A to Z of MS Cannabis

There have been anecdotal reports and some research suggesting that cannabis might be useful for multiple sclerosis symptoms such as pain, spasticity and bladder problems.

Cannabis is known to work through cannabinoid receptors in the brain. Cannabis plants contain more than 60 different cannabinoids which can affect these receptors, although only some of these are believed to help in MS.

The majority of research trials have focused on relieving symptoms of MS.

The CAMS study, which involved 660 participants around the UK, looked at the effect of cannabis on various symptoms of MS, primarily on spasticity. Results of this study were mixed, with no significant effect on spasticity as measured by the Ashworth scale. However, some improvement was shown on the time taken to complete a 10-metre walk and patient satisfaction was high.

A systematic review published in December 2009 found that five out of six double-blind, randomized controlled trials reported a decrease in spasticity and improved mobility in people with MS taking a combination of the cannabis extracts Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD). All of the studies reported some side effects which seemed to be related to the dosage. Generally the treatment was well-tolerated.

The ongoing CUPID trial is looking to see whether cannabis might have a more important role in protecting the brain from damage by multiple sclerosis, a concept called neuroprotection.

Sativex

In June 2010, Sativex, a cannabis based mouth spray, received its UK licence as an add-on treatment for moderate to severe MS spasticity in people who receive inadequate relief from the standard oral anti-spasticity medicines or have experienced unbearable side effects whilst taking these medicines. Prior to licensing, Sativex had been studied for its effects on a number of MS related symptoms including: spasticity and spasms, pain, bladder symptoms, tremor, and sleep disturbance.

References

Zajicek J, et al.
Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial.
Lancet. 2003 Nov 8;362(9395):1517-1526.
abstract

Lakhan SE, Rowland M.
Whole plant cannabis extracts in the treatment of spasticity in multiple sclerosis: a systematic review.
BMC Neurology 2009;9:59
Read article

Collin C, et al.
Randomised controlled trial of cannabis-based medicine in spasticity caused by multiple sclerosis.
European Journal of Neurology 2007; 14: 290-296.
abstract

Wade DT, et al.
Do cannabis-based medicinal extracts have general or specific effects on symptoms of multiple sclerosis? A double-blind randomised, placebo-controlled study on 160 participants.
Multiple Sclerosis 2004; 10(4): 434-441.
abstract

Wade DT, et al.
Long-term use of a cannabis-based medicine in the treatment of spasticity and other symptoms in multiple sclerosis.
Multiple Sclerosis 2006; 12(5): 639-645.
abstract

Rog DJ, et al.
Randomised controlled trial of cannabis-based medicine in central pain in multiple sclerosis.
Neurology 2005; 65(6): 812-819.
abstract

de Ridder D, Constantinescu C.
Randomised controlled study of cannabis based medicine in patients suffering from multiple sclerosis associated detrusor overactivity.
Poster 411 presented at the 22nd Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS 2006), Spain.

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