Latest on Spasticity: the untreated symptom of Multiple Sclerosis
Spasticity affects more than three-quarters of individuals who have multiple sclerosis (MS) during their lifetime, but this symptom is often untreated and underappreciated by the medical community. A non-smoking form of marijuana has been found to be quite effective in managing spasticity and the related pain.
MS and marijuana
Spasticity is one of the more common and distressing symptoms of MS. The stiffness and involuntary muscle spasms can range from mild to severe and cause significant pain in the legs, joints, and lower back, although it can occur in any limb.
Because spasticity varies greatly from person to person and can be triggered by numerous factors, treatment is a challenge. Daily exercise and stretching are often helpful as are antispasticity drugs (baclofen, tizanidine) and less commonly used drugs (diazepam, dantrolene, botulinum toxin), but none of these approaches can cure spasticity.
One other treatment that has produced good results is marijuana. In a new article appearing in Expert Review of Neurotherapeutics, the author explains that smoking marijuana is one option for spasticity relief and related neuropathic pain, but that psychoactive side effects have been a hurdle.
Another form of marijuana, however, has proven itself to be effective and to cause only mild side effects. Sativex® is an oral spray that relieved spasticity within four weeks of starting treatment in up to 50 percent of individuals who were resistant to other oral antispasticity drugs.
In clinical practice, an average of less than 7 sprays per day relieved spasticity in about 70 percent of individuals who previously had not responded to other treatments. In addition, the patients experienced marked improvement in sleep problems, cramps, loss of mobility, and bladder problems.
Large studies of patients who used Sativex have shown that more than 80 percent of the users had no side effects. When adverse effects did occur, they included mild to moderate dizziness and sleepiness.
The reviewer also explained that patients who had responded to Sativex continued to do well on the same dose for at least 12 months without a need to increase it.
Sativex has already been approved in New Zealand, Canada, and eight European countries (including the UK) for treatment of spasticity in MS. The US Food and Drug Administration (FDA), however, has not approved Sativex, although it is being used in clinical trials as an add-on treatment for people with advanced cancer.
Unlike other marijuana-based drugs on the market, Sativex consists of two marijuana compounds, delta 9-THC (which has psychotropic properties) and cannabidiol (which does not) and not synthetic ingredients. The ratio of THC to cannabidiol is 1:1, which the manufacturer (GW Pharmaceuticals) says results in a drug that has a much reduced chance of side effects associated with THC (e.g., anxiety, flash backs, dry mouth, headache, rapid heart beat).
The combination of THC and cannabidiol also is said to enhance the benefits of THC. Because the drug is a spray, it prevents THC from entering the bloodstream too quickly and thus reduces the chances of psychotropic side effects.
Other studies of MS and marijuana
A number of other studies have examined the impact of marijuana on MS symptoms, including spasticity. One from the University of California Los Angeles reported that MS patients who smoked marijuana had results that were “superior to placebo in reducing symptoms and pain in patients with treatment-resistant spasticity.”
In another study conducted at the University of Plymouth, marijuana extract capsules containing both THC and cannabidiol were compared with placebo for their effect in relieving muscle stiffness. A total of 279 patients participated.
Overall, muscle stiffness declined in 29 percent of individuals who took the capsules compared with 16 percent who took placebo. Muscle spasms improved in 31 percent of those who used marijuana compared with only 13 percent of those in the placebo group. Side effects among the marijuana users included balance problems, dizziness, dry mouth, fatigue, confusion, nausea, and urinary tract infections and were mostly seen when the THC dose was increased.
Marijuana in various forms appears to provide significant advantages for MS patients. The oral spray form, however, seems to be especially beneficial since it delivers good results for spasticity without nearly as many side effects. However, availability of this marijuana treatment for spasticity in MS remains a problem.
Pozzilli C. Advances in the management of multiple sclerosis spasticity: experiences from recent studies and everyday clinical practice. Expert Review of Neurotherapeutics 2013 Dec; 13(12 Suppl): 49-54