Cannabis Extracts “Improve Pain, Bladder Control and Muscle Spasms in M.S. Patients”
Ever since the term medical marijuana erupted on the cannabis scene, along with the recent discovery of the largest neurotransmitter system in the body — the endocannabinoid system — one disease in particular has garnered much media and medical attention.
That disease is multiple sclerosis commonly referred to as MS. The reasons I believe will become self-evident as we delve into the research that has been performed using cannabis extracts or other preparations to treat the myriad signs and symptoms of this complex disease.
There has been an explosion of research using cannabis preparations in treating MS over the last decade or so, much of it using gold-standard techniques. Once again, this information is available to those government officials who insist that pot has no medical applications. A quick Google Scholar search reveals over 145 results. In it, there are dozens of studies that clearly demonstrate a viable, and effective alternative treatment strategy using marijuana to treat MS.
In fact, the UK’s pharmaceutical firm GW Pharmaceuticals, whose stock has recently skyrocketed, has their own studies to back up using their proprietary mixture of a one to one THC:CBD formula called Sativex®.
But, before we dive into the research let me define for you what exactly MS is. We have all heard the term before since it is one of the most common neurological disorders around.
Let’s head over to the National Multiple Sclerosis Society for a workable definition:
Multiple sclerosis (MS) involves an immune-mediated process in which an abnormal response of the body’s immune system is directed against the central nervous system (CNS), which is made up of the brain, spinal cord and optic nerves. The exact antigen — or target that the immune cells are sensitized to attack — remains unknown, which is why MS is considered by many experts to be “immune-mediated” rather than “autoimmune.”
- Within the CNS, the immune system attacks myelin — the fatty substance that surrounds and insulates the nerve fibers — as well as the nerve fibers themselves.
- The damaged myelin forms scar tissue (sclerosis), which gives the disease its name.
- When any part of the myelin sheath or nerve fiber is damaged or destroyed, nerve impulses traveling to and from the brain and spinal cord are distorted or interrupted, producing a wide variety of symptoms.
- The disease is thought to be triggered in a genetically susceptible individual by a combination of one or more environmental factors.
People with MS typically experience one of four disease courses, which can be mild, moderate or severe.
Briefly, the possible outcomes depend on which type of disease course the patient takes. It can be an isolated form which does not meet the criteria for full-blown MS but does share some initial symptoms.
There is also Relapsing-remitting MS (RRMS) which is the most common presentation. As the name implies, the patient experiences relapses with often times complete recovery or remissions without any apparent progression in between (see figure below).
The next form called Primary Progressive MS (PPMS) is characterized by worsening neurologic function (accumulation of disability) from the onset of symptoms, without early relapses or remissions (see below).
Finally, we have secondary progressive MS (SPMS).
SPMS follows an initial relapsing-remitting course. Most people who are diagnosed with RRMS will eventually transition to a secondary progressive course in which there is a progressive worsening of neurologic function (accumulation of disability) over time (see figure below).
EXAMPLES OF COMMON SYMPTOMS OF MS
Due to the nature of this disease, there are dozens of differing symptoms since it can strike virtually anywhere in the CNS. Some of the more common symptoms include:
- Spasticity including muscle spasms
- Bladder problems
- Difficulty walking/sexual problems
- Disturbed sleep/insomnia
- There are another dozen symptoms or more
PREVALENCE/INCIDENCE OF MS IN THE UK AND THE WORLD
Prevalence: the number of people with a condition. Usually measured in cases per 100,000
Incidence: the number of new cases of a condition within a set period of time, usually a year
There are an estimated 2,500,000 people with MS in the world. The distribution of MS around the world is uneven. The disease prevalence tends to increase as we head either north or south of the equator. So people tend to have much more MS in Canada and Scotland versus folks living in equatorial regions such as Thailand. But it’s hard to pinpoint exactly how many people in the UK have this disorder.
There is currently no accurate data on the exact number of people with MS in the UK. A study by McKenzie et al at the University of Dundee worked out a figure based on coding in GP records. This gave a figure of 127,000 people with MS in the UK in 2010.
What this tells us is that, in spite of the fact that we don’t have exact numbers, there are plenty of people living in the UK and the rest of Europe suffering from this dreaded disease.
