Cannabinoid drugs have been used increasingly in the treatment of neuropathic pain and spasticity. Even though the evidence still is scarce, patients with multiple sclerosis seem to benefit substiantially from cannabinoid therapy. In a case report dose finding and long-term therapie with delta9-tetrahydrocannabinol are described. Dronabinol proved effective and was well tolerated in long-term treatment. Pain was reduced significantly and opioid requirements decreased. At the same time spasticity was reduced and appetite and weight increased. It still needs to bei discussed whether or not part of the positive effect on symptoms was probably mediated by psychomimetic effects. This case report shows, that dronabinol offers an additional therapeutic option in a palliative treatment concept for patiens with high symptom load.