Skip to content

Patients › General-Health

Cannabis and CBD for Pain

PDF Evidence

What the evidence does and doesn't show for cannabis and CBD in musculoskeletal pain, and practical and safety considerations.

Updated Sep 202614 citations
A cannabis leaf.
Cannabis and CBD are increasingly asked about for musculoskeletal pain; the evidence and regulations are still evolving. Kieran Hirpara 4.0

What it is

Cannabis-based medicine covers products made from the cannabis plant, including cannabidiol (CBD) and THC. CBD is one part of the plant that does not cause a "high". THC is the part that does. These products come as oils, tablets or creams you can take by mouth or rub on the skin.

People with long-term pain from arthritis, nerve pain, or pain after surgery sometimes ask about these products. Many patients are curious. In one survey, 80.9% of people seeing a hand and upper-limb clinic said they would consider using medical cannabis [1]. Among people with spine pain, one in three were already using it [2]. Large numbers of people with wear-and-tear arthritis at the base of the thumb said they would be interested in trying it [3].

How it works is still being worked out. Your body has its own system that responds to the active parts of cannabis. CBD and THC act on that system, which is thought to affect how you feel pain. Some doctor's see a place for CBD in managing pain after keyhole shoulder surgery and long-term pain [4]. Early work on CBD taken under the tongue after keyhole rotator cuff (shoulder tendon) repair found it showed significant promise in reducing pain in the first days after surgery [5].

The picture is mixed, though. For nerve pain caused by traumatic brachial plexus injuries (stretching or tearing of the nerve network between the neck and arm), trials found no clinically important benefit when cannabis-based treatment was added to standard drug therapy [6]. A synthetic form of THC did not appear to limit opioid intake after knee replacement surgery [7]. Current evidence does show efficacy and safety for chronic musculoskeletal and neuropathic pain [8], but more research is needed before firm advice can be given for many conditions.

Does it work?

The honest answer is that it depends on the condition. For long-term muscle, joint and nerve pain, current evidence shows cannabinoids can work and are safe [1]. Reviews also point to a possible role for cannabis-based medicines in peripheral neuropathy, which is pain from nerves outside the brain and spinal cord [2]. But for many hand and arm conditions, the research has not caught up yet, so firm conclusions cannot be drawn [1].

Some findings are encouraging. CBD can be included in a combined pain plan after keyhole rotator cuff repair without harming the result [3], and without long-term harm either [4]. For teenagers and young adults having keyhole hip surgery, marijuana use before the operation did not change their pain levels, painkiller needs, or how well they recovered [5]. They showed marked improvement after surgery whether or not they had used it [5].

Other findings are less clear. Teenagers who reported using marijuana before ACL (knee ligament) reconstruction were more likely to need an overnight stay in hospital for pain and took longer to return to sport [6]. And a study looking at cannabis and nicotine use together after upper limb fracture surgery found no clear added risk, though the study may simply have been too small to detect one [7].

So the picture is genuinely mixed. Some evidence supports cannabis-based medicines for chronic pain conditions. Some shows no effect. Some raises questions in younger patients. If you are considering these products, talk it through with your doctor, who can weigh the evidence for your specific condition.

What are the risks?

The honest answer is that the research on safety is still patchy, and it depends on which product you use and why. Here is what the evidence does and does not show.

For CBD taken under the tongue after keyhole shoulder tendon repair, studies found an acceptable safety profile [1]. It could be used as part of a combined pain plan without harming the result of surgery [2], and without long-term harm either [3]. That is the clearest safety signal we have, and it comes from one type of surgery and one way of taking it.

For cannabis-based medicines generally, current evidence shows they can work and are safe for long-term muscle, joint and nerve pain [4]. But that finding comes with a caveat: firm conclusions for many hand and arm conditions need more research [4]. Reviews also point to a possible role in peripheral neuropathy, which is pain from nerves outside the brain and spinal cord [5].

Some findings raise questions rather than reassurance. Teenagers who reported using marijuana before ACL (knee ligament) reconstruction were more likely to need an overnight stay in hospital for pain, and took longer to return to sport [6]. For cannabis and nicotine used together after upper limb fracture surgery, one study found no clear added risk, but it may simply have been too small to detect one [7]. And for nerve pain from traumatic brachial plexus injuries (stretching or tearing of the nerve network between the neck and arm), trials found no clinically important benefit when cannabis-based treatment was added to standard drug therapy [8].

