According to the accompanying survey conducted by the Federal Institute for Drugs and Medical Devices (BfArM), 76.4% of all documented cannabis prescriptions are for patients with chronic pain, which includes nerve pain. There is a growing body of scientific evidence that medical cannabis can be an effective treatment option for nerve pain in some patients—especially when conventional treatments are not sufficiently effective or are not well tolerated.
Both cannabis flowers and cannabis extracts have been studied in several clinical trials in recent years and have been shown to significantly relieve pain and associated symptoms in some patients. This raises not only the question of whether cannabis helps with nerve pain, but also what scientific findings underpin the various cannabis-based medications.
This article provides background information, summarizes the current state of research, and outlines the new legal situation in Germany. It clearly explains the key studies and identifies which patients may be candidates for cannabis therapy for nerve pain.
What is nerve pain?
Nerve pain—medically known as neuropathic pain—is caused by damage to or a malfunction of the nervous system. Unlike typical pain, it is not triggered by tissue injury, but rather by misdirected pain signals from the nerves themselves. Those affected often report:
- Burning or stabbing pain
- Tingling and numbness
- Pain attacks that feel like electric shocks
- Hypersensitivity to touch or cold
The most common causes include:
- Diabetes mellitus (diabetic polyneuropathy)
- Herniated Discs
- Multiple Sclerosis
- Shingles (Post-herpetic Neuralgia)
- Nerve damage following injuries or surgeries
- Chemotherapy-Induced Polyneuropathies
Chronic nerve pain significantly limits the daily lives of many people affected by it and is often difficult to manage. For this reason, intensive research has been conducted for years to determine what role cannabis can play in treating nerve pain as part of modern treatment approaches.
Why is nerve pain often difficult to treat?
The treatment of neuropathic pain differs fundamentally from the treatment of traditional forms of pain. Conventional pain relievers such as ibuprofen or acetaminophen often have only a minimal effect. Instead, antidepressants, anticonvulsants, or—in certain cases—opioids are usually used. However, even these medications do not relieve symptoms in all patients and can be associated with side effects, some of which are significant. For this reason, national and international guidelines recommend cannabis therapy as a possible treatment option when established therapies have been exhausted or are not tolerated. Whether medical cannabis can be used effectively for nerve pain, however, always depends on the individual’s situation and the underlying condition.
Good to know:
How does medical cannabis work for nerve pain?
Medical cannabis contains various cannabinoids, most notably THC (tetrahydrocannabinol) and CBD (cannabidiol). These act through the body’s endocannabinoid system, which is involved, among other things, in the processing of pain signals.
Possible effects?
Inhibition of pain signal transmission Reduction in pain perception Relief from muscle tension Improved sleep Enhanced quality of life for those with chronic pain
Important: The effects vary from person to person and depend, among other factors, on the underlying condition, the dosage, and the ratio of THC to CBD.
What is the current state of research on cannabis for nerve pain?
In recent years, various cannabis-based medications have been studied for neuropathic pain—ranging from medical cannabis flowers to standardized cannabis extracts and preparations containing THC and CBD. Although the studies vary in terms of the number of participants, dosage form, and study design, they often yield similar results: Some patients report significant pain relief, particularly when previous treatments have not produced the desired results.
Cannabis Flowers: Positive Results Even at Low THC Dosages
1One of the first clinical studies was the 2008 study by Wilsey et al. In this randomized, double-blind, placebo-controlled crossover study involving 38 patients, both cannabis containing 3.5% THC and cannabis containing 7% THC resulted in significant pain relief compared to placebo. At the same time, typical symptoms of neuropathic pain—including burning, stabbing, and deep-seated pain—improved. Of particular interest: even the lower THC dose achieved treatment success comparable to that of the higher concentration.
Five years later, the same research group confirmed these findings. In a study published in 20132 , 39 patients with treatment-resistant neuropathic pain received vaporized cannabis containing 1.29% or 3.53% THC, or a placebo. A clinically relevant reduction in pain of at least 30% was achieved by 57% and 61% of the patients receiving cannabis, respectively—compared to 26% of those receiving the placebo. Here, too, both THC dosages proved to be similarly effective.
Conclusion of the studies: Even low-dose inhaled cannabis can effectively relieve neuropathic pain in some patients.
Cannabis Extracts: The Largest Clinical Study to Date
While early studies focused primarily on cannabis flowers, standardized cannabis extracts later became the focus of research. The largest study to date was conducted by Karst et al. and was published in 20253 in the journal *Nature Medicine *. A total of 820 patients with chronic back pain participated, including 180 patients with a confirmed neuropathic pain component. This patient group in particular benefited significantly from the full-spectrum extract studied: neuropathic pain symptoms decreased significantly more than with a placebo. At the same time, typical symptoms such as burning, deep-seated, or touch-induced nerve pain, as well as paresthesia, improved.
