Severe chronic pain and a Pennsylvania medical marijuana card
The pain entry was broadened in 2018
Pennsylvania's pain entry is not the same as it was when the Medical Marijuana Act first took effect. Effective May 17, 2018, the Department of Health broadened it, according to the Department's 2022 program report. The official wording now reads: "severe chronic or intractable pain of neuropathic origin or severe chronic or intractable pain."
Read it twice and the structure is clear. The first half covers pain that comes from nerve damage. The second half covers severe chronic or intractable pain whatever its origin. A patient whose pain is not neurological can still fit the entry, provided the physician agrees it is severe and chronic, or intractable.
What "severe," "chronic" and "intractable" suggest
The list does not define these words, and the certifying physician applies them. In ordinary medical usage, "chronic" describes pain that persists over a long period, and "intractable" generally describes pain that has not responded adequately to standard treatment. "Severe" speaks to how much the pain affects your life.
The practical lesson: occasional or mild pain is unlikely to be what the entry has in mind. Long-lasting pain that has resisted other treatments, and that shapes your daily routine, is closer to the language. Only the physician can decide whether your situation fits.
Keep a simple pain diary for a few weeks before the appointment: how bad the pain is, what you tried and what happened. It gives the physician something concrete to evaluate.
Records worth bringing
- Imaging, specialist notes or other records that document the source of the pain, if known.
- A list of treatments you have tried: physical therapy, injections, medications and anything else, with dates if you have them.
- Your current medications, including any opioids, so the physician can consider interactions.
- Notes on how the pain affects work, sleep and daily activities.
Who can certify you
Pennsylvania limits certification to MDs and DOs with an active state license who have registered with the Department of Health and finished its four-hour training. Nurse practitioners and physician assistants, who often handle day-to-day care in pain practices, cannot certify. A registered physician can also certify you through real-time audio or video under Act 44 of 2021, which matters if pain makes travel difficult. Our page on online evaluations explains how that works.
Need a physician certification?
Online evaluations are available for Pennsylvania residents. Code DRWDY85872 takes 5% off. The physician, not the booking service, decides whether you are certified.
Book my PA evaluation →Pain, opioids and two separate entries
Some people living with chronic pain also take opioids or have been treated for opioid use disorder. Pennsylvania lists opioid use disorder as a separate qualifying condition, with its own specific wording. If both apply to you, the physician can select both; a certification may list up to 10 conditions. Our opioid use disorder guide explains that entry, and the neuropathy guide covers the overlapping nerve-related entries.
Forms people with pain ask about
Pennsylvania's law allows pills, oils, tinctures, liquids, topical forms (gels, creams and ointments), forms for vaporization or nebulization, and flower for vaporization. Topicals are applied to the skin; pills and tinctures are taken by mouth; vaporized products are inhaled. Smoking is illegal, and dispensaries sell no edibles. Your physician can help you think about which form suits the kind of pain you have.
What research says
Chronic pain has drawn a large share of the research on medical cannabis, and the findings are not settled. Some studies suggest that cannabis may provide modest relief for certain kinds of chronic pain in some people, while others find little or no benefit. Side effects such as drowsiness or dizziness are possible. A registered physician can weigh this evidence against your own history; no general finding guarantees an individual result.
Safety and work
Medical marijuana can impair alertness. Pennsylvania has long applied zero-tolerance DUI rules to marijuana, so check current law and do not drive after using it. If you work, your employer may not fire you solely for being certified, but it may restrict certain duties while you are under the influence. Our page on medical marijuana and your job explains those limits. Tell every prescriber you see that you are certified.
Your next steps
- Check that your situation plausibly fits the pain entry on the qualifying conditions list.
- Gather records and start a pain diary.
- Create your registry account with a Pennsylvania driver's license or state ID showing your current address.
- Book a certification with a registered physician, in person or by audio or video.
- Pay the $50 annual fee within 60 days, or $0 if you are enrolled in Medicaid, CHIP, PACE/PACENET, SNAP or WIC. The cost guide lists every fee.
Questions people ask
Does my pain have to be nerve pain to qualify?
No. The entry, broadened effective May 17, 2018, covers severe chronic or intractable pain of neuropathic origin or severe chronic or intractable pain, so it is not limited to nerve pain.
Can my pain management nurse practitioner certify me?
No. Only MDs and DOs registered with the Pennsylvania Department of Health can certify patients. Nurse practitioners and physician assistants cannot.
Are topical products allowed?
Yes. The Medical Marijuana Act lists topical forms, including gels, creams and ointments, among the forms dispensaries may sell.
Worth reading next
Sources
This page explains Pennsylvania law and Department of Health guidance in general terms; it is not medical or legal advice, and only a registered physician can certify a patient.