For teenagers and young adults having keyhole hip surgery, marijuana use before the operation did not change pain levels, painkiller needs, or recovery [9].

The overall picture is mixed. If you are considering these products, talk it through with your doctor, who can weigh the evidence for your specific condition.

Is it right for you?

There is no simple test for this. The evidence points to some groups where these products may have a place, and others where they probably do not.

If you have long-term muscle, joint or nerve pain, current evidence shows cannabis-based medicines can work and are safe [1]. Reviews also point to a possible role for pain from nerves outside the brain and spinal cord [2]. If you are having keyhole shoulder tendon repair, CBD taken under the tongue has been studied in the first days after surgery and showed significant promise in reducing pain [3], with an acceptable safety profile [3].

Some situations argue against it. If you have nerve pain from a traumatic brachial plexus injury (stretching or tearing of the nerve network between the neck and arm), trials found no clinically important benefit when cannabis-based treatment was added to standard drug therapy [4]. If you are having knee replacement surgery, a synthetic form of THC did not appear to limit opioid (strong painkiller) intake [5]. If you are a teenager facing ACL (knee ligament) reconstruction, reported marijuana use before the operation was linked to a longer hospital stay for pain and a slower return to sport [6].

Compared with standard pain medicines, these products are not a replacement. They are best thought of as one option your doctor might add to a plan that already includes other treatments.

This should be a shared decision with your doctor. They know your condition, your other medicines and your health history, and can weigh the evidence for you specifically.

The bottom line

Cannabis-based medicines may have a place in your pain plan, but it depends on your condition. For long-term muscle, joint and nerve pain, the evidence shows they can work and are safe [1]. Reviews also point to a possible role for pain from nerves outside the brain and spinal cord [2]. For many hand and arm conditions, though, the research has not caught up yet [1]. So go in with realistic expectations: these products are one option to consider, not a proven fix for everything. The most important caveat is that the evidence is mixed, so talk it through with your doctor before trying anything.

Reviewed by Kieran Hirpara · 13 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

