CBD Improved Walking Speed in MS Patients but Did Not Reduce Spasticity | Research

The takeaway

A randomized trial in 49 MS patients found that 4 weeks of escalating CBD doses improved walking test times and reduced maximum pain, but did not significantly reduce spasticity.

MS patients and neurologists, spasticity treatment researchers, medical cannabis prescribers

CBD improved MS walking speed (p=0.031) without reducing spasticity itself

What the researchers found

CBD treatment (escalating from 5 to 80 mg/day over 4 weeks) significantly improved walking speed on the T25-FW test (p=0.031) and reduced maximum pain (p=0.033) compared to placebo, but did not significantly reduce spasticity severity at 4 or 8 weeks.

Why it matters

MS spasticity affects millions and current treatments have significant side effects. While CBD did not reduce spasticity per se, the functional improvement in walking speed is clinically meaningful.

The numbers in context

49 patients (24 CBD, 25 placebo). CBD escalated from 5 to 80 mg/day. T25-FW improvement: p=0.031. Maximum pain reduction: p=0.033. No significant spasticity reduction at 4 or 8 weeks.

How the study worked

Double-blind randomized controlled trial of 49 MS patients with spasticity-related walking difficulties, comparing escalating-dose sublingual pure CBD to placebo over 4 weeks at Ghaem Hospital, Iran.

What this study cannot tell us

Small sample size. Short 4-week treatment. Relatively low CBD doses. Single-center study in Iran. High dropout (9 of 49). Does not address long-term effects.

How to read the evidence

Double-blind RCT provides good internal validity, but small sample and short duration limit conclusions.

When this study was published

2025 RCT from Iran, the first of its kind in that country.

The bigger picture

The disconnect between spasticity scores and walking improvement suggests CBD may help MS patients through pathways other than direct spasticity reduction, possibly through pain reduction, anxiety relief, or other mechanisms.

Questions still open

Would higher CBD doses reduce spasticity directly? Why did walking improve without spasticity changes? How does pure CBD compare to THC/CBD combinations already approved for MS spasticity?

Common questions

Does CBD help with MS spasticity?

This trial found CBD did not directly reduce spasticity severity, but it did improve walking speed and reduce pain in MS patients with spasticity-related gait problems. The benefit may come through pain or other pathways rather than spasticity itself.

How much CBD was used in this MS study?

Patients started at 5 mg/day and escalated to 80 mg/day over 4 weeks. This is relatively low compared to some CBD studies, and higher doses might show different results.

Read the original research

A randomized trial on efficacy of purified cannabidiol on spasticity in multiple sclerosis patients with gait problems: first report in Iran.

Naunyn-Schmiedeberg's archives of pharmacology, 398(12), 17435-17444

View on PubMed ↗Publisher’s paper ↗

Citation

Mousavi, Pegah; Emadzadeh, Maryam; Karimikhoshnoudian, Bahar; Sahraian, Mohammad Ali; Ghaffari, Mehran; Shaygannejad, Vahid; Payere, Maryam; Baghaei, Ava; Zabeti, Aram; Nahayati, Mohammadali. (2025). A randomized trial on efficacy of purified cannabidiol on spasticity in multiple sclerosis patients with gait problems: first report in Iran.. Naunyn-Schmiedeberg's archives of pharmacology, 398(12), 17435-17444. https://doi.org/10.1007/s00210-025-04347-w