Two high-quality systematic reviews concluded that nabiximols, oral cannabis extract, and synthetic THC are probably effective for reducing patient-reported spasticity and central pain in multiple sclerosis.
MS patients, neurologists, medical cannabis prescribers.
20-40 mg of THC daily in divided doses was the effective range in most clinical trials for MS symptoms.
What the researchers found
Nabiximols (Sativex), oral cannabis extract (OCE), and synthetic THC are probably effective for patient-reported spasticity and central pain in MS. However, OCE and synthetic THC did not reduce physician-measured spasticity scores. Cannabinoids were generally well-tolerated, though risks include psychosis in at-risk individuals and cardiovascular events.
Why it matters
MS patients frequently deal with spasticity and pain that are difficult to control with conventional medications. This review provides the strongest available evidence base for using cannabinoids as a treatment option for these symptoms.
The numbers in context
Most study participants used 20-40 mg of THC daily in divided doses. Cannabinoids were the only complementary/alternative medicine intervention with strong evidence in MS. Adverse events were more common with cannabinoids but serious adverse events were rare.
How the study worked
Review synthesizing findings from two recent high-quality systematic reviews of cannabinoid use in MS, with discussion of available formulations and dosing.
What this study cannot tell us
Patient-reported spasticity improvements did not match physician-measured scores, raising questions about the nature of the benefit. Optimal dosing remains uncertain. Long-term safety data is limited.
How to read the evidence
Strong - based on two high-quality systematic reviews of clinical trials, the highest level of evidence available.
When this study was published
Published in 2018.
The bigger picture
MS was one of the first neurological conditions to generate high-quality cannabinoid research. The evidence here represents a model for how cannabinoid therapies can be rigorously evaluated and has influenced medical cannabis policies worldwide.
Questions still open
- Why do patient-reported and physician-measured spasticity outcomes differ? What is the optimal THC:CBD ratio for MS symptoms? Could lower doses be equally effective with fewer side effects?
Common questions
Does cannabis help with MS symptoms?
What form of cannabis works best for MS?
Read the original research
Cannabinoids for Treatment of MS Symptoms: State of the Evidence.
Current neurology and neuroscience reports, 18(8), 50
Citation
Rice, Jessica; Cameron, Michelle. (2018). Cannabinoids for Treatment of MS Symptoms: State of the Evidence.. Current neurology and neuroscience reports, 18(8), 50. https://doi.org/10.1007/s11910-018-0859-x
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