Positive study results are also available for nabiximols, a standardized THC/CBD oral spray. Lynch et al. conducted a study in 20144 a total of 18 patients with chemotherapy-induced neuropathic pain. About one-third of the participants achieved a clinically significant reduction in pain of at least two points on the pain scale. In these patients, pain intensity decreased by an average of 2.6 points, compared with a decrease of only 0.6 points in the placebo group.
Conclusions from the studies: Standardized cannabis extracts are currently among the most thoroughly studied cannabis-based medications for neuropathic pain and show promising results, particularly in selected patients.
CBD and Oral Cannabinoids: Not Every Study Reaches the Same Conclusion
In addition to THC-containing cannabis-based medications, the therapeutic benefits of CBD have also been studied. In 2020, Xu et al. published a randomized, double-blind, placebo-controlled study5 involving 29 patients to evaluate a CBD-containing oil for peripheral nerve pain. After just four weeks, overall pain intensity as well as typical symptoms such as stabbing nerve pain, sensitivity to cold, and neuropathic itching decreased significantly. At the same time, the preparation was very well tolerated, and no relevant side effects occurred.
However, not all studies were able to confirm these results. In 2023, Zubcevic et al. conducted a randomized, placebo-controlled study6 THC, CBD, and a combination of both cannabinoids in 115 patients with peripheral neuropathic pain. Although individual patients—particularly those receiving the THC/CBD combination—reported significant improvements, overall the treatment did not demonstrate a statistically significant advantage over placebo. At the same time, the study showed that the oral treatment was well tolerated and neither impaired cognitive function nor worsened existing symptoms of anxiety or depression.
Conclusions from the studies: CBD and oral cannabinoids show therapeutic potential. However, the results to date are less conclusive than those for inhaled cannabis flowers or standardized cannabis extracts.
Synthetic cannabinoids provide additional clues
Not all of the cannabinoids studied are derived directly from the cannabis plant. In 2015, Turcotte et al. investigated nabilone, a synthetically produced THC-like compound, as an adjunct to gabapentin7 in 15 patients with multiple sclerosis and neuropathic pain. The combination resulted in significantly greater pain relief than a placebo; furthermore, all treated patients reported an improvement in their symptoms.
However, the results can only be applied to medical cannabis to a limited extent. Nabilone is a synthetic cannabinoid and differs in composition from cannabis flowers or cannabis extracts.
What do reviews say?
Individual studies provide important insights. However, systematic reviews—in which the results of many studies are analyzed collectively—are even more informative.
The most comprehensive analysis to date comes from the Cochrane review by Ateş et al., which was published in 20268. It evaluated 21 randomized trials involving a total of 2,187 patients. The authors found evidence that THC/CBD-containing cannabis medications may alleviate pain and improve the subjective treatment experience in some patients. At the same time, they rated the overall quality of the available evidence as low to very low. Reasons for this include small sample sizes, varying study designs, and different cannabis formulations.
classification
Taken together, the studies suggest that medical cannabis may be an effective treatment option for selected patients with nerve pain. At the same time, further research is needed to evaluate the benefits of individual cannabis-based medications more precisely and to tailor treatment more specifically to different patient groups in the future.
Who might be a candidate for medical cannabis to treat nerve pain?
Medical cannabis is generally not considered the first-line treatment for neuropathic pain. Guidelines recommend its use primarily when established treatments are not sufficiently effective or cannot be continued due to side effects. There is no one-size-fits-all answer as to which cannabis therapy is appropriate. Rather, studies show that different cannabis-based medications—ranging from cannabis flowers to cannabis extracts to THC/CBD combination products—can be effective to varying degrees depending on the clinical presentation and the individual patient, but they are definitely effective. For this reason, the specific product, dosage, and form of administration should always be determined on an individual basis by a physician and reviewed regularly.
The Relevance of the Statutory Health Insurance Premium Stabilization Act for Cannabis Patients
On July 10, 2026, the federal government passed the new Statutory Health Insurance Premium Rate Stabilization Act to limit expenditures under the statutory health insurance system (GKV). Until now, individuals with statutory health insurance could, under the conditions set forth in Section 31(6) of Book V of the Social Code (SGB V), obtain medical cannabis flowers, cannabis extracts, and dronabinol at the expense of the GKV through an application process, provided that the respective eligibility requirements were met. With the new law, these reimbursement options are now significantly restricted. The original draft bill already provided for limiting coverage for medical cannabis flowers. During the parliamentary process, the regulation was tightened further: In the future, cannabis extracts and dronabinol may generally be prescribed at the expense of the GKV only after a six-month trial of treatment with an approved cannabis-based finished pharmaceutical product has been completed.
However, it is important to note: Doctors can still prescribe medical cannabis. The main change will be in how costs are covered by statutory health insurance—if coverage is not provided, treatment can still be prescribed on a private basis.
