Cochrane review: nabiximols probably reduces MS spasticity, but pain evidence is uncertain
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?Would longer-term studies show sustained spasticity benefits?
- ?How do different cannabis formulations compare for MS symptoms?
- ?What patient characteristics predict response?
Trust & Context
- Key Stat:
- 216 more per 1,000 report spasticity benefit with nabiximols vs placebo
- Evidence Grade:
- Cochrane review using GRADE methodology. Spasticity evidence rated moderate certainty; pain evidence very low certainty.
- Study Age:
- Published in 2022 with studies searched through December 2021.
- Original Title:
- Cannabis and cannabinoids for symptomatic treatment for people with multiple sclerosis.
- Published In:
- The Cochrane database of systematic reviews, 5(5), CD013444 (2022)
- Authors:
- Filippini, Graziella, Minozzi, Silvia, Borrelli, Francesca(2), Cinquini, Michela, Dwan, Kerry
- Database ID:
- RTHC-03841
Evidence Hierarchy
Analyzes all available research on a topic using a structured method.
What do these levels mean? →Frequently Asked 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.
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Cite This Study
https://rethinkthc.com/research/RTHC-03841APA
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
MLA
Filippini, Graziella, et al. "Cannabis and cannabinoids for symptomatic treatment for people with multiple sclerosis.." The Cochrane database of systematic reviews, 2022. https://doi.org/10.1002/14651858.CD013444.pub2
RethinkTHC
RethinkTHC Research Database. "Cannabis and cannabinoids for symptomatic treatment for peop..." RTHC-03841. Retrieved from https://rethinkthc.com/research/filippini-2022-cannabis-and-cannabinoids-for
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.