Multiple Sclerosis: Here’s Why Cannabis Is So Effective Against MS
Over the many years that I have been providing cannabis recommendations for MS patients, I have seen dramatic results. In particular, one patient came to the office with a walker and after using cannabis for a year, she was walking without the walker. This first report is general information, followed by the position on cannabis by the National Multiple Sclerosis Association
Credits for the following Report: http://herb.co/2016/07/28/marijuana-and-ms/
Cannabis has been wildly successful in treating symptoms of Multiple Sclerosis. Patients all over the world have found much-needed relief from pain, gastrointestinal distress, muscle spasms, and even paralysis thanks to cannabis. But, how can a herb possibly be so effective in treating an incurable neurodegenerative disorder? The answer to this question will amaze you. Here’s how cannabis eases symptoms of Multiple Sclerosis.
What is Multiple Sclerosis (MS)?
Tracey is a Multiple Sclerosis (MS) patient. After living with the condition for decades, she made the unconventional choice to ease her MS with marijuana. As she speaks to her YouTube audience, her calm voice is laced with the wisdom gained only after coming to terms with years of discomfort.
When I use medical marijuana, I get to have a normal body. I get to have a normal body for a little while. That’s a freedom you need. It’s essential and very hard to just let go, because you can’t let go. There’s something in your brain that makes you feel tight and rotten as you can possibly feel. BOOM. And that’s what happens every day.
Tracy’s feelings about her body may hit close to home for many MS patients. Those living with this condition face an insurmountable amount of pain on a daily basis. A constant attack on the central nervous system means that they slowly lose their ability to move their muscles and limbs. Vision and other bodily functions are also affected.
Multiple Sclerosis is a neurodegenerative autoimmune disease that affects the brain, spinal cord, and optic nerve. For some reason, the immune system begins to think of neurons as harmful invaders. So, the body’s own immune cells begin to attack neurons. All of the self-inflicted damage causes a buildup of scar tissue. This means that neurons can no longer fire correctly to send basic signals to the rest of the body.
The condition affects millions of people worldwide, but there is no cure. Treatments with MS typically involve powerful drugs that aim to slow the progression of the disease, manage symptoms, and speed up recovery from attacks. This is where cannabis comes in. The herb can improve brain function and ease symptoms of MS.
7 ways cannabis eases MS symptoms
The overwhelming success of cannabis in MS treatment is one of the reasons why the medicinal herb has gained legitimacy around the globe. Multiple Sclerosis is one of the primary conditions treated with some variation of medical cannabis in many different countries–be it in the form of prescription drug or a little cannabis oil.
1. It Protects Your Brain
Multiple Sclerosis patients face one major villain: inflammation. When immune cells activate, they release pro-inflammatory proteins called cytokines. These cytokines cause rampant inflammation in the brain. This ultimately results in the destruction of neurons, and progressively worsening symptoms.
The active components in cannabis, called cannabinoids, are potent anti-inflammatories. Compounds like psychoactive THC and non-psychoactive CBD deactivate the immune system, halting the violent assault on the central nervous system. When the immune system is calmed down, it no longer attacks your central nervous system.
This same quality is what makes the herb so powerful in combatting other types of autoimmune diseases, like lupus.
Cannabinoids are a few of a handful of key substances that promote neurogenesis in adults. Neurogenesis is the creation of new brain cells. Some of the others on the list include:
- Dark chocolate
- Red wine (only in moderation)
Compounds in cannabis are also potent antioxidants, which give them neuroprotective properties. The herb combats oxidative stress, protecting your cells, tissues, and DNA from damage. The antioxidant, anti-inflammatory, and neurogenetic qualities in this herb make it one powerful brain-boosting medicine. It’s quite miraculous, really.
2. It Eases Pain
You may have already heard: cannabis is amazing for chronic pain. A potent analgesic, cannabinoids like THC and CBD engage pain receptors in the body. The herb’s power to knock-out inflammation also plays a role, as inflammation and pain go hand-in-hand.
