# THC:CBD Oil for Spinal Cord Injury Spasticity- What a Pilot Trial Found > **Author:** Benjamin Caplan, MD (ABFM Board Certified, MA Lic. #240562, NPI: 1962722637) > **Publisher:** CED Clinic (https://cedclinic.com) > **Canonical URL:** https://cedclinic.com/spinal-cord-injury-thc-cbd-spasticity-trial/ > **Published:** 2026-08-05T17:16:19-04:00 | **Last Modified / Clinically Audited:** 2026-09-28T10:47:57-04:00 > **Clinical Summary:** THC CBD oil for spinal cord injury spasticity did not improve the objective primary outcome, while one patient-rated measure favored treatment. --- CED Clinical Relevance #90 [Cannabis Science](https://cedclinic.com/biphasic-effects-of-cannabis/) Evidence Report A placebo-controlled, double-blind crossover pilot directly tested balanced THC:CBD oil in people with chronic spinal cord injury. The objective primary outcome was negative, while one patient-rated outcome improved, making careful interpretation clinically useful. Clinical Insight | CED Clinic A 16-person randomized crossover pilot found no statistically significant improvement in clinician-rated spasticity with balanced THC:CBD oil compared with placebo. Participants did report less spasticity on a visual analog scale, but the study was small, short, and not designed to establish durable functional benefit or long-term safety. The central clinical lesson is the disagreement between objective examination and [patient experience](https://cedclinic.com/testimonials/). That signal may justify larger trials, but it does not establish the oil as effective treatment. Spinal Cord InjurySpasticityTHC:CBDPilot TrialSafety Audience People living with spinal cord injury, caregivers, rehabilitation clinicians, neurologists, and cannabis-science readers Primary Topic THC CBD oil for spinal cord injury spasticity Source [Read the full source](https://pubmed.ncbi.nlm.nih.gov/42544174/) A June 25, 2026 accepted pilot trial tested one month of balanced THC:CBD oil against placebo in 16 people with chronic spinal cord injury. Clinician-rated spasticity did not significantly improve, while one patient-rated measure favored the oil. What This Study Teaches Us The trial separates two outcomes that are often blended together. The combined Ashworth Scale, the objective primary outcome, did not significantly change, while patient-rated spasticity improved by 13.9 points relative to placebo on a visual analog scale. Why This Matters Spasticity after spinal cord injury can affect sleep, transfers, mobility, comfort, and caregiving. A controlled trial in this specific population is more informative than extrapolating from multiple sclerosis, but its very small sample makes precision and replication essential. Study Snapshot Study Type Single-center, randomized, placebo-controlled, double-blind crossover pilot clinical trial Population 16 adults with chronic spinal cord injury and intractable spasticity Intervention Naturally extracted 1:1 THC:CBD oil Comparator Placebo, with participants crossing over after one month Average Dose 11.6 mg per day, standard deviation 1.3 mg Primary Outcome Combined Ashworth Scale across involved muscle groups Primary Result No statistically significant pre-post or between-phase difference Patient-Rated Result Visual analog scale effect size -13.9 points; 95% CI -25.5 to -2.3; p=0.010 Completion All 16 participants completed the study Setting Single center in Thailand Registry Thai [Clinical Trials](https://cedclinic.com/endocannabinoid-system-emotional-memory-ptsd-treatment/) Registry TCTR20220329001 Journal Therapeutic Advances in Neurological Disorders Accepted June 25, 2026 Authors Nattha Boonthanakorn, Sintip Pattanakuhar, Pratchayapon Kammuang-Lue, Siam Tongprasert, and Apichana Kovindha PMID / DOI 42544174 / 10.1177/17562864261468464 Major Limitation Pilot sample of 16, short treatment periods, and discordant objective and subjective outcomes Clinical Bottom Line Balanced THC:CBD oil did not improve the trial’s objective primary measure of spasticity, although participants reported a modest subjective improvement. The result is hypothesis-generating and supports larger, longer trials rather than routine treatment claims. What the Trial Tested 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 Objective Primary Outcome Was Negative 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. Patients Reported a Different Experience 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. Why the Measures May Disagree 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. How to Use the Finding Clinically 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. How Strong Is This Evidence? Randomization, placebo control, double blinding, crossover exposure, complete follow-up, and a condition-specific population strengthen this pilot compared with an uncontrolled survey or case series. Where This Paper Deserves Skepticism Only 16 participants were studied at one center for short periods. The objective primary outcome was negative, the favorable signal came from a patient-rated secondary measure, and psychoactive effects may complicate blinding. The abstract does not provide enough detail to establish long-term safety or functional benefit. What This Paper Does Not Show The trial does not prove that THC:CBD oil treats spinal cord injury spasticity, demonstrate improvement in mobility or independence, establish superiority to standard therapies, identify an ideal dose, validate higher dosing, or establish long-term benefit and safety. How This Fits With the Broader Clinical Conversation 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. Dr. Caplan’s Take *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.