Cannabis and spasticity
Various cannabis (marijuana) preparations have been touted as treatments for multiple sclerosis (MS) spasticity (muscle stiffness or spasms). Does cannabis work – or is it a pipe dream?
The most recent trial, called MUSEC (for Multiple Sclerosis and Extract of Cannabis), was conducted at 22 MS centres in the UK. The phase III study found that an oral cannabis extract was twice as effective as a placebo in providing relief from muscle stiffness (Zajicek and colleagues. J Neurol Neurosurg Psychiatry, epublished July 12, 2012). About 30% of people said that the cannabis extract made them feel better. The extract was THC (tetrahydrocannabinol), the active ingredient in marijuana. The dose was 25 mg per day, followed by a lower maintenance dose of 10 mg per day.
A previous study by some of the same UK researchers found that different cannabis preparations relieved spasticity in about 60% of people (compared to 46% on a placebo) (Zajicek and colleagues. Lancet 2003;362:1517-1526). A separate study in the UK also found that a combination of THC and cannabidiol (another cannabis extract) was effective in relieving muscle stiffness and spasms in people with MS (Collin and colleagues. Eur J Neurol 2007;14:290-296).
A review of six studies was less convinced by the benefits of cannabinoids, but did find that people often reported symptom relief (Lakhan & Rowland. BMC Neurol 2009;9:59; free full text at www.ncbi.nlm.nih.gov/pmc/articles/PMC2793241/pdf/1471-2377-9-59.pdf).
A commercial cannabinoid mixture of THC and cannabidiol (called Sativex), which is administered by a mouth spray, has also been found to improve spasticity and help people perform their daily tasks (Sastre-Garriga and colleagues. Expert Rev Neurother 2011;11:627-637).
A recently published study also found that smoking marijuana (one cigarette per day) was effective in relieving pain and muscle stiffness (Corey-Bloom and colleagues. CMAJ 2012;184:1143-1150). The researchers concluded that it needs to be determined if different doses can achieve the same results with “less cognitive impact”.
So whether swallowed, sprayed or smoked, marijuana appears to relieve symptoms in people with MS.
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