As tissues in your body begin to swell up and become irritated, they deteriorate. The breakdown of these tissues is painful. Plus, nerve cells can send pain signals out to the rest of the body as they are destroyed.
The plant’s pain-numbing effects were put to the test by a group at University of California San Diego. In a clinical trial, researchers tested the effects of smoking marijuana on physical pain. 5 minutes after smoking? No difference. 45 minutes after smoking? Participants that smoked medium to high levels of cannabis showed a significant reduction in pain levels.
3. It Stops Muscle Stiffness and Spasms
Listen to this: At Israel Labs. It’s solely a coincidence that this scientific miracle happened in one of the holiest countries in the world.
Researchers infected mice with an MS-like condition. They then injected them with CBD. Amazingly, the mice, whose legs had been locked stiff with crippling muscle tightness, began to move again. The mice treated with CBD also had significantly less damage to their nerve cells and less overall inflammation.
This is more confirmation that the neuroprotective qualities of cannabis are extremely effective in mitigating MS symptoms.
The Israeli findings are corroborated by additional research. 2012 study conducted by the University of Plymouth found that cannabis was twice as effective at relieving MS muscle stiffness and spasms when compared to a placebo. After 12 weeks, participants that used cannabis showed a significant reduction in spasticity over their counterparts.
Around 20% of MS patients have issues with spasticity. That is, uncontrollable muscle stiffness and twitching. This loss of muscular control occurs when nerve cells responsible for movement are damaged. This damage is caused by inflammation. Particularly, inflammation in the brain and spine.
A 2013 study out of Tel Aviv University found that THC and CBD prevent inflammation of these areas. These findings led researchers to conclude that marijuana may do a little more than ease Multiple Sclerosis symptoms.
4. It Helps Digestion Photo credit
Gastrointestinal issues are all too common in MS patients. Constipation, problems with bowel control, and difficulty digesting can make day-to-day life miserable. Marijuana can help. 70% of immune cells are in your gut. Unsurprisingly, cannabinoids engage with these immune cells and quiet inflammation in the bowels.
THC is also a well-known appetite stimulant. The cannabinoid triggers the release of hunger hormones and jump-starts the metabolism. So, not only do cannabinoids reduce gastrointestinal inflammation, but they also get your digestive juices flowing for an all-around improved eating experience.
For a simple analogy, you can think of cannabinoids as traffic policemen. These simple compounds direct the flow of communication hormones in and out of cells like a traffic cop at a jammed intersection. When they plug into the right place, THC and CBD act as tools to help your body stay regular and go with the flow.
Binding to specific cell receptors, cannabinoids have the ability to:
- Quell nausea and vomiting
- Relax muscles
- Relieve diarrhea
- Reduce inflammation
5. It Helps You Sleep
When your body is out of your control, sleeping through the night can be a daunting challenge. If you need to catch up on some quality sleep, a heavy indica will put your body and mind to rest. Cannabis helps you fall asleep faster and stay asleep longer.
A 2013 study of male cannabis smokers found that they had an easier time falling asleep. They also fell asleep faster and were more likely to have a sleep hangover the next day. A “sleep hangover” may not be great on a busy workday. But, patients that need a little extra rest may find this enjoyable.
Patients in pain also sleep better with cannabis. At least, according to a study conducted by British GW pharmaceuticals. GW Pharma tested the effects of CBD and THC on 2000 patients experiencing pain. The study found that participants got markedly better sleep and experienced less pain.
Cannabis also helps you sleep more deeply. Consuming THC before bed causes you to spend a little more time in deep sleep. During deep sleep, your body takes the time it needs to repair itself. This is when your body rebuilds bones and muscles. The immune system is also repaired during this sleep phase.
6. It Takes Away The Blues
It’s a well-known fact that weed has a way of lifting your spirits. It’s not surprising, then, to find that marijuana also eases rates of stress-related depression. Researchers at the University of Buffalo found that rats under chronic stress produce fewer endocannabinoids.
