Can cannabis help with spinal cord injury symptoms?

Spinal cord injury (SCI) produces a constellation of symptoms — neuropathic pain, spasticity, bladder dysfunction, depression, and sleep disturbance — that are all theoretically addressable by cannabinoids. Evidence by symptom: Neuropathic pain: moderate evidence from RCTs in SCI-associated neuropathic pain; a 2007 RCT (Rintala et al.) found dronabinol reduced central neuropathic pain vs. placebo. Spasticity: nabiximols (Sativex) has RCT evidence for spasticity in SCI, similar to MS spasticity. Bladder dysfunction: nabiximols reduced bladder incontinence episodes in a 2010 RCT. Depression/anxiety: observational evidence only. Sleep: THC reduces sleep latency and improves subjective sleep quality in SCI patients. A 2022 systematic review concluded cannabinoids have moderate evidence for SCI-associated pain and spasticity. Practical considerations: SCI patients often use multiple medications (baclofen, gabapentin, opioids) with potential interactions with CBD. Autonomic dysreflexia risk with high-level SCI is a concern with THC-induced cardiovascular effects.