THC and CBD extracts significantly reduced pain compared to placebo and improved further neurogenic symptoms in a subset of patients.
Summary
n=24 (of which n=18 MS patients), cannabis extracts (THC, CBD, THC:CBD 1:1) vs. placebo sublingual (2-week periods); pain relief under THC and CBD significantly superior to placebo; spasticity, bladder symptoms and muscle cramps improved in MS patients. Provided evidence for cannabis efficacy in MS-associated neurological symptoms.
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PopulationPatients with treatment-refractory neurogenic symptoms (multiple sclerosis n=18, spinal cord injury n=4, brachial plexus lesion n=1, amputation due to neurofibromatosis n=1), n=24
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InterventionWhole-plant cannabis extracts (THC, CBD, CBD:THC 1:1) as sublingual spray, dosage 2,5–120 mg/24 h, titrated according to symptom response, 2-week treatment periods
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ControlMatched placebo (sublingual spray)
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OutcomePain relief under THC and CBD significantly superior to placebo; improvement of bladder control, muscle spasm and spasticity in a subset of affected patients; 3 patients with transient hypotension and intoxication under THC-containing extracts
Confidence in the evidence
Very lowLowModerateHigh
Moderate
The third of four GRADE levels, the effect estimate is probably reliable.
<h4>Objectives</h4>To determine whether plant-derived cannabis medicinal extracts (CME) can alleviate neurogenic symptoms unresponsive to standard treatment, and to quantify adverse effects.<h4>Design</h4>A consecutive series of double-blind, randomized, placebo-controlled single-patient cross-over trials with two-week treatment periods.<h4>Setting</h4>Patients attended as outpatients, but took the CME at home.<h4>Subjects</h4>Twenty-four patients with multiple sclerosis (18), spinal cord injury (4), brachial plexus damage (1), and limb amputation due to neurofibromatosis (1).<h4>Intervention</h4>Whole-plant extracts of delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), 1:1 CBD:THC, or matched placebo were self-administered by sublingual spray at doses determined by titration against symptom relief or unwanted effects within the range of 2.5-120 mg/24 hours. Measures used: Patients recorded symptom, well-being and intoxication scores on a daily basis using visual analogue scales. At the end of each two-week period an observer rated severity and frequency of symptoms on numerical rating scales, administered standard measures of disability (Barthel Index), mood and cognition, and recorded adverse events.<h4>Results</h4>Pain relief associated with both THC and CBD was significantly superior to placebo. Impaired bladder control, muscle spasms and spasticity were improved by CME in some patients with these symptoms. Three patients had transient hypotension and intoxication with rapid initial dosing of THC-containing CME.<h4>Conclusions</h4>Cannabis medicinal extracts can improve neurogenic symptoms unresponsive to standard treatments. Unwanted effects are predictable and generally well tolerated. Larger scale studies are warranted to confirm these findings.