Endocannabinoids are compounds like THC and CBD that our bodies produce naturally. After finding rats with low levels of natural cannabinoids, researchers injected them with cannabis compounds.
Guess what happened? The surge of cannabinoids from marijuana increased the cannabinoids in their brain. This alleviated depression symptoms in the rats. Chronic stress is one of the primary causes of depression in adults. Unfortunately for MS patients, there’s rarely a shortage of it. Cannabis helps by easing away the blues, flooding your brain with the endocannabinoids it needs to eliminate symptoms.
7. It Protects Your Eyes
If you have MS, then you know it’s not uncommon for the disease to blur your vision. Some patients even go blind temporarily or have uncontrolled eye movements. Once again, inflammation is the culprit. In some cases, MS causes inflammation of the optic nerve. This causes you to lose some or all of your ability to see until the swelling subsides.
Cannabis may help reduce the disorienting effects of MS on your vision. In this case, cannabis reduces the inflammation of the optic nerve. Over time, this inflammation is degenerative. The herb has already been pinpointed as a potential treatment for many degenerative eye problems.
The cannabis plant is miraculous, but perhaps what’s even more miraculous is what this plant teaches us about ourselves. THC is a puzzle piece that stimulates systems in our bodies into action and helps them stay regular.
The systems affected by THC help regulate your appetite, your memory, your ability to sleep, and even the all-important immune system. All of these small systems are a part of a much larger endocannabinoid system. These vital functions are controlled and affected by the same chemicals and hormones: endocannabinoids.
As mentioned earlier, endocannabinoids occur naturally in bodies, while phytocannabinoids occur in plants.
Regardless of the illness or ailment, most cannabinoids function in the same basic way. By connecting with cells in your brain and your body, they change the ways that your cells communicate with one another. That is, they change the way cells give each other specific instructions.
The same thing happens when our own natural cannabinoids, like anandamide, connect to the same receptors on our cells–though with different outcomes.
In Multiple Sclerosis, cannabinoids work as such a broad sweeping treatments because they tap into this natural system. In those with MS, research suggests that this system has gone bunk. A 2007 study found that endocannabinoid activity was significantly altered in animal models of MS.
Additional research shows that endocannabinoids control spasticity in the disorder. By tapping into the endocannabinoid system, compounds like THC and CBD slow down the autoimmune reaction, stop inflammation, improve muscular control, and eliminate bodily side effects of MS.
In fact, studying how THC affects MS patients has taught us a lot about how the condition works. Because of cannabis, we now know that the endocannabinoid system plays a crucial role in mediating symptoms of the disorder.
These findings have spurred pharmaceutical companies like GW Pharma to use THC in prescription MS drugs. Sativex has been on the market in the United Kingdom for twelve years, and it’s used to treat MS-related muscle spasms and pain.
While the drug has spurred many headlines around the world, Sativex is more or less a fancy, pharmaceutical grade marijuana extract that has equal parts of activated THC and CBD; a 1:1 ratio.
Sativex is currently available outside the U.S. for the treatment of MS symptoms, and inside the U.S. the drug is in Phase III testing for cancer pain. So far, the company hasn’t submitted an application to use Sativex as a treatment for MS muscle spasms. For those who can’t access Sativex, you might want to consider some of these strains:
- One to One (this strain is the most like Sativex)
- Critical Mass
- Sour Tsunami
- Permafrost (High THC)
We’ve come a long way in cannabis science. Researchers around the world are making major headway on understanding cannabis as a treatment for MS. A cannabis-based MS drug is already on pharmacy shelves. Half of all U.S. states legally allow medical cannabis treatment for muscle spasticity. Overall, things are looking up.
National Multiple Sclerosis Association Position with Cannabis
Learn more about two issues that can have a profound impact on quality of life – pain and sleep disorders in MS – and about managing these problems, available treatment options, and research to identify the cause of pain and sleep disorders.Learn More From: http://www.nationalmssociety.org/
The question of whether marijuana — produced from the flowering top of the hemp plant, cannabis sativa — should be used for symptom management in multiple sclerosis (MS) is a complex one. It is generally agreed that better therapies are needed for distressing symptoms of MS — including pain, tremor and spasticity — that may not be sufficiently relieved by available treatments. Still, there are uncertainties about the benefits of marijuana relative to its side effects.