ENTER GW PHARMACEUTICALS
Using GW Pharmaceuticals patented formulation Sativex®, Yahiya Y. Syed et al, published a clinical trial in 2014 which demonstrated a significant, over 30%, reduction in spasticity in the experimental group. The title: ‘Delta-9 Tetrahydrocannabinol/Cannabidiol (Sativex®): A Review of Its Use in Patients with Moderate to Severe Spasticity Due to Multiple Sclerosis.’
In the largest multinational clinical trial that evaluated the approved THC/CBD regimen in this population, 12 weeks’ double-blind treatment with THC/CBD significantly reduced spasticity severity (primary endpoint) compared with placebo in patients who achieved a clinically significant improvement in spasticity after 4 weeks’ single-blind THC/CBD treatment, as assessed by a patient-rated numerical rating scale… A significantly greater proportion of THC/CBD than placebo recipients achieved a ≥30 % reduction (a clinically relevant reduction) in spasticity severity.
There is a wonderful review summary (P. J. Robson) that I highly recommend reading since it covers many symptoms of MS that are therapeutic targets for Sativex or any THC/CBD combination.
Author P. J. Robson in his elegant 2014 review (available on www.wileyonlinelibrary.com) entitled ‘Therapeutic potential of cannabinoid medicines’ had this to say in reference to using Sativex®:
Exploratory trials in several hundred patients consistently showed significant advantages for Sativex® over placebo in the relief of spasticity, chronic pain, muscle spasms, bladder-related problems and sleep quality which appeared to be maintained over long-term treatment, and the medicine was generally well tolerated.
Robson refers to the largest study accomplished so far which lead to the approval of this drug for commercial use as an adjunct therapy for MS:
The largest study of Sativex® published to date…(Novotna et al), recruited 572 refractory MS patients into a 4-week, single-blind period of treatment with Sativex® in addition to their existing medicine. Only those subjects who demonstrated at least a 20% improvement from baseline in spasticity over this period progressed into the second phase of the study. These subjects (n = 272) entered a 12-week, randomized, parallel group double-blind comparison of Sativex® and placebo. A highly significant (p = 0.0002) benefit in spasticity score (NRS) was reported for Sativex® in comparison with placebo, along with significant improvements in spasm frequency, sleep disturbance and global impression of change. Overall, the adverse event rate was similar between Sativex® and placebo, the most common events on the active drug being vertigo, fatigue, muscle spasms and urinary tract infection. On the basis of the collective results, Sativex® was granted regulatory approval in the UK and Spain for the treatment of MS spasticity in 2010 and subsequently in a further 19 countries…. Although there are as yet no clinical data, there is growing evidence from laboratory studies that THC and other cannabinoids, notably CBD, have neuroprotective properties as a result of their anti-oxidant, anti-inflammatory and anti-excitotoxic properties which may prove disease modifying in MS and other neurodegenerative conditions.
I should remind you that double-blinded, placebo controlled studies are the very best quality studies in medical research. Therefore, these clinical trials easily provide proof of efficacy of THC with CBD to significantly ameliorate many symptoms of MS.
In another recent publication Dr. Grotenhermen summarized the previous catalog of cannabis research. In it he clearly shows its value in treating MS.
F Grotenhermen et al., in 2012 published ‘The therapeutic potential of cannabis and cannabinoids.’
More than 100 controlled clinical trials of cannabinoids or whole-plant preparations for various indications have been conducted since 1975. The findings of these trials have led to the approval of cannabis-based medicines (dronabinol, nabilone, and a cannabis extract [THC:CBD=1:1]) in several countries. In Germany, a cannabis extract was approved in 2011 for the treatment of moderate to severe refractory spasticity in multiple sclerosis. It is commonly used off label for the treatment of anorexia, nausea, and neuropathic pain…The most common side effects of cannabinoids are tiredness and dizziness (in more than 10% of patients), psychological effects, and dry mouth. Tolerance to these side effects nearly always develops within a short time. Withdrawal symptoms are hardly ever a problem in the therapeutic setting.
Conclusion: There is now clear evidence that cannabinoids are useful for the treatment of various medical conditions.
In summary, examining the very latest medical publications of clinical trials using THC/CBD preparations to treat MS over the last four years, we see overwhelmingly positive results in relieving many differing symptoms of MS. This provides the clinical proof needed to convince legislators of the efficacy of cannabis, and to inform patients suffering from MS that cannabis may indeed be an effective option.
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