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Cannabis for Pain Management in Rheumatology

Joanna Zeiger, PhD, & Kaleb Michaud, PhD  |  Issue: March 2025  |  March 7, 2025

3. Delivery Methods:

     • Oral Administration (e.g., capsules, oils): Offers a slower onset but longer duration of action, making it a preferred method for chronic pain. Effects may take 1–2 hours to appear and last 4–8 hours.

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     • Topical Application: Some patients may benefit from CBD/THC creams or gels applied directly to painful areas, which may avoid systemic side effects.

Specific Protocols

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     • Titration Schedule: Increase the dose by 1–2 mg of THC (or equivalent CBD if using a combined product) every 2–3 days until desired effects are achieved or side effects appear.

     • Maximum Doses: Although there is no universally accepted maximum, many guidelines suggest a ceiling of 20–40 mg of THC daily for chronic pain, with higher doses monitored closely for adverse effects.

Source: Canadian Rheumatology Association Position Statement on Medical Cannabis Use in Rheumatic Disease.

A Path Forward

As cannabis continues to gain acceptance, it holds the potential to become an adjunctive treatment for rheumatology patients struggling with pain and inflammation. However, to incorporate it safely and effectively, our field needs enhanced knowledge and evidence-based guidelines. The survey findings underscore that although some providers are comfortable discussing and recommending cannabis, a significant number remain uncertain or skeptical.

The future of cannabis in rheumatology hinges on high-quality research that can address these uncertainties, provide insights into long-term safety and explore interactions with conventional treatments. Until then, we are encouraged to approach cannabis with an evidence-informed perspective, focusing on patient-centered guidance that maximizes benefits while minimizing risks. By staying informed and fostering open communication with patients, rheumatology providers can contribute to a growing body of knowledge that may one day position cannabis as a respected and regulated option within the standard toolkit for managing RMDs.

In this evolving landscape, cannabis education and research will enable us to confidently support our patients’ pain management needs, helping us navigate the complexities of cannabis with greater clarity and understanding.


Joanna Zeiger, MS, PhD, works as a cannabis epidemiologist, one of the few in the U.S. She is the founder and CEO of Canna Research Foundation, a nonprofit organization whose goal is to understand the role of cannabis patterns of use and benefits/adverse effects in various populations to better understand the efficacy and safety of medical cannabis. She is also chief scientific officer and the epidemiologist and biostatistician Clinika Research, a CRO that focuses on health outcomes, pharmacokinetic studies and plant-based medicine, including cannabis.

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Filed under:ConditionsDrug UpdatesPain SyndromesPatient Perspective Tagged with:Editor's PickJoanna ZeigerKaleb MichaudPhD

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