The Society supports the rights of people with MS to work with their MS health care providers to access marijuana for medical purposes in accordance with legal regulations in those states where such use has been approved. In addition, the Society supports advancing research to better understand the benefits and potential risks of marijuana and its derivatives as a treatment for MS.
Studies of note
On effects of cannabis on cognition / cognitive function in people with MS:
- 20 subjects with MS who smoked cannabis and 19 noncannabis users with MS, matched on demographic and neurologic variables, underwent functional magnetic resonance imaging (fMRI, which measures patterns of brain activity during performance of a task) while completing a test of working memory. The cannabis group performed more poorly on the more demanding tasks. (Neurology, 2014)
- 25 people with MS who regularly smoked or ingested street cannabis were tested and results compared to 25 people with MS who did not use cannabis. Users were tested at least 12 hours after last using cannabis so that intoxication was minimized. (Groups were matched and also differences were controlled for in terms of disease course and duration, age, gender, education and other factors.) The cannabis users were found to perform significantly worse on measures of information processing speed, working memory, executive functions and other cognitive functions, and were twice as likely as nonusers to be considered cognitively impaired. The study confirmed for the first time that cannabis can worsen cognitive problems in MS. (Neurology, 2012)
On oral cannabis/extract effect on spasticity and/or muscle stiffness:
- MS and Extract of Cannabis (MUSEC): Participants with stable MS were randomly assigned to receive oral cannabis extract (144 people) or placebo (135 people), and reported their perceptions of changes in muscle stiffness before and after 12 weeks of treatment. Muscle stiffness improved by almost twofold in the group taking cannabis compared to placebo, and improvements were also noted in body pain, spasms and sleep quality. The most frequent adverse events were urinary tract infections, dizziness, dry mouth and headache; no new safety concerns were observed. (NIH, 2012)
- Nabiximols—an oral spray derived from cannabis—(Sativex®, GW Pharmaceuticals) significantly improved spasticity in a proportion of people with MS who had been identified as likely to respond to the therapy. Well-controlled clinical trials such as this one help sort out conflicting findings surrounding the use of marijuana and related products to treat MS symptoms. Sativex is now available in 15 countries and approved in an additional 12 countries—not including the United States—to treat MS-related spasticity. (European Journal of Neurology, 2011)
- Effectiveness and long-term safety of cannabinoids in MS: 630 subjects with stable MS and muscle spasticity, from 33 UK centers, were randomly assigned to receive oral THC (tetrohydrocannabinol, an active ingredient in marijuana) , cannabis extract or placebo over 15 weeks. Oral derivatives of marijuana did not provide objective improvement in spasticity (as measured by a standardized assessment tool). However, significantly more participants in the treatment group reported subjective improvements in spasticity and pain (but not in tremor or bladder symptoms). In other words, participants reported feeling improvements that could not be confirmed by the study physicians. These findings were further complicated by the fact that the study became unblinded: unpleasant side effects made it clear to many patients that they were receiving the active drug rather than the placebo. (Journal of Neurology, Neurosurgery & Psychiatry, 2005)
On progression of MS: Effect of oral dronabinol (a synthetic Cannabis/marijuana derivative) on progression in progressive MS: Previous laboratory evidence has shown that cannabinoids might protect the nervous system. In this study, 329 people received at least one dose of dronabinol and 164 received at least one dose of placebo. Dronabinol had no overall effect on the progression of MS. (Lancet Neurology, 2013)
Guideline from American Academy of Neurology
The American Academy of Neurology (AAN), an association of neurologists and neuroscientists dedicated to promoting high-quality care for people with nervous system disorders, released a “Summary of evidence-based guideline: Complementary and alternative medicine in MS” in 2014, including the following conclusions on the evidence regarding marijuana and its derivatives:
- Oral cannabis extract and synthetic THC (tetrahydrocannabinol — a major active component of cannabis) are probably effective for reducing patient-reported symptoms spasticity and pain, but not MS-related tremor or spasticity measured by tests administered by the physician. For these cannabis derivatives the most commonly reported side effects were dizziness, drowsiness, difficulty concentrating and memory disturbance.