* What a Careful Reader Should Take Away The trial found a subjective signal without objective confirmation. Both results belong in the same sentence, and the sample of 16 makes replication more important than enthusiasm. Evidence Interpretation Guide Table of Contents - [How to Interpret the Spinal Cord Injury Pilot](#How_to_Interpret_the_Spinal_Cord_Injury_Pilot)[A Four-Step Reading Frame](#A_Four-Step_Reading_Frame) - [The Same Study Can Mean Different Things Depending on the Question Being Asked](#The_Same_Study_Can_Mean_Different_Things_Depending_on_the_Question_Being_Asked)[Your Experience Matters, but Needs Measurement](#Your_Experience_Matters_but_Needs_Measurement) - [Anchor Counseling to the Negative Primary Outcome](#Anchor_Counseling_to_the_Negative_Primary_Outcome) - [Sixteen Participants Are Not Definitive](#Sixteen_Participants_Are_Not_Definitive) - [Blinding and Carryover Need Scrutiny](#Blinding_and_Carryover_Need_Scrutiny) - [A Distinct Spinal Cord Injury Population](#A_Distinct_Spinal_Cord_Injury_Population) - [Dose and Product Cannot Be Generalized](#Dose_and_Product_Cannot_Be_Generalized) - [Measure What Changes Daily Life](#Measure_What_Changes_Daily_Life) - [Pilot Evidence Needs Proportionate Communication](#Pilot_Evidence_Needs_Proportionate_Communication) - [Frequently Asked Questions](#Frequently_Asked_Questions)[Related](#Related) ## How to Interpret the Spinal Cord Injury Pilot A randomized design improves confidence, but a pilot remains exploratory. Four checks keep the result proportionate. ### A Four-Step Reading Frame **Start with the primary outcome**Clinician-rated spasticity did not significantly improve. **Keep the subjective signal**Participants reported less spasticity on one visual analog scale. **Respect sample size**Sixteen participants cannot provide precise or broadly generalizable estimates. **Ask about function and harm**Future work must connect symptom ratings to daily function, adverse effects, and durability. The Research Question Does one month of balanced THC:CBD oil reduce spasticity in chronic spinal cord injury compared with placebo? The Patient Question Could a carefully monitored trial improve the symptoms that matter to my daily life? The Bottom Line The objective result was negative, while one patient-rated signal warrants confirmation. CED Perspective Lens ## The Same Study Can Mean Different Things Depending on the Question Being Asked Scientific papers rarely answer a single question. Patients, clinicians, researchers, policymakers, and critics often read the same data differently. The perspectives below explore how this study looks through several evidence-based lenses. Lens Overview Eight perspectives keep a small, mixed-result pilot from being read as either proof of benefit or proof of no value. #### Your Experience Matters, but Needs Measurement Participants reported less spasticity even though the examination scale did not improve. Track a specific symptom and daily function rather than relying on a vague impression. Lens takeaway Define meaningful improvement before starting. #### Anchor Counseling to the Negative Primary Outcome The study does not establish efficacy on clinician-rated spasticity. If a trial is considered, document product, dose, goals, adverse effects, and a review date. Lens takeaway Use structured monitoring and stopping rules. #### Sixteen Participants Are Not Definitive Small studies can exaggerate benefits and miss uncommon harms. One favorable secondary outcome should be considered hypothesis-generating. Lens takeaway Replication matters more than the p value alone. #### Blinding and Carryover Need Scrutiny THC effects can reveal treatment assignment even in a double-blind study. Crossover trials also depend on adequate washout and appropriate analysis of period effects. Lens takeaway Design labels do not remove every source of bias. #### A Distinct Spinal Cord Injury Population Earlier evidence often centers on multiple sclerosis spasticity. This trial adds a condition-specific population and balanced oil, but far less statistical power than a [systematic review](https://cedclinic.com/cannabinoid-safety-efficacy-mental-health-study/). Lens takeaway Population specificity is the genuine new contribution. #### Dose and Product Cannot Be Generalized The average dose was 11.6 mg per day of a specific 1:1 oil. The result does not validate other ratios, inhaled cannabis, dispensary products, or higher doses. Lens takeaway Match any discussion to the studied formulation. #### Measure What Changes Daily Life Larger studies should include spasm frequency, sleep, pain, transfers, mobility, caregiver burden, and [quality of life](https://cedclinic.com/cannabis-policy-enforcement-february-26-2026/). Longer follow-up is needed for durability and safety. Lens takeaway Objective and patient-important outcomes should be prespecified together. #### Pilot Evidence Needs Proportionate Communication A randomized pilot is valuable but should not be marketed as established treatment evidence. Clear product labeling and adverse-event reporting are necessary for meaningful translation. Lens takeaway Evidence communication should match study maturity. Join the Conversation Have a question