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Cbd oil for spasticity in ms

Cbd oil for spasticity in ms

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Cannabis Extract Improves Spasticity Without Increasing Weakness in Patients With MS

A pooled analysis of three randomized trials of nabiximols helps lay the groundwork for an FDA submission in 2021. Approval would yield the first novel treatment for spasticity in multiple sclerosis in many years.

Cannabis Extract Improves Spasticity Without Increasing Weakness in Patients With MS

Cannabinoid oromucosal spray is poised for FDA submission in 2021

Nabiximols, a complex botanical medication formulated from extracts of the cannabis plant, improves spasticity in patients with multiple sclerosis (MS) without producing the accompanying muscle weakness sometimes observed with other antispasticity medications, according to an analysis of three European studies.

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“There also was no notable decrease in patients’ preferred walking speed,” reports Francois Bethoux, MD, of Cleveland Clinic’s Mellen Center for Multiple Sclerosis Treatment and Research. Although he did not participate in the studies analyzed, as an MS rehab expert and a consultant to GW Pharmaceuticals/Greenwich Biosciences, Dr. Bethoux was asked to present the European data at the virtual 2020 annual assembly of the American Academy of Physical Medicine & Rehabilitation in November.

An established spasticity therapy in many nations

Nabiximols is approved in over 25 countries outside the United States under the brand name Sativex ® and is self-administered as an oral spray. “It’s been many years since there has been a new treatment for spasticity in MS with a unique mechanism of action, so this drug would be a welcome addition to our armamentarium,” says Dr. Bethoux, who also serves as Chair of Cleveland Clinic’s Department of Physical Medicine & Rehabilitation. “In addition, nabiximols can be taken several times a day on an as-needed and as-tolerated basis, while currently available antispasticity agents are generally given on a schedule. This gives patients an opportunity to adjust the dosing schedule based on their needs.”

The cannabis extracts tetrahydrocannabinol (THC) and cannabidiol (CBD) are primary components of the medication, and work via the endocannabinoid system. For instance, THC has been observed to impact CB1 and CB2 receptors, which can be found in the nociceptive and spasticity pathways of the brain and spinal cord, as well as in the peripheral nervous system.

“Published reports suggest that a large number of persons with MS have used or currently use cannabis to help relieve symptoms related to spasticity,” observes Dr. Bethoux, “so it is not a surprise that a cannabis extract could be efficacious.” He notes that Cleveland Clinic, like many other health systems, has a policy that prohibits clinicians from condoning or making referrals to medical marijuana providers, so the availability of a regulated prescription option could be helpful to both patients and clinicians.

European trial results

Dr. Bethoux’s presentation focused on an analysis of three randomized controlled trials conducted at European hospitals involving more than 500 patients assigned to receive either nabiximols or placebo. All subjects had MS and spasticity that was not adequately controlled by current medications.

All three trials, which lasted from six to 16 weeks, evaluated spasticity using the Numeric Rating Scale (NRS). Two trials each evaluated muscle strength using the Motricity Index (MI) for legs, and two assessed mobility via the timed 10-Meter Walk Test. Two of the studies used an enriched trial design, in which patients were treated with single-blind nabiximols in phase A. Subjects who reported at least a 20% improvement in spasticity on the NRS were then randomized to nabiximols or placebo in phase B. The aim was to identify any correlation between spasticity and muscle strength or walking speed during the randomized portions of the studies.

Each of the trials demonstrated a statistically significantly greater improvement in spasticity from baseline with nabiximols compared with placebo, with treatment differences of 0.52 to 1.9 points on the NRS in favor of nabiximols.

Notably, the improvement in spasticity was not accompanied by an increase in muscle weakness or a change in walking speed. There was no meaningful association between change in spasticity on the NRS and change in MI score, according to Dr. Bethoux, and there was a weak-to-negligible correlation between change in spasticity on the NRS and change in preferred walking speed.

Imminent launch of US trials

The European trials were sponsored by GW Pharmaceuticals/Greenwich Biosciences, which owns the commercial rights to nabiximols in the United States. The company is in the process of launching five phase 3 clinical trials of the compound in the United States, with plans to use data from one of those trials and the three European studies from the current analysis to submit a New Drug Application to the FDA in mid-2021.

“Quite a few studies of nabiximols have been conducted in addition to the three I presented,” says Dr. Bethoux, who adds that many have been completed in Europe. “Some have been sponsored by the company, and others have been initiated by investigators independently to look into side effects and patient perceptions of nabiximols.” He notes that these studies have found the medication to be well tolerated and have revealed no concerning safety signals.

