There was an increased risk of non-serious AEs with cannabinoids compared with placebo .
Conclusions There was moderate evidence to support cannabinoids in treating chronic , non-cancer pain at 2 weeks .
Similar results were observed at later time points , but the confidence in effect is low .
There is little evidence that cannabinoids increase the risk of experiencing serious AEs , although non-serious AEs may be common in the short-term period following use
Background For patients with chronic , non-cancer pain , traditional pain-relieving medications include opioids , which have shown benefits but are associated with increased risks of addiction and adverse effects .
Medical cannabis has emerged as a treatment alternative for managing these patients and there has been a rise in the number of r and omized clinical trials in recent years ; therefore , a systematic review of the evidence was warranted .
Objective To analyze the evidence surrounding the benefits and harms of medical cannabinoids in the treatment of chronic , non-cancer-related pain .
Sativex® and clinical–neurophysiological measures of spasticity in progressive multiple sclerosis
Despite the proven efficacy of Sativex ® ( 9-delta-tetrahydrocannabinol plus cannabidiol ) oromucosal spray in reducing spasticity symptoms in multiple sclerosis ( MS ) , little is known about the neurophysiological correlates of such effects . The aim of the study was to investigate the effects of Sativex on neurophysiological measures of spasticity ( H/M ratio ) and corticospinal excitability in patients with progressive MS . This was a r and omized , double-blind , placebo-controlled , crossover study . Consecutive subjects with progressive MS and lower limb spasticity referred to our center were r and omized to 4 weeks ’ treatment ( including 2 weeks ’ titration ) with Sativex or placebo , with crossover after a 2-week washout . Clinical and neurophysiological measures ( H/M ratio and cortical excitability ) of spasticity were assessed . The H/M ratio was the primary outcome , with sample size calculation of 40 patients . Of 44 recruited patients , 34 were analyzed due to 6 drop-outs and 4 exclusions , which lowered the power of the study to show differences between treatments . Neurophysiological measures did not differ significantly according to treatment and did not correlate significantly with clinical response . Response on the modified Ashworth scale ( at least 20 % improvement ) was significantly more frequent after Sativex than placebo ( 50 vs 23.5 % ; p = 0.041 ; McNemar ) . Side effects did not differ significantly according to treatment . Our findings confirm the clinical benefit of Sativex  on MS spasticity . The lack of corresponding changes in corticospinal excitability and on the monosynaptic component , of the stretch reflex , although in a limited sample size , points to the involvement of other spinal and supraspinal mechanisms in the physiopathology of spasticity in progressive MS
There was an increased risk of non-serious AEs with cannabinoids compared with placebo .
Conclusions There was moderate evidence to support cannabinoids in treating chronic , non-cancer pain at 2 weeks .
Similar results were observed at later time points , but the confidence in effect is low .
There is little evidence that cannabinoids increase the risk of experiencing serious AEs , although non-serious AEs may be common in the short-term period following use
Background For patients with chronic , non-cancer pain , traditional pain-relieving medications include opioids , which have shown benefits but are associated with increased risks of addiction and adverse effects .
Medical cannabis has emerged as a treatment alternative for managing these patients and there has been a rise in the number of r and omized clinical trials in recent years ; therefore , a systematic review of the evidence was warranted .
Objective To analyze the evidence surrounding the benefits and harms of medical cannabinoids in the treatment of chronic , non-cancer-related pain .