Conclusion
Current research indicates that medical cannabis can be an effective treatment option for some people with neuropathic pain—especially when conventional treatments are not sufficiently effective or are not well tolerated. At the same time, a striking contradiction has emerged: While clinical studies are increasingly demonstrating the potential benefits of cannabis for nerve pain, many people with public health insurance will no longer have the costs of medical cannabis flowers covered in the future. Ironically, this could make a treatment that can provide significant relief for some patients much harder to access.
While medical cannabis is not a cure-all, it can be a viable treatment option following a thorough medical evaluation—provided that cost is not a barrier to access.
FAQ
Yes, several clinical studies show that medical cannabis can relieve pain in some patients with nerve pain. In particular, some studies indicate that people with chronic or treatment-resistant neuropathic pain benefit from a noticeable reduction in pain. However, the effects vary from person to person, and medical cannabis does not replace established treatments.
There is no one-size-fits-all recommendation. Studies show positive results for medical cannabis flowers, cannabis extracts, and THC/CBD-containing medications alike. The appropriate cannabis therapy depends on the underlying condition, the symptoms, and the individual treatment goals.
Yes. Medically prescribed cannabis extracts—often referred to as cannabis drops—are among the most thoroughly studied forms of administration. Several studies show that they can effectively relieve neuropathic pain in some patients.
The current body of research suggests that CBD may alleviate certain neuropathic symptoms. However, the scientific evidence for CBD alone is currently less robust than that for THC-containing or combined THC/CBD formulations. Further studies are needed.
Yes, depending on the cause of the polyneuropathy, medical cannabis may be a treatment option. Clinical studies have examined, among others, patients with diabetic polyneuropathy, chemotherapy-induced nerve damage, and other forms of neuropathic pain. Whether this treatment is appropriate should always be determined on a case-by-case basis by a doctor.
Under certain conditions, statutory health insurance plans may cover the costs of medical cannabis. However, the proposed Statutory Health Insurance Premium Rate Stabilization Act calls for changes to the reimbursement of cannabis-based medications (effective June 2026). The final regulations will be determined by the ongoing legislative process.
- Wilsey BL, Marcotte T, Tsodikov A, Millman J, Bentley H, Gouaux B, Fishman S. A Randomized, Placebo-Controlled, Crossover Trial of Cannabis Cigarettes in Neuropathic Pain. The Journal of Pain. 2008;9(6):506–521. doi:10.1016/j.jpain.2007.12.010. ↩︎
- Wilsey B, Marcotte T, Deutsch R, Gouaux B, Sakai S, Donaghe H. Low-Dose Vaporized Cannabis Significantly Improves Neuropathic Pain. The Journal of Pain. 2013;14(2):136–148. doi:10.1016/j.jpain.2012.10.009. ↩︎
- Karst M, Meissner W, Sator S, Keßler J, Schoder V, Häuser W. Full-spectrum extract from Cannabis sativa DKJ127 for chronic low back pain: a phase 3 randomized placebo-controlled trial. Nature Medicine. 2025;31(12):4189–4196. doi:10.1038/s41591-025-03977-0. ↩︎
- Lynch ME, Cesar-Rittenberg P, Hohmann AG. A Double-Blind, Placebo-Controlled, Crossover Pilot Trial With Extension Using an Oral Mucosal Cannabinoid Extract for the Treatment of Chemotherapy-Induced Neuropathic Pain. J Pain Symptom Manage. 2014;47(1):166–173. doi:10.1016/j.jpainsymman.2013.02.018. ↩︎
- Xu DH, Cullen BD, Tang M, Fang Y. The Effectiveness of Topical Cannabidiol Oil in Relieving Symptoms of Peripheral Neuropathy of the Lower Extremities. Current Pharmaceutical Biotechnology. 2020;21(5):390–402. doi: 10.2174/1389201020666191202111534. ↩︎
- Zubcevic K, Petersen M, Bach FW, Heinesen A, Enggaard TP, Almdal TP, Holbech JV, Vase L, Jensen TS, Finnerup NB, Sindrup SH. Oral capsules of tetrahydrocannabinol (THC), cannabidiol (CBD), and their combination for the treatment of peripheral neuropathic pain. European Journal of Pain. 2023;27(4):492–506. doi:10.1002/ejp.2072. ↩︎
- Turcotte D, Doupe M, Torabi M, Gomori A, Ethans K, Esfahani F, et al. Nabilone as an Adjunct to Gabapentin for Multiple Sclerosis-Induced Neuropathic Pain: A Randomized Controlled Trial. Pain Medicine. 2015;16(1):149–159. doi:10.1111/pme.12612. ↩︎
- Ateş G, Welsch P, Klose P, Phillips T, Lambers B, Häuser W, Radbruch L. Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews. 2026;1. doi:10.1002/14651858.CD012182.pub3. ↩︎