reported outcomes. Single center and single prescriber in Israel; limited generalizability. Predominantly smoked route (~91%); findings not transferable to vaporized or oral products. Telemedicine-related Year-3 attrition addressed by MAR-based imputation. Excluded opioid-naive and non-refractory populations; no data beyond five years.
In practice
Why this matters
This study shows that people with hard-to-treat back pain who used smoked medical cannabis often reported lasting improvement and were able to stop several older medicines over five years. It cannot prove that cannabis itself caused those changes, because everyone knew they were getting the treatment and there was no group for comparison. It leaves open whether the results apply to other forms of cannabis, other doses, other patients, or treatment beyond five years.
Frequently asked questions
Clinical Questions & Answers
What were the primary clinical findings regarding cannabinoids and Pain?
The study found that pain and daily function improved over the five years, and many people stopped taking their stronger prescription medicines. The study had no comparison group that did not receive cannabis, so it cannot prove the cannabis caused these changes.
What study limitations or clinical safeguards should patients keep in mind?
Single-arm observational design without a concurrent control arm; causal inference not possible. Regression to the mean and expectancy/self-selection effects cannot be excluded. Open-label, self-titrated therapy with unblinded patient-reported outcomes.
Browse related research
Condition: Inflammation Condition: Low back pain Condition: Pain Topic: Cannabis Topic: Medical cannabis Topic: Smoked cannabis
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Reviewed by Dr. Caplan on October 19, 2026.
This page is general education about a published study. It is not medical advice and does not create a doctor-patient relationship. For care specific to you, book a consultation.
