Navigating Musculoskeletal Pain: The Role of Medical Cannabis

Exploring non-surgical and non-opioid approaches in musculoskeletal pain management opens new pathways for patient-centered care, as endorsed by major clinical guidelines that prioritize conservative, multimodal strategies.

Emphasizing treatments that prioritize efficacy and patient outcomes, medical cannabis and diagnostic imaging emerge as prominent and debated components—but guidelines continue to foreground exercise, self-management, and appropriate pharmacologic care as first-line options. Are these strategies living up to their promises, or are there hidden complexities?

The therapeutic potential of medical cannabis in musculoskeletal pain management is supported by mixed-quality evidence and appears modest and patient-specific rather than broadly superior to traditional modalities. The trend towards non-opioid treatments highlights an evolving need to balance efficacy and patient preference, yet challenges such as inconsistency in patient experiences persist. In most guideline frameworks, first-line care emphasizes a multimodal, biopsychosocial approach—exercise therapy, self-management support, cognitive-behavioral strategies, and NSAIDs or topical agents—while cannabis, where legal, is generally considered an adjunct after these measures have been tried.

For patients who experience fluctuating relief, the cannabis approach warrants closer scrutiny, with notable discontinuation due to side effects or limited benefit. Continuing this thread, high discontinuation rates in medical cannabis underscore major barriers in long-term pain management strategies. Reflecting this uncertainty, major guidelines remain cautious about routine cannabis use for chronic musculoskeletal pain, generally positioning it as an adjunct only after established first-line options have been tried.

These trade-offs reinforce a central theme: align patient preferences with evidence strength and guideline-concordant care.

Key Takeaways:

• Guidelines prioritize conservative, multimodal care for musculoskeletal pain and osteoarthritis, including exercise therapy, self-management, NSAIDs or topical agents, and behavioral strategies such as CBT.
• Medical cannabis may help some patients as an adjunct after first-line measures, but evidence is mixed and discontinuation due to side effects or limited benefit is common.