Abstract

BACKGROUND:
People with spinal cord injuries (SCI) commonly experience pain and spasticity, but limitations of current treatments have generated interest in cannabis as a possible therapy.

OBJECTIVES:
We conducted this systematic review to: 1) examine usage patterns and reasons for cannabinoid use, and 2) determine the treatment efficacy and safety of cannabinoid use, in people with SCI.

METHODS:
PubMed, Embase, Web of Science and Cumulative Index to Nursing and Allied Health Literature databases were queried for keywords related to SCI and cannabinoid.

RESULTS:
7,232 studies were screened, 34 were included in this systematic review. Though 26 studies addressed cannabinoid usage, only 8 investigated its therapeutic potential on outcomes such as pain and spasticity. The most common usage method was smoking. Relief of pain, spasticity and pleasure were the most common reasons for use. Statistically significant reduction of pain and spasticity was observed with cannabinoid use in 80% and 90% of experimental studies, respectively. However, on examination of randomized control trials (RCTs) alone, effect sizes ranged from -0.82 to 0.83 for pain and -0.95 to 0.09 for spasticity. Cannabinoid use was associated with fatigue and cognitive deficits.

CONCLUSIONS:
Current evidence suggests cannabinoids may reduce pain and spasticity in people with SCI, but its effect magnitude and clinical significance is unclear. Existing information is lacking on optimal dosage, method of use, composition and concentration of compounds. Longterm, double-blind, RCTs, assessing a wider range of outcomes should be conducted to further understanding of the effects of cannabinoid use in people with SCI.