Chronic pain in older patients represents a significant medical challenge. A substantial portion of individuals over 65 suffer from it. Many of these chronic pain conditions cannot be fully eliminated with conventional analgesics, dramatically reducing quality of life.
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Adding to this problem is the fact that older adults often take multiple medications, creating an elevated risk of drug interactions with many pain relievers. Despite ongoing stigmatization of the plant, cannabis is increasingly gaining attention as an alternative with minimal side effects. A recently published German study investigated how CBD-rich cannabis extracts compare to dronabinol—or pure THC—in their ability to relieve chronic pain.
Data from Nearly 1,000 Cannabis Patients Analyzed
As part of the CARE study—a retrospective study based on data from the German pain registry—data from 968 patients were analyzed. All patients were at least 65 years old and had suffered from chronic pain for years. Patients were divided into two groups of 484 persons each. One group received an oral hemp extract with significantly more CBD than THC for treatment, while the other group received dronabinol, which is pharmacologically equivalent to pure THC. Pain data were recorded and analyzed for both groups over a 24-week period to evaluate the effectiveness of the different cannabis preparations.
The patients‘ pain severity at the start of treatment was significant: the VAS scale score was above 50 for all participants. Treatment was considered effective if pain decreased by at least 20 points on the VAS scale or decreased by 50% from baseline. The VAS scale is a point system where patients can rate their subjective pain intensity from 0 to 100. Another criterion for assessing effectiveness was that pain relief could be maintained consistently over 24 hours and sleep improved as well.
Hemp Extract as the Clear Winner
Both treatment methods led to improvement, with the CBD-rich hemp extract performing significantly better compared to dronabinol. While patients who received hemp extract achieved the required minimum level of pain relief in 85.7% of cases, this was only 21.9% in the dronabinol group. The two formulations also differed significantly in tolerability. Only 15.5% of patients who received hemp extract reported side effects. With dronabinol, however, it was 37.5%.
In the dronabinol group, 19.2% of patients discontinued therapy due to side effects, while among patients treated with hemp extract, it was only 5.6%. The most common side effects reported were dizziness, headaches, and muscle weakness. Regardless, it can be concluded that a full-spectrum extract is a significantly better choice than a single isolated cannabinoid like THC.
Discontinuation of Other Pain Medications
Not only were pain levels significantly reduced, but pain medications could also be partially discontinued through cannabis use. Within 12 weeks, 70.5% of patients who received hemp extract were able to discontinue at least one pain medication. In the dronabinol group, this was 38.2%. This effect intensified significantly by the end of the observation period. By week 24, 86.1% of patients who received hemp extract and 55.1% in the dronabinol group were able to completely discontinue at least one pain medication.
Since chronic pain significantly impairs quality of life, depression was widespread among patients. Through the use of cannabis preparations, antidepressant use could also be substantially reduced. After 24 weeks, 78.8% of the CBD group and 38.9% of the dronabinol group had stopped taking antidepressants. The study once again demonstrates that for maximum medical success, the complete package of active compounds should be used rather than an isolated cannabinoid.
Frequently Asked Questions about CBD Extract and Dronabinol
What is the difference between CBD extract and dronabinol?
CBD-rich cannabis extracts contain a broad spectrum of cannabinoids, terpenes, and other plant compounds (full-spectrum). Dronabinol, on the other hand, is a synthetically produced, isolated THC preparation without additional compounds. The CARE study shows that the interaction of all active compounds in the extract (entourage effect) produces significantly better results.
How effective is CBD extract for chronic pain?
According to the CARE study, 85.7% of patients who received CBD-rich cannabis extracts achieved the required minimum level of pain relief. For comparison: with dronabinol it was only 21.9%. Furthermore, 86.1% of the CBD group were able to completely discontinue at least one additional pain medication by week 24.
What is the CARE study?
The CARE study (Cannabis and Analgesic Reduction in the Elderly) is a retrospective German study based on the national pain registry. It analyzed data from 968 patients aged 65 and older over a 24-week period and compared the effectiveness of CBD-rich cannabis extracts with dronabinol in treating chronic pain.
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