References
  1. Hand Surgery Patient Perspectives on Medical Cannabis: A Survey of Over 600 Patients. *Journal of Hand Surgery Global Online*. 2023. 10.1016/j.jhsg.2022.02.009
  2. Perceptions in orthopedic surgery on the use of cannabis in treating pain: a survey of patients with spine pain (POSIT Spine). *Journal of Orthopaedic Surgery and Research*. 2024. 10.1186/s13018-024-04558-6
  3. Assessment of Medical Cannabis in Patients With Osteoarthritis of the Thumb Basal Joint. *The Journal of Hand Surgery*. 2023. 10.1016/j.jhsa.2021.10.018
  4. Poster 373: Perceptions & Opinions on Cannabidiol Among Sports Medicine Orthopaedic Surgeons. *Orthopaedic Journal of Sports Medicine*. 2023. 10.1177/2325967123s00336
  5. Effects Of Cannabidiol On Post-Operative Pain Following Arthroscopic Rotator Cuff Repair. *Journal of Shoulder and Elbow Surgery*. 2023. 10.1016/j.jse.2023.02.032
  6. CORR Insights®: Does Cannabis-based Medicine Improve Pain and Sleep Quality in Patients With Traumatic Brachial Plexus Injuries? A Triple-blind, Crossover, Randomized Controlled Trial. *Clinical Orthopaedics & Related Research*. 2024. 10.1097/corr.0000000000003265
  7. A Synthetic Form of Cannabinoid Does Not Decrease Opioid Use After Total Knee Arthroplasty: A Prospective, Randomized, Triple-Blind, Placebo-Controlled Study. *The Journal of Arthroplasty*. 2026. 10.1016/j.arth.2026.02.047
  8. Medical Cannabis in Hand Surgery: A Review of the Current Evidence. *The Journal of Hand Surgery*. 2023. 10.1016/j.jhsa.2022.11.008
  9. The Use of Cannabinoids in the Treatment of Peripheral Neuropathy and Neuropathic Pain: A Systematic Review. *The Journal of Hand Surgery*. 2025. 10.1016/j.jhsa.2024.09.015
  10. Cannabidiol for Postoperative Pain Control After Arthroscopic Rotator Cuff Repair Demonstrates No Deficits in Patient-Reported Outcomes Versus Placebo: 1-Year Follow-up of a Randomized Controlled Trial. *Orthopaedic Journal of Sports Medicine*. 2024. 10.1177/23259671231222265
  11. Poster 186: Cannabidiol for Post-Operative Pain Control after Arthroscopic Rotator Cuff Repair Demonstrates No Functional Deficits at 1-Year. *Orthopaedic Journal of Sports Medicine*. 2023. 10.1177/2325967123s00172
  12. No Evidence That Preoperative Marijuana Use Influences the Success of Hip Arthroscopy for Femoracetabular Impingement in Adolescents and Young Adults. *Orthopaedic Journal of Sports Medicine*. 2025. 10.1177/23259671251385152
  13. Effect of Marijuana Use on Pain Management and Return to Sport After Anterior Cruciate Ligament Reconstruction in Pediatric and Adolescent Patients: A Matched Control Study. *Orthopaedic Journal of Sports Medicine*. 2025. 10.1177/23259671251369015
  14. Cannabis and nicotine use are independently associated with adverse surgical, medical, and psychosocial outcomes following upper extremity fracture fixation. *Journal of Orthopaedic Surgery and Research*. 2026. 10.1186/s13018-025-06635-w
Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Cannabidiol (CBD) can be considered in a postoperative multimodal pain management regimen without detrimental effects on patient-reported outcomes at 1-year follow-up after arthroscopic rotator cuff repair [1].
  • CBD can be considered in a postoperative multimodal pain management regimen without long-term functional deficits at 1-year follow-up after arthroscopic rotator cuff repair [2].
  • Cannabis-based medicines are applicable for the treatment of peripheral neuropathy and neuropathic pain [3].
  • 89% of participants in a survey of musculoskeletal pain patients considered medical cannabis to be more effective than narcotics for adequate pain management [4].
  • Regular cannabis use may be associated with increased opioid usage in the context of total joint arthroplasty [5].
  • No specific guidance for the use of cannabis in perioperative pain management can be suggested based on the association between regular cannabis use and increased opioid usage after total joint arthroplasty [5].
  • Patients estimated that medical cannabis could treat more than half of their spine pain [6].
  • One in three patients with spine pain were already using medical cannabis [6].
  • 79% of patients with spine pain believe cannabis could reduce opioid usage [6].
  • Most survey respondents in the orthopaedic sports medicine community believed that CBD has a role in postoperative and chronic pain management [7].
  • Large numbers of patients with osteoarthritis of the thumb basal joint would be interested in trialing either oral or topical formulations of medical cannabis for treatment of their pain [8].
  • 80.9% of patients presenting for hand and upper-extremity complaints would consider using medical cannabis [9].
  • Patients presenting for hand and upper-extremity complaints perceive medical cannabis as a safe treatment option for common orthopedic conditions [9].
  • Cost is identified as a major barrier to the use of medical cannabis by patients presenting for hand and upper-extremity complaints [9].
  • A synthetic form of THC does not appear to limit opioid intake after primary total knee arthroplasty [10].
  • Current evidence demonstrates efficacy and safety for chronic musculoskeletal and neuropathic pain [19].
  • Definitive conclusions regarding the efficacy of medical cannabis in hand and upper extremity conditions require continued investigation [19].

How It Works

  • Cannabidiol (CBD) can be considered in a postoperative multimodal pain management regimen without long-term functional deficits at 1-year follow-up after arthroscopic rotator cuff repair [2].
  • 89% of participants considered medical cannabis to be more effective than narcotics for adequate pain management [4].
  • No specific guidance in the use of cannabis in perioperative pain management can be suggested based on the association between regular cannabis use and increased opioid usage after total joint arthroplasty [5].
  • Cannabis-based medicine did not provide clinical improvement in pain compared with a placebo in patients with traumatic brachial plexus injuries [11].
  • A majority of sports medicine surgeons believe that CBD has a role in post-operative and chronic pain management [12].
  • More clinical research for cannabinoids is needed to help orthopaedic traumatologists provide guidance for patients seeking advice for this therapeutic [13].
  • Patients with documented cannabis dependence demonstrated higher odds of developing wound complications following hand and wrist soft-tissue surgical procedures [16].

What the Evidence Shows

Postoperative Pain Management

  • CBD can be considered in a post-operative multimodal pain management regimen without long-term functional deficits at 1-year follow-up after arthroscopic rotator cuff repair [2].
  • Buccally absorbed CBD demonstrates an acceptable safety profile and shows significant promise in reducing pain in the immediate peri-operative period following arthroscopic rotator cuff repair compared to control [17].
  • Cannabis use does not affect outcomes after total hip arthroplasty [14].
  • Further studies are warranted to determine the efficacy and safety of perioperative cannabis use after total hip arthroplasty to help guide orthopaedic surgeons in counseling patients [14].
  • Higher-level studies are needed to ascertain the impact of cannabis use for patients undergoing total joint arthroplasty [15].

