Cochrane review: nabiximols probably reduces MS spasticity, but pain evidence is uncertain | Research

The takeaway

A Cochrane review of 25 trials found moderate-certainty evidence that nabiximols (THC:CBD spray) probably reduces spasticity in multiple sclerosis, but evidence for chronic neuropathic pain remains very uncertain.

MS patients, neurologists, and healthcare policymakers evaluating cannabis-based treatments.

216 more per 1,000 report spasticity benefit with nabiximols vs placebo

What the researchers found

Nabiximols probably increases the number of people reporting significant spasticity reduction (OR 2.51, moderate certainty). For pain, only one small trial was available (very low certainty). Cannabinoids probably increase self-reported health improvement (OR 1.80, moderate certainty) but may slightly increase treatment discontinuation due to adverse events, nervous system disorders, and psychiatric disorders.

Why it matters

This is the gold-standard Cochrane review on cannabinoids for MS symptoms, providing the most authoritative evidence summary available for clinical decision-making.

The numbers in context

25 RCTs, 3,763 participants (2,290 received cannabinoids). 50-88% female. Spasticity: OR 2.51, 216 more per 1,000 benefiting. Treatment discontinuation: OR 2.41, 39 more per 1,000 stopping. Health improvement: OR 1.80, 113 more per 1,000 reporting benefit.

How the study worked

Cochrane systematic review of 25 RCTs (3,763 participants) comparing nabiximols, synthetic cannabinoids, oral THC extract, or inhaled cannabis against placebo. Searched databases through December 2021. Evidence quality assessed using GRADE.

What this study cannot tell us

Most evidence was from nabiximols studies. Only limited data on other formulations. Short study durations (3-48 weeks). Pain evidence came from just one small trial.

How to read the evidence

Cochrane review using GRADE methodology. Spasticity evidence rated moderate certainty; pain evidence very low certainty.

When this study was published

Published in 2022 with studies searched through December 2021.

The bigger picture

While cannabinoids show moderate benefit for spasticity and patient-reported improvement, the trade-off includes increased nervous system and psychiatric side effects, requiring careful risk-benefit assessment.

Questions still open

Would longer-term studies show sustained spasticity benefits? How do different cannabis formulations compare for MS symptoms? What patient characteristics predict response?

Common questions

Does cannabis help MS spasticity?

Moderate-certainty evidence suggests nabiximols (a THC:CBD mouth spray) probably helps, with about 216 more people per 1,000 reporting significant spasticity improvement compared to placebo.

What about pain in MS?

Evidence for chronic neuropathic pain was very uncertain, based on only one small trial of 48 participants. More research is needed before conclusions can be drawn.

Read the original research

Cannabis and cannabinoids for symptomatic treatment for people with multiple sclerosis.

The Cochrane database of systematic reviews, 5(5), CD013444

View on PubMed ↗Publisher’s paper ↗

Citation

Filippini, Graziella; Minozzi, Silvia; Borrelli, Francesca; Cinquini, Michela; Dwan, Kerry. (2022). Cannabis and cannabinoids for symptomatic treatment for people with multiple sclerosis.. The Cochrane database of systematic reviews, 5(5), CD013444. https://doi.org/10.1002/14651858.CD013444.pub2