We searched the literature (1970-March 2011; March 2011-September 2013 MEDLINE search), classified articles, and linked recommendations to evidence.
RESULTS AND RECOMMENDATIONS: Clinicians might offer oral cannabis extract for spasticity symptoms and
pain (excluding central
neuropathic pain) (Level A). Clinicians might offer
tetrahydrocannabinol for spasticity symptoms and
pain (excluding central
neuropathic pain) (Level B). Clinicians should counsel patients that these agents are probably ineffective for objective spasticity (short-term)/
tremor (Level B) and possibly effective for spasticity and
pain (long-term) (Level C). Clinicians might offer
Sativex oromucosal
cannabinoid spray (
nabiximols) for spasticity symptoms,
pain, and urinary frequency (Level B). Clinicians should counsel patients that these agents are probably ineffective for objective spasticity/
urinary incontinence (Level B). Clinicians might choose not to offer these agents for
tremor (Level C). Clinicians might counsel patients that magnetic
therapy is probably effective for
fatigue and probably ineffective for depression (Level B);
fish oil is probably ineffective for relapses, disability,
fatigue, MRI lesions, and quality of life (QOL) (Level B); ginkgo biloba is ineffective for cognition (Level A) and possibly effective for
fatigue (Level C);
reflexology is possibly effective for
paresthesia (Level C); Cari Loder regimen is possibly ineffective for disability, symptoms, depression, and
fatigue (Level C); and bee
sting therapy is possibly ineffective for relapses, disability,
fatigue, lesion burden/volume, and health-related QOL (Level C).
Cannabinoids may cause adverse effects. Clinicians should exercise caution regarding standardized vs nonstandardized cannabis extracts and overall CAM quality control/nonregulation. Safety/efficacy of other CAM/CAM interaction with MS disease-modifying
therapies is unknown.