Cannabinoids for MS Spasticity: Objective Measures Say No, Patients Say Yes
Randomized trials failed to show objective improvement in MS spasticity with cannabinoids, but patients consistently reported significant subjective improvement in spasticity, spasms, sleep, and pain.
Quick Facts
What This Study Found
A structured critical appraisal examined whether cannabinoids improve MS-related spasticity.
The largest randomized placebo-controlled trial of oral cannabinoid therapy found no improvement on the Ashworth scale (an objective spasticity measure). However, patients reported significant improvement in spasticity (p=0.01), spasms (p=0.038), sleep quality (p=0.025), and pain (p=0.002) without worsening depression, fatigue, irritability, or walking.
A second RCT confirmed the same disconnect between objective and subjective outcomes.
The authors concluded that this raises important questions about whether current objective instruments are sensitive or valid enough to capture the clinical benefits patients experience.
Key Numbers
Ashworth scale: no significant improvement. Subjective spasticity: p=0.01. Spasms: p=0.038. Sleep: p=0.025. Pain: p=0.002. No worsening of depression, fatigue, irritability, or walk time.
How They Did This
Critically appraised topic developed by neurologists, epidemiologists, and MS specialists. Structured literature search and critical appraisal of the best available randomized controlled trial evidence.
Why This Research Matters
The consistent disconnect between what objective scales measure and what patients experience suggests a measurement problem rather than a drug problem, with implications for how clinical trials should evaluate cannabis-based medicines.
The Bigger Picture
This finding has been replicated across multiple cannabis-MS studies and contributed to regulatory decisions. Sativex was eventually approved for MS spasticity in multiple countries, with approval partly based on patient-reported outcomes.
What This Study Doesn't Tell Us
Limited number of high-quality RCTs available. The Ashworth scale is known to have inter-rater variability. Subjective improvement could be influenced by psychoactive effects rather than true spasticity reduction.
Questions This Raises
- ?Should patient-reported outcomes carry more weight in spasticity trials?
- ?Do current objective measures miss clinically meaningful changes?
- ?Are the subjective benefits from direct spasticity improvement or from other effects (pain relief, sleep improvement)?
Trust & Context
- Key Stat:
- No objective improvement, but significant patient-reported benefits for spasticity, spasms, sleep, and pain
- Evidence Grade:
- Critical appraisal of existing RCT evidence by a multidisciplinary team. Quality limited by the available trial data.
- Study Age:
- Published in 2009. Sativex has since been approved for MS spasticity in multiple countries, and more sensitive outcome measures have been developed.
- Original Title:
- Do cannabinoids reduce multiple sclerosis-related spasticity?
- Published In:
- The neurologist, 15(6), 369-71 (2009)
- Authors:
- Thaera, Greg M, Wellik, Kay E, Carter, Jonathan L, Demaerschalk, Bart M, Wingerchuk, Dean M
- Database ID:
- RTHC-00393
Evidence Hierarchy
Summarizes existing research on a topic.
What do these levels mean? →Frequently Asked Questions
Why would patients feel better if clinical measures do not improve?
The Ashworth scale measures muscle resistance during passive movement, which may not capture all aspects of spasticity that affect daily life. Pain, spasms, and sleep disruption all contribute to the lived experience of spasticity and may improve independently of what the Ashworth scale measures.
Does this mean cannabinoids work for MS spasticity or not?
Patients consistently report benefit, but objective clinical scales do not show significant changes. This may reflect limitations of the scales rather than ineffectiveness of the drug. Regulatory agencies in multiple countries have found the evidence sufficient for approval.
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Cite This Study
https://rethinkthc.com/research/RTHC-00393APA
Thaera, Greg M; Wellik, Kay E; Carter, Jonathan L; Demaerschalk, Bart M; Wingerchuk, Dean M. (2009). Do cannabinoids reduce multiple sclerosis-related spasticity?. The neurologist, 15(6), 369-71. https://doi.org/10.1097/NRL.0b013e3181bf5572
MLA
Thaera, Greg M, et al. "Do cannabinoids reduce multiple sclerosis-related spasticity?." The neurologist, 2009. https://doi.org/10.1097/NRL.0b013e3181bf5572
RethinkTHC
RethinkTHC Research Database. "Do cannabinoids reduce multiple sclerosis-related spasticity..." RTHC-00393. Retrieved from https://rethinkthc.com/research/thaera-2009-do-cannabinoids-reduce-multiple
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.