A large-scale phase 3 clinical trial has demonstrated that VER-01, a standardized full-spectrum cannabis extract, provides clinically meaningful pain relief for adults with chronic low back pain while improving sleep quality and physical function. The study, published in Nature Medicine, represents what researchers call "high level evidence" for cannabis-based pain treatment after years of mixed results from lower-quality studies.
Trial Design and Patient Population
The randomized controlled trial enrolled 820 adults across 66 sites in Germany and Austria. Participants were randomized to receive either VER-01 (n=394) or placebo (n=426) in a 12-week double-blind phase, followed by a 6-month open-label extension, and then either a 6-month continuation or randomized withdrawal phase.
At baseline, patients reported moderate-to-severe pain with an average numeric rating scale (NRS) score of around 6, and over 22% had a neuropathic pain component. The study design allowed researchers to evaluate both immediate efficacy and long-term sustainability of treatment effects.
Primary Efficacy Results
VER-01 met its primary endpoint in the initial phase, reducing mean pain by 1.9 NRS points versus 1.4 for placebo, representing a statistically significant mean difference of −0.6 points (95% CI −0.9 to −0.3; P<0.001). For patients with neuropathic pain components, the effect was more pronounced, with an additional reduction of −1.5 points.
More than half (54%) of VER-01 participants achieved at least a 30% reduction in pain compared to 40% in the placebo group, while 32% reached a 50% reduction versus 23% in placebo. By the end of the open-label phase, pain decreased by nearly 3 points from baseline, with benefits maintained through 12 months.
Secondary Outcomes and Functional Improvements
The benefits extended beyond pain reduction. Sleep quality scores improved significantly (−2.2 versus −1.5 NRS points, P<0.001), and physical function measured by the Roland Morris Disability Questionnaire also favored VER-01 (−3.1 versus −2.0 points, P<0.001). Over 45% of patients reported meaningful global improvement, double the placebo rate.
Rescue medication use was nearly halved in the VER-01 group, with participants averaging 10.5 ibuprofen tablets compared to 18.3 for placebo, suggesting reduced reliance on conventional analgesics.
Safety Profile and Tolerability
Safety data showed VER-01 was generally well-tolerated despite a higher incidence of adverse events compared to placebo (83% versus 67%). Most adverse events were mild to moderate and transient, with dizziness, fatigue, nausea, dry mouth, and somnolence being the most frequent. Serious adverse event rates were comparable between groups (6.2% vs 6.8%).
Importantly, researchers found no signs of dependence, abuse, or withdrawal symptoms during abrupt discontinuation in the randomized withdrawal phase, addressing key concerns about cannabis-based therapeutics.
Clinical Significance and Expert Perspectives
Dr. Jan Vollert, Lecturer in Neuroscience at the University of Exeter, described the study as "excellent" and noted that "the pain relief was clinically significant and would be meaningful to the many people living with chronic pain out there." He emphasized the importance of the double-blind design, noting that pain relief was much higher in the open-label phase, demonstrating "why well-conducted, double-blind trials are so important."
Prof David Nutt from Imperial College London called it "an elegant study" that confirms what researchers have been suggesting based on previous initiatives. He noted that the research "helps encourage a more rational approach to medical cannabis prescribing" and highlighted evidence that medical cannabis can help people reduce use of harmful painkillers like opiates.
Therapeutic Positioning
With a number needed to treat for benefit (NNTB) of 6.8 for a 30% pain reduction, VER-01 performed more favorably than opioids in similar trials. Researchers positioned VER-01 as a potential nonaddictive alternative to NSAIDs and opioids, which carry significant risks in long-term chronic low back pain treatment.
The standardized formulation of VER-01—characterized for cannabinoids, terpenes, flavonoids, and other compounds—ensures consistency often lacking in cannabis-based products. Vollert emphasized that "this is a very specific substance, provided in a controlled manner" and cautioned that the results are "in no way comparable to smoking cannabis."
Future Research Directions
While researchers noted that the randomized withdrawal phase was not significant, suggesting the need for additional studies to determine if the main outcomes can be sustained, the trial represents a significant step forward in cannabis-based pain research. The study provides the high-level evidence that researchers have long argued is necessary for cannabis-based substances in pain management.