- Sativex oral spray (GW Pharmaceuticals) is probably effective for improving patient-reported symptoms of spasticity, pain and urinary frequency, but not bladder incontinence, MS-related tremor or spasticity measured by tests administered by the physician.
- Smoked cannabis research studies have not produced enough evidence to assess its safety or effectiveness for treating MS symptoms including spasticity, pain, balance, posture and cognition changes.
- The long-term safety of marijuana use for MS symptom management is not yet known.
Although marijuana is illegal at the federal level, federal legislation passed in 2015 clarified that the federal government would no longer use federal funds to enforce federal marijuana laws in states that permit medical marijuana use. This should reduce confusion in those states listed in the legislation where the use of marijuana was approved for medical-purposes-before-May,2014.
This legislation overturned the Supreme Court’s 2005 ruling that the federal government could prohibit and prosecute the possession and use of marijuana for medical purposes—even in the states where it was legal.
What is the Society’s position on the use of marijuana for medical purposes?
The Society supports the rights of people with MS to work with their health care provider to access marijuana for medical purposes in accordance with legal regulations in those states where such use has been approved. In addition, the Society supports the need for more research to better understand the benefits and potential risks of marijuana and its derivatives as a treatment for MS.
Although marijuana is still illegal at the federal level, federal legislation passed in 2015 clarified that the federal government would no longer use federal funds to enforce federal marijuana laws in states that enacted legislation prior to May 7, 2014 permitting medical marijuana use. This should reduce the existing legal confusion in those states listed in the legislation, where the use of marijuana was approved for medical purposes before May 2014.
Does the Society advocate for access to medical marijuana?
The National MS Society supports the ability of people living with MS to make an informed choice about their treatments, including the use of medical marijuana, with their MS health care providers. Recognizing that additional research is still needed, we are evaluating ways we can remove the barriers to allowing research on medical marijuana at the federal level, which is complex due to government restrictions. We advocate in support of legalizing medical cannabis at the state level.
What is the basis for the Society’s position?
In 2014, the American Academy of Neurology (AAN) released a “Summary of evidence-based guideline: Complementary and alternative medicine in multiple sclerosis.” The guideline was created by a panel of medical experts who evaluated all published research studies. Among studies of several forms of cannabis and its derivatives evaluated by the panel, evidence suggests:
- Oral cannabis extract and synthetic THC (tetrahydrocannabinol—a major active component of cannabis) are probably effective for reducing patient-reported symptoms of spasticity and pain, but not MS-related tremor or spasticity measurable by tests administered by the physician; and
- Sativex oral spray (GW Pharmaceuticals) is probably effective for improving patient-reported symptoms of spasticity, pain and urinary frequency, but not bladder incontinence, MS-related tremor or spasticity measurable by tests administered by the physician.
The AAN findings state that smoked cannabis research studies have not produced enough evidence to assess its safety or effectiveness for treating MS symptoms including spasticity, pain, balance, posture and cognition changes.
Oral cannabis extract, THC and Sativex are not currently approved by the US Food and Drug Administration (FDA) for use by people with MS. The FDA has approved only two forms of marijuana for medical use: dronabinol (Marinol) and nabilone (Cesamet). Dronabinol also is approved for loss of appetite associated with weight loss in patients with AIDS. At this time, the drugs are not approved for other uses.
Marijuana is a complex substance which may contain many different components affecting the body. Production of marijuana for medical use is not standardized or supervised by the FDA or any other agency for its quality, purity, or specific ingredients, hence, the effects of different batches of marijuana may not be the same.
