I see problems with this meta-analysis.

- Not adjusted for strain, dose or delivery method across all studies.

- Not adjusted for receptor downregulation, for which rotation and/or drug holidays would be appropriate strategies.

- Not adjusted across all studies for time effect, e.g. 6 hours of relief, 1 hour, etc.

I can tell you from personal experience with a related disorder that disciplined rotation of 10mg edible cannabis provides 90% relief, 90% of the time, with far fewer side effects than alternative medications for the same disorder.