Neuropathic Pain

  • Cannabis-based treatment did not provide clinically important benefit as an adjuvant to standard multimodal drug therapy for neuropathic pain in traumatic brachial plexus injuries [18].
  • Findings suggest the applicability of cannabis-based medicines for peripheral neuropathy [3].

Patient and Surgeon Perceptions

  • Patients estimated medical cannabis could treat more than half of their spine pain [6].

Practical Considerations

Postoperative Pain Management

  • CBD can be considered in a postoperative multimodal pain management regimen without detrimental effects on outcome [1].
  • CBD can be considered in a post-operative multimodal pain management regimen without long-term detrimental effects [2].

Patient and Provider Perceptions

  • Large numbers of patients with osteoarthritis of the thumb basal joint would be interested in trialing either oral or topical formulations of medical cannabis for treatment of their thumb basal joint pain [8].

Clinical Guidance and Research Needs

  • No specific guidance in the use of cannabis in perioperative pain management can be suggested based on the association between regular cannabis use and increased opioid usage in total joint arthroplasty [5].
  • More clinical research for cannabinoids is needed to help orthopaedic traumatologists provide guidance for patients seeking advice [13].

Key Evidence

  • [L2] These findings suggest that CBD can be considered in a postoperative multimodal pain management regimen without detrimental effects on outcome. [1] (10.1177/23259671231222265)
  • [L2] These findings suggest that CBD can be considered in a post-operative multimodal pain management regimen without long-term detrimental effects. [2] (10.1177/2325967123s00172)
  • [L2] These findings suggest the applicability of cannabis-based medicines for peripheral neuropathy. [3] (10.1016/j.jhsa.2024.09.015)
  • [L4] In addition, 89% of the participants considered medical cannabis to be more effective than narcotics for adequate pain management. [4] (10.5435/jaaosglobal-d-22-00055)
  • [Paper] Regular cannabis use may be associated with increased opioid usage in the context of total joint arthroplasty, and no specific guidance in the use of cannabis in perioperative pain management can be suggested based on this discovery. [5] (10.1097/corr.0000000000003472)
  • [L4] Patients estimated medical cannabis could treat more than half of their spine pain, with one in three patients already using medical cannabis, and 79% of patients believe cannabis could reduce opioid usage. [6] (10.1186/s13018-024-04558-6)
  • [L4] Most survey respondents believed that CBD has a role in postoperative and chronic pain management. [7] (10.1177/23259671231191766)
  • [L4] Large numbers of these patients would be interested in trialing either oral or topical formulations of medical cannabis for treatment of their thumb basal joint pain. [8] (10.1016/j.jhsa.2021.10.018)
  • [L3] Most patients presenting for hand and upper-extremity complaints would consider using medical cannabis (80.9%) and perceive it as a safe treatment option for common orthopedic conditions, with cost identified as a major barrier to use. [9] (10.1016/j.jhsg.2022.02.009)
  • [L1] Despite enthusiasm for cannabis after orthopaedic surgical procedures, this THC does not appear to limit opioid intake after primary TKA. [10] (10.1016/j.arth.2026.02.047)
  • [L1] Cannabis-based medicine did not provide clinical improvement in pain compared with a placebo in patients with traumatic brachial plexus injuries. [11] (10.1097/corr.0000000000003221)
  • [L4] A majority of sports medicine surgeons believe that CBD has a role in post-operative and chronic pain management. [12] (10.1177/2325967123s00336)
  • [L4] More clinical research for cannabinoids is needed to help orthopaedic traumatologists provide guidance for patients seeking advice for this recently popular therapeutic. [13] (10.5435/jaaosglobal-d-21-00047)
  • [L3] Further studies are warranted to determine the efficacy and safety of perioperative cannabis use after THA to help guide orthopaedic surgeons in counseling patients. [14] (10.1016/j.arth.2023.03.040)
  • [L1] Higher-level studies are needed to ascertain the impact of cannabis use for patients undergoing TJA. [15] (10.1016/j.arth.2023.07.008)
  • [L2] Patients with documented cannabis dependence demonstrated higher odds of developing wound complications following hand and wrist soft-tissue surgical procedures. [16] (10.1016/j.jhsg.2026.100948)
  • [L1] Buccally absorbed CBD demonstrates an acceptable safety profile and shows significant promise in reduction of pain in the immediate peri-operative period following ARCR compared to the control. [17] (10.1016/j.jse.2023.02.032)
  • [Paper] This is a commentary on a randomized controlled trial by Kittithamvongs et al., which found no clinically important benefit to cannabis-based treatment as an adjuvant to standard multimodal drug therapy for neuropathic pain in traumatic brachial plexus injuries. [18] (10.1097/corr.0000000000003265)
  • [L4] Current evidence demonstrates efficacy and safety for chronic musculoskeletal and neuropathic pain, but definitive conclusions regarding efficacy in hand and upper extremity conditions require continued investigation. [19] (10.1016/j.jhsa.2022.11.008)

