CoChat
Sign Up
Cited by 75Cannabis and Cannabinoid ResearchMultiple Sclerosis Research StudiesBotulinum Toxin and Related Neurological Disorders

Cannabis and cannabinoids for symptomatic treatment for people with multiple sclerosis

Open access
Filippini, Graziella, Minozzi, Silvia, Borrelli, Francesca, Cinquini, Michela, Dwan, Kerry·2022·Cochrane Database Systematic Reviews
DOI 10.1002/14651858.cd013444.pub2PMC PMC9069991
Open this paper in CoChat — free account

Abstract

BACKGROUND: Spasticity and chronic neuropathic pain are common and serious symptoms in people with multiple sclerosis (MS). These symptoms increase with disease progression and lead to worsening disability, impaired activities of daily living and quality of life. Anti-spasticity medications and analgesics are of limited benefit or poorly tolerated. Cannabinoids may reduce spasticity and pain in people with MS. Demand for symptomatic treatment with cannabinoids is high. A thorough understanding of the current body of evidence regarding benefits and harms of these drugs is required. OBJECTIVES: To assess benefit and harms of cannabinoids, including synthetic, or herbal and plant-derived cannabinoids, for reducing symptoms for adults with MS. SEARCH METHODS: We searched the following databases from inception to December 2021: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library), CINAHL (EBSCO host), LILACS, the Physiotherapy Evidence Database (PEDro), the World Health Organisation International Clinical Trials Registry Platform, the US National Institutes of Health clinical trial register, the European Union Clinical Trials Register, the International Association for Cannabinoid Medicines databank. We hand searched citation lists of included studies and relevant reviews. SELECTION CRITERIA: We included randomised parallel or cross-over trials (RCTs) evaluating any cannabinoid (including herbal Cannabis, Cannabis flowers, plant-based cannabinoids, or synthetic cannabinoids) irrespective of dose, route, frequency, or duration of use for adults with MS. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methodology. To assess bias in included studies, we used the Cochrane Risk of bias 2 tool for parallel RCTs and crossover trials. We rated the certainty of evidence using the GRADE approach for the following outcomes: reduction of 30% in the spasticity Numeric Rating Scale, pain relief of 50% or greater in the Numeric Rating Scale-Pain Intensity, much or very much improvement in the Patient Global Impression of Change (PGIC), Health-Related Quality of Life (HRQoL), withdrawals due to adverse events (AEs) (tolerability), serious adverse events (SAEs), nervous system disorders, psychiatric disorders, physical dependence. MAIN RESULTS: = 0%; low-certainty evidence); • SAEs: cannabinoids may result in little to no difference in the number of participants who have SAEs compared with placebo (OR 1.38, 95% CI 0.96 to 1.99; 20 studies, 3124 participants; I² = 0%; low-certainty evidence); • AEs of the nervous system: cannabinoids may increase nervous system disorders compared with placebo (OR 2.61, 95% CI 1.53 to 4.44; 7 studies, 1154 participants; I² = 63%; low-certainty evidence); • Psychiatric disorders: cannabinoids may increase psychiatric disorders compared with placebo (OR 1.94, 95% CI 1.31 to 2.88; 6 studies, 1122 participants; I² = 0%; low-certainty evidence); • Drug tolerance: the evidence is very uncertain about the effect of cannabinoids on drug tolerance (OR 3.07, 95% CI 0.12 to 75.95; 2 studies, 458 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS: Compared with placebo, nabiximols probably reduces the severity of spasticity in the short-term in people with MS. We are uncertain about the effect on chronic neurological pain and health-related quality of life. Cannabinoids may increase slightly treatment discontinuation due to AEs, nervous system and psychiatric disorders compared with placebo. We are uncertain about the effect on drug tolerance. The overall certainty of evidence is limited by short-term duration of the included studies.

Integrity signals

Registry

Crossref · 10.1002/14651858.cd013444.pub2

Cites

22 of 22 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

We couldn’t retrieve this paper’s full text, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Cannabinoids may increase slightly treatment discontinuation due to adverse events, nervous system and psychiatric disorders.

    “Cannabinoids may increase slightly treatment discontinuation due to adverse events, nervous system and psychiatric disorders [93].”

    From Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits (2025) · cites this paper as [93]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Authors
Filippini, G., Minozzi, S., Borrelli, F., Cinquini, M., & Dwan, K.
Affiliations
  • Fondazione IRCCS Istituto Neurologico Carlo Besta (IT)
  • Regione Lazio (IT)
  • University of Naples Federico II (IT)
  • Mario Negri Institute for Pharmacological Research (IT)
  • Cochrane Canada (CA)
ORCID
Venue
Cochrane Database Systematic Reviews
Publisher
Wiley
Published
2022-05-05
Volume
5
Pages
CD013444-CD013444
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd013444.pub2
PMC
PMC9069991
OpenAlex
W4229005706
Cited by
75
References
22
Citations by year
2026: 7 · 2025: 25 · 2024: 17 · 2023: 16 · 2022: 9 · 2021: 1
FWCI
10.02
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
  • Health Sciences › Medicine › Neurology › Botulinum Toxin and Related Neurological Disorders
Keywords
multiple sclerosis, cannabinoids, cannabis, spasticity, neuropathic pain, symptom management, health-related quality of life, adverse events, drug tolerability, synthetic cannabinoids, herbal cannabis, cannabis flower, physical dependence, mental illness, neurological disorders, patient-reported outcomes, disability progression
MeSH terms
Activities of Daily Living, Adolescent, Adult, Analgesics, Cannabinoids, Cannabis, Female, Humans, Male, Middle Aged, Multiple Sclerosis, Neuralgia, Plant Extracts, Quality of Life, Dronabinol, Young Adult, Chronic Pain

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review