Clinical experiences with cannabinoids in spasticity management in multiple sclerosis

Neurologia. 2014 Jun;29(5):257-60. doi: 10.1016/j.nrl.2013.06.014. Epub 2013 Sep 10.
[Article in English, Spanish]


Introduction: Spasticity is a common symptom among patients with multiple sclerosis (MS). This study aims to assess the effectiveness and safety of the combination of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in clinical practice for the treatment of spasticity in MS.

Methods: Retrospective observational study with patients treated with inhaled THC/CBD between April 2008 and March 2012. Descriptive patient and treatment variables were collected. Therapeutic response was evaluated based on the doctor's analysis and overall impression.

Results: Of the 56 patients who started treatment with THC/CBD, 6 were excluded because of missing data. We evaluated 50 patients (42% male) with a median age 47.8 years (25.6-76.8); 38% were diagnosed with primary progressive MS, 44% with secondary progressive MS, and 18% with relapsing-remitting MS. The reason for prescribing the drug was spasticity (44%), pain (10%), or both (46%). Treatment was discontinued in 16 patients because of ineffectiveness (7 patients), withdrawal (4), and adverse effects (5). The median exposure time in patients whose treatment was discontinued was 30 days vs 174 days in those whose treatment continued at the end of the study. THC/CBD was effective in 80% of patients at a median dose of 5 (2-10) inhalations/day. The adverse event profile consisted of dizziness (11 patients), somnolence (6), muscle weakness (7), oral discomfort (2), diarrhoea (3), dry mouth (2), blurred vision (2), agitation (1), nausea (1), and paranoid ideation (1).

Conclusions: THC/CBD appears to be a good alternative to standard treatment as it improves refractory spasticity in MS and has an acceptable toxicity profile.

Keywords: Cannabidiol; Cannabinoides; Cannabinoids; Delta-9-tetrahidrocannabinol; Delta-9-tetrahydrocannabinol; Efectividad; Effectiveness; Esclerosis múltiple; Espasticidad; Multiple sclerosis; Spasticity.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Analgesics, Non-Narcotic / therapeutic use
  • Cannabidiol / adverse effects
  • Cannabidiol / therapeutic use*
  • Dronabinol / adverse effects
  • Dronabinol / therapeutic use*
  • Drug Therapy, Combination
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multiple Sclerosis / complications
  • Muscle Spasticity / drug therapy*
  • Muscle Spasticity / etiology
  • Pain / drug therapy*
  • Pain / etiology
  • Retrospective Studies
  • Treatment Outcome


  • Analgesics, Non-Narcotic
  • Cannabidiol
  • Dronabinol