Sixteen people with chronic spinal cord injury and difficult-to-treat spasticity entered a double-blind crossover study. Each participant received balanced THC:CBD oil and placebo in separate one-month phases.

The crossover design lets each participant contribute data under both conditions, but it does not overcome the imprecision created by a very small sample.

The combined Ashworth Scale did not significantly improve within the treatment phase or compared with placebo. This objective primary result should anchor interpretation.

A negative primary outcome means the study did not establish that this dose reduced examiner-rated muscle tone.

Patient-rated spasticity on a visual analog scale favored THC:CBD oil by 13.9 points, with a 95% confidence interval from 2.3 to 25.5 points in the favorable direction.

Subjective symptom relief can matter, but one secondary outcome in 16 participants needs confirmation before it can guide routine care.

The Ashworth Scale measures resistance to passive movement, while a patient may experience spasm frequency, tightness, sleep disruption, pain, or ease of movement differently.

Expectancy, imperfect blinding from psychoactive effects, measurement variability, and genuine differences between experienced and examiner-rated spasticity are all plausible considerations. This trial cannot determine which explanation dominates.

This pilot does not establish an effective dose, an optimal THC:CBD ratio, durable functional benefit, or long-term safety. It should not displace established rehabilitation and spasticity care.

If cannabis is considered in an individualized setting, define a target symptom and functional goal, use a known formulation, review impairment and interactions, and stop when meaningful benefit does not outweigh harm.

Most cannabinoid spasticity research has focused on multiple sclerosis. This study adds a distinct spinal cord injury population and directly tests balanced naturally extracted oil.

The most useful next trial would be larger, multicenter, and longer, with prespecified patient-important outcomes, objective measures, function, adverse events, blinding assessment, and clear carryover controls.

The patient-reported improvement deserves attention, especially because spasticity is experienced in daily life, but it should not erase the negative objective primary outcome.

I would treat this as a signal to measure more carefully, not as a reason to promise benefit. A monitored therapeutic trial, when otherwise appropriate, needs explicit goals and stopping rules.

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