The guideline notes that cannabis usage, as with any therapy, may result in both potential benefits and potential side effects. For these cannabis derivatives, the most commonly reported side effects were dizziness, drowsiness, difficulty concentrating and memory disturbance. The guideline also points out that the long-term safety of cannabis use for MS symptom management is not yet known. Back to top
What have been the findings to date of research funded in this area by the Society?
The Society is supporting a clinical trial of different forms of cannabis products to test their ability to relieve spasticity in people with MS. Unfortunately, completion of this trial has been delayed due to challenges with recruiting patients able to adhere to the significant government requirements for trials using cannabis products.
The Society is committed to funding additional research with cannabis products and to addressing government regulations that may be impeding research progress.
Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis
- David J. Rog, BMBS,
- Turo J. Nurmikko, PhD,
- Tim Friede, PhD and
- Carolyn A. Young, MD
From the Walton Centre for Neurology and Neurosurgery (Drs. Rog and Young), Liverpool, University of Liverpool (Drs. Rog, Nurmikko, and Young); Pain Research Institute (Dr. Nurmikko), Liverpool; Medical Statistics Unit (Dr. Friede), Lancaster University, Lancaster, United Kingdom.
- doi: http://dx.doi.org/10.1212/01.wnl.0000176753.45410.8b Neurology September 27, 2005 vol. 65 no. 6 812-819
Background: Central pain in multiple sclerosis (MS) is common and often refractory to treatment.
Methods: We conducted a single-center, 5-week (1-week run-in, 4-week treatment), randomized, double-blind, placebo-controlled, parallel-group trial in 66 patients with MS and central pain states (59 dysesthetic, seven painful spasms) of a whole-plant cannabis-based medicine (CBM), containing delta-9-tetrahydrocannabinol:cannabidiol (THC:CBD) delivered via an oromucosal spray, as adjunctive analgesic treatment. Each spray delivered 2.7 mg of THC and 2.5 of CBD, and patients could gradually self-titrate to a maximum of 48 sprays in 24 hours.
Results: Sixty-four patients (97%) completed the trial, 34 received CBM. In week 4, the mean number of daily sprays taken of CBM (n = 32) was 9.6 (range 2 to 25, SD = 6.0) and of placebo (n = 31) was 19.1 (range 1 to 47, SD = 12.9). Pain and sleep disturbance were recorded daily on an 11-point numerical rating scale. CBM was superior to placebo in reducing the mean intensity of pain (CBM mean change −2.7, 95% CI: −3.4 to −2.0, placebo –1.4 95% CI: −2.0 to −0.8, comparison between groups, p = 0.005) and sleep disturbance (CBM mean change –2.5, 95% CI: −3.4 to −1.7, placebo –0.8, 95% CI: −1.5 to −0.1, comparison between groups, p = 0.003). CBM was generally well tolerated, although more patients on CBM than placebo reported dizziness, dry mouth, and somnolence. Cognitive side effects were limited to long-term memory storage.
Conclusions: Cannabis-based medicine is effective in reducing pain and sleep disturbance in patients with multiple sclerosis related central neuropathic pain and is mostly well tolerated.
Letters to Nature
Nature 404, 84-87 (2 March 2000) | doi:10.1038/35003583; Received 18 August 1999; Accepted 20 January 2000
Cannabinoids control spasticity and tremor in a multiple sclerosis model
- Neuroinflammation Group, Department of Neurochemistry, Institute of Neurology, University College London, 1 Wakefield Street, London WC1N 1PJ and the Institute of Ophthalmology, UCL, London EC1V 9EL, UK
- The Medical Research Council Human Movement and Balance Unit, National Hospital for Neurology and Neurosurgery , Queen Square, London, WC1N 3BG, UK
- Department of Biomedical Sciences, Institute of Medical Sciences, University of Aberdeen, Foresterhill , Aberdeen AB25 2ZD, UK
- Department of Chemistry, Clemson University, Clemson, South Carolina 29634-1905 , USA
- Multiple Sclerosis Society of Great Britain and Northern Ireland , 25 Effie Road, London SW6 1EE, UK
Correspondence to: Correspondence and requests for materials should be addressed to D.B. (e-mail: Email: D.Baker@ion.ucl.ac.uk).
