Use of Cannabinoids for Spasticity and Pain Management in MS
- 1k Downloads
Several randomized trials have demonstrated potential benefit of cannabis derivatives in the symptomatic treatment of multiple sclerosis (MS) patients. These provide class 1 and 2 evidence for cannabinoid product use for spasticity and pain in these patients. The precise best ratio or doses are not yet clear. The safety and potential long-term effects of these products on cognitive function in people with MS have not been evaluated. Since short-term memory and processing speed can be significantly impaired in many people with MS, the concern of potential cognitive impairment related to cannabis products needs consideration in clinical care and should be addressed in longer, prospective studies.
KeywordsMultiple sclerosis Cannabinoids Spasticity Pain Tetrahydrocannabinol Cannabidiol
Compliance with Ethical Standards
Conflict of Interest
Hardeep Chohan, Ariele L Greenfield, and Vijayshree Yadav each declare no potential conflicts of interest.
Jennifer Graves reports grants from Genentech and Race to Erase MS.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 6.••Koppel BS, Brust JCM, Fife T, Bronstein J, Youssof S, Gronseth G, et al. Systematic review: efficacy and safely of medical marijuana in selected neurologic disorders. Report of the guideline development subcommittee of the American academy of neurology. Neurology. 2014;82:1556–63. This is a systematic review of medical marijuana from 1948- Nov 2013 which addresses treatment of symptoms of MS; and also epilepsy and movement disorders.PubMedCentralCrossRefPubMedGoogle Scholar
- 8.••Whiting PF, Wolff RF, Deshpande S, Nisio MD, Duffy S, Hernandez AV, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA. 2015;313(24):2456–73. doi: 10.1001/jama.2015.6358. This is a 2015 meta-analysis which looked at benefits and adverse effects of cannabinoids from 28 databases, since their inception to April 2015.CrossRefPubMedGoogle Scholar
- 9.Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res. 2011;63:S240–52.CrossRefGoogle Scholar
- 10.•Ball S, Vickery J, Hobart J, Wright D, Green C, Shearer J, et al. The cannabinoid use in progressive inflammatory brain disease (CUPID) trial: a randomised double-blind placebo-controlled parallel-group multicentre trial and economic evaluation of cannabinoids to slow progression in multiple sclerosis. Health Technol Assess. 2015;19:1–188. This is one of the largest studies in terms of patient enrollment and also has the longest duration of follow-up.CrossRefGoogle Scholar
- 13.Heinzel-Gutenbrunner M, Vaney C, Jobin P, et al. Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled, crossover study. Mult Scler. 2004;10(4):417–24.CrossRefPubMedGoogle Scholar
- 27.Novotna A, Mares J, Ratcliffe S, Novakova I, Vachova M, Zapletalova O, et al. A randomized, double-blind, placebo-controlled, parallel-group, enriched-design study of nabiximols* (Sativex((R))), as add-on therapy, in subjects with refractory spasticity caused by multiple sclerosis. Eur J Neurol. 2011;18:1122–31.CrossRefPubMedGoogle Scholar
- 39.••Yadav V, Bever C, Bowen J, Bowling A, Weinstock-Guttman B, Cameron M, et al. Summary of evidence-based guideline: complementary and alternative medicine in multiple sclerosis. Report of the guideline development subcommittee of the American academy of neurology. Neurology. 2014;82:1083–92. doi: 10.1212/WNL.0000000000000250. This recent paper contains guidelines on various complementary and alternative medicines in MS, including cannabinoids.PubMedCentralCrossRefPubMedGoogle Scholar
- 40.••Yadav V, Narayanaswami P. Complementary and alternative medical therapies in multiple sclerosis—the American academy of neurology guidelines: a commentary. Clin Ther. 2014;36(12):1972–8. doi: 10.1016/j.clinthera.2014.10.011. This recent paper contains guidelines on various complementary and alternative medicines in MS, including cannabinoids.CrossRefPubMedGoogle Scholar
- 43.Aragona M, Onesti E, Tomassini V, Conte A, Gupta S, Gilio F, et al. Psychopathological and congnitive effects of theapeutic cannabinoids in multiple sclerosis: a double-blind, placebo controlled, crossover study. Clin Neuropharmacol. 2009;32(1):41–7. doi: 10.1097/WNF.0B013E3181633497.PubMedGoogle Scholar