about how this applies to your situation? [Ask Dr. Caplan](https://benjamincaplan.com/ask-dr-caplan) Want to discuss this topic with other patients and caregivers? [Join the forum discussion](https://cedclinic.com/interact/discussion-forums/) [https://cedclinic.com/contact/](https://cedclinic.com/contact/) Physician-Led, Whole-Person Care A doctor who takes the time to truly understand you. Personal care that starts with listening and is guided by experience and ingenuity. Health, Longevity, Wellness One-on-One Cannabis Guidance Metabolic Balance [Leave a Message](https://cedclinic.com/contact/) [Metabolic Care](https://cedclinic.com/metabolic/metabolic-how-it-works/) [Medical Consulting](https://cedclinic.com/book/) [Cannabis Care](https://cedclinic.com/book/) [https://cedclinic.com/contact/](https://cedclinic.com/contact/) Share this Evidence Watch [X](https://twitter.com/intent/tweet?text=THC%3ACBD+Oil+for+Spinal+Cord+Injury+Spasticity%3A+What+a+Pilot+Trial+Found&url=https%3A%2F%2Fcedclinic.com%2Fspinal-cord-injury-thc-cbd-spasticity-trial%2F) [LinkedIn](https://www.linkedin.com/sharing/share-offsite/?url=https%3A%2F%2Fcedclinic.com%2Fspinal-cord-injury-thc-cbd-spasticity-trial%2F) [BlueSky](https://bsky.app/intent/compose?text=THC%3ACBD+Oil+for+Spinal+Cord+Injury+Spasticity%3A+What+a+Pilot+Trial+Found%20https%3A%2F%2Fcedclinic.com%2Fspinal-cord-injury-thc-cbd-spasticity-trial%2F) [Instagram](https://www.instagram.com/drcaplan/) [Substack](https://doctorapprovedcannabis.substack.com/) [RSS](https://cedclinic.com/feed/) Source: [Medical cannabis improved self-reported spasticity rating in patients with chronic spinal cord injury: a placebo-controlled, double-blind, crossover pilot clinical trial.](https://pubmed.ncbi.nlm.nih.gov/42544174/) Related Reading at CED Clinic Continue exploring the evidence [Medical Cannabis for Spinal Cord Injury: A Complete Patient Resource Guide](https://cedclinic.com/medical-cannabis-for-spinal-cord-injury-a-complete-patient-resource-guide/) Condition-specific background on symptoms, product considerations, dosing, safety, and the limits of the broader evidence base. [Read the spinal cord injury guide](https://cedclinic.com/medical-cannabis-for-spinal-cord-injury-a-complete-patient-resource-guide/) [Cannabinoids for MS Spasticity: What 27 Randomized Trials Show](https://cedclinic.com/cannabinoids-ms-spasticity-randomized-review/) A broader randomized evidence synthesis in multiple sclerosis that helps distinguish population-specific findings from the wider spasticity literature. [Compare the MS evidence](https://cedclinic.com/cannabinoids-ms-spasticity-randomized-review/) [Medical Cannabis Beyond Pain: PM&R Review on Spasticity, Seizures, Sleep & Nausea](https://cedclinic.com/medical-cannabis-non-pain-indications-pmr-review/) Rehabilitation context for connecting symptom reports with function, sedation, falls, and monitoring. [Read the rehabilitation context](https://cedclinic.com/medical-cannabis-non-pain-indications-pmr-review/) ## Frequently Asked Questions How many people were in the trial? Sixteen people with chronic spinal cord injury and intractable spasticity completed the crossover pilot. What product was tested? The intervention was a naturally extracted oil containing THC and CBD in a 1:1 ratio. What was the average dose? The reported average dose was 11.6 mg per day, with a standard deviation of 1.3 mg. Did the objective spasticity score improve? No statistically significant improvement was found on the combined Ashworth Scale, the objective primary outcome. What did patients report? Patient-rated spasticity on a visual analog scale improved by 13.9 points relative to placebo in the reported analysis. Why can objective and subjective measures disagree? They capture different aspects of spasticity, and expectations, blinding, variability, and true differences in [patient experience](https://cedclinic.com/testimonials/) may contribute. Does the trial prove that THC CBD oil works? No. The small pilot and negative primary outcome mean the favorable secondary signal requires confirmation. Can the finding be generalized to other cannabis products? No. Different ratios, doses, routes, and products may have different effects and risks. Should standard spasticity care be replaced? No. The study does not support replacing established rehabilitation, medication, or specialist care. What research is needed next? Larger and longer multicenter trials should prespecify objective, patient-reported, functional, safety, and blinding outcomes. ### Related --- ### Verification & Medical Governance - **Lead Clinical Author:** Benjamin Caplan, MD - **Credentials:** Board Certified in Family Medicine (ABFM), Founder & CMO CED Clinic & CED Foundation, Author of *The Doctor-Approved Cannabis Handbook* (Penguin Random House). - **Clinical Scale:** 350,000+ lifetime evaluations overseen; 81,008-patient Real-World Evidence Registry (`~/.ced_rwe_vault.db`); 125,000+ peer-reviewed study literature observatory (`http://localhost:8768/api/explorer/terminal`). - **License Verification:** Commonwealth of Massachusetts License #240562 (https://checkahealthlicense.mass.gov/). - **NPI Registry:** 1962722637 (https://npiregistry.cms.hhs.gov/provider-view/1962722637). - **Ethics & Data Privacy:** Clinical registry observations adhere strictly to HIPAA Safe Harbor de-identification (45 CFR § 164.514(b)) and criteria for secondary research exemption under 45 CFR § 46.104(d)(4).