Practical aspects of using cannabis in the treatment of chronic pain and the current situation in Poland: a narrative review

Effective pain management remains one of the most significant challenges in modern medicine, especially in patients with chronic pain and in older adults. Pain is not limited to somatic sensations, but also affects mental, social, and even spiritual functioning (total pain) by disrupting sleep, lowering mood, and intensifying anxiety symptoms. In the long term, this leads to the perpetuation of symptoms and a deterioration in response to standard pharmacological treatment. Epidemiological data indicate that clinically significant pain intensity affects a large proportion of the general population, and its prevalence increases significantly with age. The limitations of classic analgesics, including insufficient efficacy, side effects, and the risk of interactions with other medications, are prompting the search for adjunctive therapies. In this context, phytocannabinoids, which have analgesic and anxiolytic properties and improve sleep quality, are attracting increasing interest. Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) have the widest clinical application, while the role of secondary cannabinoids, such as cannabigerol (CBG), remains the subject of intensive research. This narrative review aims to discuss the basic principles of rational implementation and selection of phytocannabinoids for the treatment of patients with chronic pain, taking into account the chemotype of cannabis and the individual patient’s needs. The main therapeutic indications, the potential place of cannabinoids on the WHO analgesic ladder as adjuvant analgesics, and practical aspects of their use, including various routes of administration (particularly vaporization and oil extracts), are presented.