References

[1] Cannabidiol for Postoperative Pain Control After Arthroscopic Rotator Cuff Repair Demonstrates No Deficits in Patient-Reported Outcomes Versus Placebo: 1-Year Follow-up of a Randomized Controlled Trial. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/23259671231222265

[2] Poster 186: Cannabidiol for Post-Operative Pain Control after Arthroscopic Rotator Cuff Repair Demonstrates No Functional Deficits at 1-Year. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/2325967123s00172

[3] The Use of Cannabinoids in the Treatment of Peripheral Neuropathy and Neuropathic Pain: A Systematic Review. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.09.015

[4] Patient Experience and Perspective on Medical Cannabis as an Alternative for Musculoskeletal Pain Management. JAAOS: Global Research and Reviews. 2022. DOI: 10.5435/jaaosglobal-d-22-00055

[5] CORR Insights®: Do Medical and Recreational Marijuana State Laws Impact Trends in Postoperative Opioid Prescriptions Among Patients Who Have Undergone TJA?. Clinical Orthopaedics & Related Research. 2025. DOI: 10.1097/corr.0000000000003472

[6] Perceptions in orthopedic surgery on the use of cannabis in treating pain: a survey of patients with spine pain (POSIT Spine). Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-04558-6

[7] Perceptions and Opinions on Cannabidiol in the Orthopaedic Sports Medicine Community. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/23259671231191766

[8] Assessment of Medical Cannabis in Patients With Osteoarthritis of the Thumb Basal Joint. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2021.10.018

[9] Hand Surgery Patient Perspectives on Medical Cannabis: A Survey of Over 600 Patients. Journal of Hand Surgery Global Online. 2023. DOI: 10.1016/j.jhsg.2022.02.009

[10] A Synthetic Form of Cannabinoid Does Not Decrease Opioid Use After Total Knee Arthroplasty: A Prospective, Randomized, Triple-Blind, Placebo-Controlled Study. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.02.047

[11] Does Cannabis-based Medicine Improve Pain and Sleep Quality in Patients With Traumatic Brachial Plexus Injuries? A Triple-blind, Crossover, Randomized Controlled Trial. Clinical Orthopaedics & Related Research. 2024. DOI: 10.1097/corr.0000000000003221

[12] Poster 373: Perceptions & Opinions on Cannabidiol Among Sports Medicine Orthopaedic Surgeons. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/2325967123s00336

[13] Knowledge and Opinion on Cannabinoids Among Orthopaedic Traumatologists. JAAOS: Global Research and Reviews. 2021. DOI: 10.5435/jaaosglobal-d-21-00047

[14] Cannabis Use Does Not Affect Outcomes After Total Hip Arthroplasty. The Journal of Arthroplasty. 2023. DOI: 10.1016/j.arth.2023.03.040

[15] Cannabis Use Following Total Joint Arthroplasty is Associated With Increased Risks? A Meta-Analysis. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.07.008

[16] Is Cannabis Dependence Associated with Postoperative Infections in Hand and Wrist Surgeries?. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.100948

[17] Effects Of Cannabidiol On Post-Operative Pain Following Arthroscopic Rotator Cuff Repair. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.02.032

[18] CORR Insights®: Does Cannabis-based Medicine Improve Pain and Sleep Quality in Patients With Traumatic Brachial Plexus Injuries? A Triple-blind, Crossover, Randomized Controlled Trial. Clinical Orthopaedics & Related Research. 2024. DOI: 10.1097/corr.0000000000003265

[19] Medical Cannabis in Hand Surgery: A Review of the Current Evidence. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2022.11.008

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.