Chronic relapsing experimental allergic encephalomyelitis (CREAE) is an autoimmune model of multiple sclerosis1. Although both these diseases are typified by relapsing-remitting paralytic episodes, after CREAE induction by sensitization to myelin antigens1 Biozzi ABH mice also develop spasticity and tremor. These symptoms also occur during multiple sclerosis and are difficult to control. This has prompted some patients to find alternative medicines, and to perceive benefit from cannabis use2. Although this benefit has been backed up by small clinical studies, mainly with non-quantifiable outcomes3, 4, 5, 6, 7, the value of cannabis use in multiple sclerosis remains anecdotal. Here we show that cannabinoid (CB) receptor agonism using R(+)-WIN 55,212, 9-tetrahydrocannabinol, methanandamide and JWH-133 (ref. 8) quantitatively ameliorated both tremor and spasticity in diseased mice. The exacerbation of these signs after antagonism of the CB1 and CB2 receptors, notably the CB1 receptor, using SR141716A and SR144528 (ref. 8) indicate that the endogenous cannabinoid system may be tonically active in the control of tremor and spasticity. This provides a rationale for patients’ indications of the therapeutic potential of cannabis in the control of the symptoms of multiple sclerosis2, and provides a means of evaluating more selective cannabinoids in the future.
LANCET Volume 362, Issue 9395, 8 November 2003, Pages 1517–1526
Fast track — Articles
Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial
- Dr John Zajicek, FRCPa, , ,
- Patrick Fox, MDa,
- Hilary Sanders, BScb,
- David Wright, PhDb,
- Jane Vickery, BSca,
- Prof Andrew Nunn, MScc,
- Prof Alan Thompson, FRCPd,
- on behalf of the UK MS Research Group
- a Peninsula Medical School, Plymouth, UK
- b School of Mathematics and Statistics, University of Plymouth, Plymouth, UK
- c Medical Research Council Clinical Trials Unit, London, UK
- d National Hospital for Neurology and Neurosurgery, University College Hospitals, London, UK
Available online 7 November 2003
Multiple sclerosis is associated with muscle stiffness, spasms, pain, and tremor. Much anecdotal evidence suggests that cannabinoids could help these symptoms. Our aim was to test the notion that cannabinoids have a beneficial effect on spasticity and other symptoms related to multiple sclerosis.
We did a randomised, placebo-controlled trial, to which we enrolled 667 patients with stable multiple sclerosis and muscle spasticity. 630 participants were treated at 33 UK centres with oral cannabis extract (n=211), Δ9-tetrahydrocannabinol (Δ9-THC; n=206), or placebo (n=213). Trial duration was 15 weeks. Our primary outcome measure was change in overall spasticity scores, using the Ashworth scale. Analysis was by intention to treat.
611 of 630 patients were followed up for the primary endpoint. We noted no treatment effect of cannabinoids on the primary outcome (p=0·40). The estimated difference in mean reduction in total Ashworth score for participants taking cannabis extract compared with placebo was 0·32 (95% CI −1·04 to 1·67), and for those taking Δ9-THC versus placebo it was 0·94 (−0·44 to 2·31). There was evidence of a treatment effect on patient-reported spasticity and pain (p=0·003), with improvement in spasticity reported in 61% (n=121, 95% CI 54·6–68·2), 60% (n=108, 52·5–66·8), and 46% (n=91, 39·0–52·9) of participants on cannabis extract, Δ9-THC, and placebo, respectively.
Treatment with cannabinoids did not have a beneficial effect on spasticity when assessed with the Ashworth scale. However, though there was a degree of unmasking among the patients in the active treatment groups, objective improvement in mobility and patients’ opinion of an improvement in pain suggest cannabinoids might be clinically useful.