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Cannabis for MS Spasticity — SCE Palliative Medicine MCQ

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ModerateNon-Malignant Palliative CareCannabis for MS SpasticitySCE Palliative Medicine

A 55‑year‑old woman with advanced multiple sclerosis has severe neuropathic pain that has not responded to amitriptyline or gabapentin. Cannabis‑based medicinal products are being considered. According to current NICE guidance, what is the position regarding cannabis‑based medicines for MS‑related neuropathic pain?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — NICE permits a specialist‑initiated 4‑week trial of THC:CBD oromucosal spray (Sativex) for spasticity unresponsive to other treatments

Explanation lettering: C = shown as A · E = shown as B · A = shown as C · B = shown as D · D = shown as E

Option C is correct: NICE NG144 (Cannabis‑based medicinal products) recommends THC:CBD oromucosal spray (Sativex) only for MS spasticity unresponsive to other treatments, not for neuropathic pain where the evidence is insufficient—even though some patients report subjective benefit. Distractors: A is incorrect—cannabis‑based products are not first‑line nor fully licensed for all MS symptoms. B confuses medicinal and recreational use. D is too absolute—NICE does allow Sativex for spasticity. E is incorrect since spasticity has evidence-based recommendation.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer/palliative-care