In this keynote from Athens, medical cannabis is discussed as an emerging option for neuropathic pain and spasticity, with a particular focus on people living with multiple sclerosis. Evidence from clinical trials, large real-world cohorts and national prescribing data is reviewed, together with practical experience from a high-volume pain clinic. The presentation highlights how medical cannabis may reduce pain, spasticity and opioid use, while underlining current gaps in guidelines, regulatory hurdles and the need for careful titration and follow-up.
Key Insights from the Lecture:
- Medical cannabis may be an add-on option for neuropathic pain and spasticity in MS (pain ~50–70%, spasticity ~30–50%).
- Clinical adoption lagged despite early cannabinoid discovery, partly due to opioid-dominant pain management.
- Neurological societies still ask for more evidence and formal guidelines, but are cautiously supportive for selected patients.
- Trials in MS pain/spasticity are ongoing, plus studies mapping specific cannabis components to symptoms/indications.
- Legalisation and prescribing vary; in the UK and Germany a large share of prescriptions target pain and MS-related symptoms.
- A US retrospective cohort (many with MS) found meaningful pain relief, reduced spasticity, ~20% lower opioid use, and mostly mild side effects.
- In Greece, prescribing became legal in the past 18 months, but cost and lack of reimbursement remain major barriers.
- Suggested titration (UK consensus): balanced CBD/THC dried flower, vaporisation over smoking, slow dose escalation, adjust for age/comorbidities.
- Dosing is complex; AI tools can help convert flower % and grams into estimated THC/CBD mg exposure.
- Practical advice: “start low, go slow,” avoid driving during titration, carry prescription/ID when travelling, and ensure close follow-up.
- Emphasis on personalised care, since benefits, tolerance, and optimal dose vary widely between patients.
“Endocannabinoid system – Clinical aspects: available and future treatment“.
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About the speaker:
Zinais Kontouli
Consultant in Anaesthesia and Pain Medicine and Director Anesthesiologist of Pain Clinic at Athens Medical Group in Athens
Dr. Zinais Kontouli is a Greek consultant anaesthetist and pain-medicine specialist, currently serving as Supervising Anaesthesiologist and Director of the Pain Clinic at the Athens Medical Group in Athens. She obtained her MD from the National and Kapodistrian University of Athens, where she also completed postgraduate studies and a PhD in Medicine. After graduation, Dr. Kontouli trained and specialized in anaesthesiology in the United Kingdom, and later pursued advanced fellowship training in chronic pain medicine. Her UK appointments included clinical and academic roles at Imperial College London and Guy’s & St Thomas’ Hospital, with a focus on interventional pain therapies and neuromodulation, before returning to Greece to lead pain services in major hospitals and clinics.
Her clinical and research work sits at the interface of anaesthesia, neurology, and rehabilitation, with particular interest in complex chronic pain syndromes and neurological conditions where pain and spasticity are prominent, including multiple sclerosis. She has contributed to educational and scientific initiatives on emerging symptom-management approaches such as cannabinoid-based therapies, while maintaining an active role in interventional pain practice. Dr. Kontouli is also engaged in academic activity as an Honorary Lecturer in Pain Medicine at Imperial College London and participates in research, conference teaching, and clinical innovation in pain care.
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