“However, we will be looking to see if nabiximols affects cognitive function, since marijuana can impair memory and processing speed,” Dr. Bethoux observes. “Importantly, nabiximols has not been found to impact the ability to drive safely, which has been a concern with the use of cannabis.”

CBD Oil and MS: Is Cannabis Oil a Miracle for Multiple Sclerosis?

CBD — short for cannabidiol — has a long list of well-documented health benefits. People use CBD oil to improve general well-being and to alleviate a wide range of symptoms, from anxiety to pain, inflammation, and neurological problems.

However, some areas where CBD could potentially help, are yet to be thoroughly examined.

Such is the case of using CBD oil for multiple sclerosis (MS).

Many MS patients are successfully taking cannabidiol, claiming it helps with their symptoms and repairs damaged nerves.

Current research shows that extracts like CBD oil can be effective in reducing pain and spasms in MS patients.

But can CBD oil actually treat multiple sclerosis?

Unfortunately, the research is still inconclusive. In this article, we’ll cover the most important aspects of using CBD oil for MS — including the benefits, different consumption methods, and possible side effects.

What is Multiple Sclerosis?

Multiple Sclerosis is a self-aggressive disease where the body’s immune system attacks the central nervous system (CNS). Scientists are still trying to discover the exact cause of MS; however, the general consensus is that this disease may be triggered by a combination of genetic and environmental factors.

Currently, about 2.3 million people in the US suffer from MS. The majority of diagnosed patients are between their 20s and 50s — it’s unclear why some people have this condition while others don’t.

Multiple Sclerosis damages the protective layer around nerve fibers (myelin). When the CNS notices the patches of scars left behind by an aggressive immune system, it starts to send false signals to the brain — leading to an array of symptoms.

In some people, these symptoms are relatively mild like extensive fatigue, while other cases involve severe pain, involuntary muscle cramps, impaired memory and focus, and vision problems.

When left untreated, multiple sclerosis may result in partial or complete paralysis.

Types of Multiple Sclerosis

There are 4 main forms of multiple sclerosis based on the type and severity of symptoms:

Relapsing-Remitting (RRMS)

This is the most prevalent type of MS and affects about 85% of patients diagnosed with MS.

People with RRMS suffer from periodical fare-ups that exacerbate their symptoms, followed by silent periods where the patient remains symptom-free until the next flare-up.

Secondary-Progressive (SPMS)

For SPMS sufferers, symptoms deteriorate over time but without flare-ups. In most cases, RRMS transforms into SPMS.

Primary-Progressive (PPMS)

A less common form of MS, primary-progressive multiple sclerosis affects about 10% of all MS patients.

This form of the disease is marked by worsening symptoms from the beginning, without flare-ups or remissions typical to other types of MS.

Progressive-Relapsing (PRMS)

This is the rarest form of MS and occurs in about 5% of MS sufferers. The symptoms of PRMS worsen steadily over time, with flare-ups and acute relapses but without remission periods.

What is CBD Oil?

CBD oil is a concentrated CBD extract made from cannabis plants — both hemp and marijuana.

CBD is a cannabinoid — a naturally occurring phytochemical — and the second-most recognized active ingredient of cannabis.

Unlike the most popular cannabinoid, delta-9-tetrahydrocannabinol (THC), CBD is non-psychoactive and thus won’t get you high. This makes CBD legal in most countries across the world.

The lack of psychoactive effects doesn’t make it an inferior cannabinoid. On the contrary, CBD has a long list of well-documented health benefits with only a few mild side effects. Cannabis advocates argue that CBD can help with virtually any condition deriving from a compromised endocannabinoid system (ECS) — the prime neurochemical network in our bodies.

Most CBD stuff sold online and in local dispensaries comes from hemp plants, which takes us to the next question.

How is CBD Hemp Oil Different from Medical Marijuana?

The main difference between CBD from hemp and medical marijuana is the aforementioned THC content.

Hemp plants are high in CBD and very low in THC. The THC content of hemp plants is usually below 0.3%, which isn’t enough to produce any psychoactive effects.

On the other hand, marijuana has high THC levels and doesn’t offer much CBD. However, some strains are specifically bred to achieve higher CBD levels at the cost of some THC.

Still, you won’t buy marijuana products in your local head shop or health store as marijuana remains a controlled substance according to federal law. You can buy medical marijuana if you live in a state that runs a medical marijuana program.

CBD oil from hemp is legal in all 50 states. You can find it in cannabis dispensaries, head shops, and online stores. You don’t need a doctor’s prescription to try CBD oil for multiple sclerosis.

