Pain Management Articles
Chronic pain is complex and can affect sleep, mood, mobility, relationships and daily activities. Good pain care starts with a careful assessment and usually combines education, physical activity or rehabilitation, psychological support and medication when appropriate. Treatment should be individualized and reviewed regularly for benefit and harm.
Medical Cannabis for Chronic Pain
Cannabis is not a cure for chronic pain and is not usually a first-line treatment. Evidence suggests that cannabinoids may provide a modest reduction in pain for some carefully selected adults, particularly with certain neuropathic pain conditions, when established treatments have not provided enough benefit or have caused unacceptable side effects. Many people obtain little or no meaningful benefit.
Possible risks
THC-containing products can cause sleepiness, dizziness, impaired attention and memory, anxiety, panic, changes in mood, faster heart rate and impaired driving. Regular use can lead to cannabis use disorder. Risk may be higher with high-THC products, frequent use, a personal or family history of psychosis, significant heart disease, pregnancy or breastfeeding, and in younger people.
A monitored treatment trial
If cannabis is considered, discuss other medications, mental-health history, substance-use history, pregnancy plans and driving requirements with a clinician. Treatment should begin cautiously, use the lowest practical THC exposure and have clear goals such as improved sleep or function. Stop or reconsider treatment when meaningful benefit is not achieved or harms outweigh benefits.
Health Canada: Information for health care professionals | Health Canada: Health effects of cannabis
Neuropathic Pain and Ketamine
Neuropathic pain results from disease or injury affecting the nerves or the nervous system. It may feel burning, electric, shooting, stabbing or like pins and needles. Light touch may be painful, and numbness can occur. Causes include diabetes, shingles, nerve injury, some spinal conditions and certain medical treatments.
Assessment and treatment
Evaluation may include a review of symptoms, medications and medical conditions; a neurological and musculoskeletal examination; and selected tests when needed. Treatment can include activity and rehabilitation, sleep and mood support, treatment of the underlying cause, and medications chosen according to the patient's health, symptoms and preferences.
Where ketamine may fit
Ketamine is not a routine first-line treatment for neuropathic pain. Specialist-supervised ketamine may be considered for selected people with severe, treatment-resistant pain. Research suggests possible short-term relief for some patients, but long-term benefit and the best dosing strategy remain uncertain.
Possible adverse effects include sedation, dizziness, nausea, increased blood pressure or heart rate, unusual perceptions, anxiety, confusion and dissociation. Repeated exposure may also affect the bladder or liver, and ketamine has misuse potential. Appropriate screening, monitoring and follow-up are essential.
Chronic Migraine and Botox
Chronic migraine generally involves headache on 15 or more days each month for more than three months, with migraine features on at least eight days per month. Symptoms may include throbbing or one-sided pain, nausea, sensitivity to light or sound, and worsening with routine activity. Other disorders and medication-overuse headache should be considered during assessment.
Botox preventive treatment
OnabotulinumtoxinA (Botox) is a preventive treatment for adults with chronic migraine; it does not treat an attack that is already underway. A trained clinician gives small injections at specific sites around the head and neck, commonly on a schedule of about every 12 weeks. A headache diary can help measure changes in headache days, severity, medication use and function. More than one treatment cycle may be needed to assess benefit.
Possible side effects
Side effects may include injection-site discomfort, neck pain, stiffness, headache, temporary eyelid or eyebrow droop and localized muscle weakness. Seek urgent medical attention for trouble swallowing, speaking or breathing, or for widespread weakness.
Spinal Stenosis
Spinal stenosis is narrowing of the space available for the spinal cord or nerve roots. It most often develops from age-related changes in the neck or lower back. Lumbar stenosis may cause back or leg pain, numbness, heaviness or weakness when standing or walking, with relief when sitting or leaning forward. Cervical stenosis can cause neck or arm symptoms, hand clumsiness, balance problems or weakness.
Diagnosis and treatment
Diagnosis is based on symptoms and examination, with imaging used when it will help guide care. Initial treatment may include staying active within tolerance, physiotherapy, exercise, activity modification and carefully selected medication. Injections may help selected patients for a limited period. A surgical opinion may be appropriate when symptoms remain disabling despite conservative care or when neurological problems are significant or progressing.
HealthLink BC: Lumbar spinal stenosis | HealthLink BC: Cervical spinal stenosis
Patient-education content was developed and reviewed by Dr. Mohammed Al Haidari, MD, CCFP, CCFP-AM, Addiction Medicine Fellowship, University of Manitoba, MSc Pain Medicine USC, Graduate Certificate in Pain Medicine USC and Graduate Certificate in Cannabis Science McMaster; Assistant Clinical Professor (Adjunct), McMaster University; Lecturer, Max Rady College of Medicine at the University of Manitoba.
Page reviewed: September 16, 2026.