Neither THC, CBD, nor their combination was superior to placebo for treating neuropathic pain or spasticity in patients with multiple sclerosis or spinal cord injury.
Neurologists, pain specialists, MS patients, and policymakers evaluating cannabis medicine evidence.
No significant differencebetween THC, CBD, THC+CBD, or placebo for pain or spasticity in MS and spinal cord injury patients
What the researchers found
In a four-arm parallel trial of 134 patients, no significant difference was found between THC, CBD, THC+CBD, or placebo for pain intensity, spasticity, patient global impression of change, or quality of life.
Why it matters
Despite widespread belief in cannabis for pain and spasticity, this rigorous trial found no benefit, challenging assumptions about cannabis-based medicine for these conditions.
The numbers in context
134 patients randomized (119 MS, 15 SCI). THC (max 22.5 mg/day), CBD (max 45 mg/day), THC+CBD (max 22.5/45 mg/day), or placebo for 6 weeks. Target was 448 patients but COVID-19 limited recruitment.
How the study worked
Multicenter, randomized, double-blinded, placebo-controlled trial in Denmark with four arms (THC, CBD, THC+CBD, placebo). Six-week treatment followed by one-week phaseout.
Who was studied
134 patients with multiple sclerosis (n=119) or spinal cord injury (n=15) with neuropathic pain (>3 NRS) and/or spasticity in Denmark.
What this study cannot tell us
Significantly underpowered — enrolled 134 of planned 448 patients due to COVID-19 and recruitment challenges. Small SCI subgroup (n=15). Maximum doses may have been insufficient.
How to read the evidence
Randomized, double-blind, placebo-controlled trial but significantly underpowered (134 of 448 planned participants).
When this study was published
Conducted February 2019 to December 2021, affected by COVID-19 recruitment limitations.
The bigger picture
This null result adds to growing evidence questioning the efficacy of cannabis-based medicines for pain and spasticity, though the underpowered design means the question remains open.
Replication
Underpowered trial; adequately powered replication needed.
Funding
Not specified in abstract
Conflicts of interest
Not specified in abstract
Questions still open
- Would higher doses or longer treatment duration yield different results?
- Was the trial too underpowered to detect a real but modest effect?
Read the original research
Cannabis-Based Medicine for Neuropathic Pain and Spasticity-A Multicenter, Randomized, Double-Blinded, Placebo-Controlled Trial.
Pharmaceuticals (Basel, Switzerland), 16(8)
Citation
Hansen, Julie Schjødtz; Gustavsen, Stefan; Roshanisefat, Homayoun; Kant, Matthias; Biering-Sørensen, Fin; Andersen, Claus; Olsson, Anna; Chow, Helene Højsgaard; Asgari, Nasrin; Hansen, Julie Richter; Nielsen, Helle Hvilsted; Hansen, Rikke Middelhede; Petersen, Thor; Oturai, Annette Bang; Sellebjerg, Finn; Sædder, Eva Aggerholm; Kasch, Helge; Rasmussen, Peter Vestergaard; Finnerup, Nanna Brix; Svendsen, Kristina Bacher. (2023). Cannabis-Based Medicine for Neuropathic Pain and Spasticity-A Multicenter, Randomized, Double-Blinded, Placebo-Controlled Trial.. Pharmaceuticals (Basel, Switzerland), 16(8). https://doi.org/10.3390/ph16081079