Different Ways to Take CBD Oil for Multiple Sclerosis

If you’re considering trying CBD oil for your MS symptoms, it is available in the form of oil drops, tinctures, sprays, capsules, and edibles, which can be ingested, as well as vape products and creams for topical use.

Can CBD Oil Help With Multiple Sclerosis?

Dr. Ben Thrower, a physician at the Shepherd Center in Atlanta, GA, is very optimistic about using CBD oil for multiple sclerosis, but at the same time, he underlines the importance of THC in the treatment.

“Many of our MS patients have used hemp-based CBD products with 0.3 percent THC or less (…) For the management of spasticity/spasms or burning pain (central neuropathic pain), I have found that most patients need higher THC concentrations.”

THC is a well-known pain reliever — this may explain the need for higher levels of THC in CBD products for treating MS symptoms.

However, Thrower points to CBD topicals as a potential solution for fighting localized pain in MS patients

“Some patients do find relief with Low-THC, CBD lotions applied topically,” said Thrower.

What Does the Research Say About Using CBD Oil for Multiple Sclerosis

In a 2009 study, researchers investigated previous reports from MS patients who used cannabis for their symptoms to find out whether a mix of CBD and THC may reduce spasticity associated with MS.

Each of the analyzed papers focused on testing THC and CBD in capsules and oral sprays. These products generally involved more THC than CBD, which resulted in a trend of reduced spasticity.

Researchers also concluded that THC/CBD solutions are well tolerated by patients and that the experienced side effects didn’t always stem from using cannabis alone.

In 2016, researchers were looking at how a pharmaceutical spray Sativex might reduce muscle spasms in MS sufferers.

Sativex is an oral solution made from CBD and THC in a 1:1 ratio. The spray was developed to reduce neuropathic pain, overactive bladder, spasticity, and other common symptoms of multiple sclerosis.

Researchers examined self-reported data from several hundred MS patients who were using the drug for one year. Results showed a 20% improvement in muscle spasticity for 70% of subjects and a 30% improvement in 28% of patients.

For about 39% of patients, the treatment was ineffective. Although those patients dropped out of the study, the results do provide evidence to support further research on cannabinoids for multiple sclerosis.

Finally, there’s a 2018 research review that analyzed existing studies to find indirect that CBD, along with other cannabinoids, can improve the mobility of MS patients.

The paper focused mostly on a high CBD to THC ratio as the potential reliever of muscle spasms and pain in MS patients. It also discussed how cannabis reduces inflammation, contributing to less fatigue in subjects.

Because CBD oil may be able to alleviate so many symptoms of multiple sclerosis — pain, spasticity, inflammation, and fatigue — it’s reasonable to assume that CBD can have a positive impact on mobility in MS patients.

What Are the Side Effects of Using CBD Oil for Multiple Sclerosis?

When it comes to unwanted reactions to CBD, Thrower said there are very few. They’re also uncommon and generally considered mild.

“I have found the side effect profile of these products to be less than some of the prescription medications,” he added. “CBD/THC products tend to be far less sedating than Baclofen or Tizanidine, which are [muscle relaxants] traditionally used for spasticity,” he added.

Most often, taking too much CBD oil results in a dry mouth, lowered blood pressure, and dizziness. In very rare cases, high doses of CBD oil can trigger diarrhea.

Key Takeaways: What You Need to Know About Using CBD Oil for MS

So, there you have it — everything we know about using CBD oil for MS so far.

Let’s summarize the article in a nutshell:

  • CBD can be effective in reducing pain and spasms in multiple sclerosis patients
  • However, CBD alone has limited potential for relieving MS.
  • It appears that adding THC significantly improves the therapeutic properties of CBD
  • Some people can have negative reactions to the psychoactive effects of THC, especially if their symptoms call for higher doses of medical cannabis oil.
  • Moreover, equal ratios of CBD to THC may not work for certain people, as studies have shown.
  • Full-spectrum cannabis extracts with higher ratios of CBD to THC may be able to relieve a wider range of symptoms and improve mobility in MS patients.
  • Hemp-derived CBD topicals may be effective in reducing localized pain and inflammation during flare-ups.

I hope this article has helped you understand how cannabinoids work for specific MS symptoms. As always, make sure to contact your GP before taking any CBD product, especially if you’re already taking prescribed medications cannabidiol can interact with.

Nina Julia

Nina created CFAH.org following the birth of her second child. She was a science and math teacher for 6 years prior to becoming a parent — teaching in schools in White Plains, New York and later in Paterson, New Jersey.

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