A Voice For MS » marijuana

Spasticity in MS – Treatment

admin — Fri, 06 Nov 2009 09:15:45 +0000

As a follow on from my previous article about spasticity I would now like to address the treatments used

Oral medications
A number of medications have been used to treat generalised spasticity. Although there is variability in response to and tolerability of different medications, most practitioners will suggest baclofen as a first line agent. It works at the level of the spinal cord to help the body inhibit muscle movement. A number of studies have shown that baclofen is effective in reducing pain, improving gait and overall function, as well as decreasing spasm frequency.

However, baclofen can cause fatigue, dry mouth, dizziness and nausea and many people start on baclofen and say it doesn’t work for them. However, if assessed carefully and consideration is given to dose and timing, the results may be more positive. A written regime, with slowly increasing doses that help a person with MS assess how baclofen affects them over a period of time, and regular review can make the use of baclofen much more successful. Even so, some people with MS still find they cannot tolerate the dose of baclofen required for efficacy because of the side effects.

Another medication clinicians frequently prescribe is tizanidine. Again starting at a low dose, tizanidine appears to be particularly effective for painful spasms at night. Like baclofen, it can cause sleepiness, dry mouth, dizziness and fatigue.

Diazepam is also effective in treating spasticity in some people. It appears to have a greater risk of causing sleepiness and muscle weakness, and it has the potential for dependence and addiction which can affect adherence.

Dantrolene can be used for spasticity and it works at the level of the muscles to limit contractions.

Besides sharing most of the side-effects of diazepam, baclofen and tizanidine, dantrolene also requires frequent laboratory monitoring to ensure the medication does not damage the liver. As a result, dantrolene is not prescribed as frequently as the other medications.

Other medications that may be prescribed include clonazepam and gabapentin, although again, side effects can be problematic.

A combination of therapies may also be helpful for some people, and this approach has become increasingly utilised by clinicians.

Local treatments for spasticity
For those with spasticity affecting a small area (focal spasticity), or who do not get relief from oral medications, local injections of botulinum toxin or phenol into the muscles can improve quality of life. You probably know that “Botox” is now a well known and frequently used poison which paralyses the muscles and is used in non-surgical cosmetic treatment of moderate to severe frown lines.
A typical example of spasticity treatable with botulinum toxin would be the overactivity of muscles that flex the wrist, reducing the ability to reach and grasp objects. Making those muscles weaker can improve both function and pain.

There are two types of botulinum toxin, type A, known as Botox® in the United States and Dysport® in Europe; and type B, Myoblock®. A local injection of botulinim toxin can last 3–6 months and make functional activities easier to undertake.

Phenol or alcohol blocks are done less frequently, and involve identifying a point where nerve and muscle meet. Phenol is injected to destroy the nerve endings in that area only.

With both phenol and botulinum toxin, the effects are temporary and may require frequent injections. Also, individuals can build up antibodies to the botulinum toxin over time, making it ineffective. Some people are able to switch from the type A toxin to type B to prolong the therapeutic effect. The most appropriate treatment plan usually includes work with a physical and/or occupational therapist after the injection to improve functional movement of the affected area.

Surgery for spasticity
Orthopaedic surgeons and neurosurgeons might get involved in the management of spasticity in two ways. If a person experiences spasticity that has caused permanent deformity, a surgeon can lengthen tendons or fuse joints or otherwise address malformations. Surgical correction of deformity coupled with proper rehabilitation interventions can prolong sitting times in a chair, prevent skin breakdown or its recurrence, and reduce pain.

Cannabinoids and spasticity

Experimental pharmacological studies support the hypothesis that cannabinoid chemicals within cannabis, such as delta-9-tetrahydrocannabinol (delta-9-THC) and cannabidiol (CBD), exert muscle relaxant effects. While delta-9-THC does this via a specific cannabinoid receptor (the CB1 receptor) which was discovered in the central nervous system in the late 1980’s, CBD appears to have more complicated actions and may affect cytokines (proteins that are released by cells of the immune system and play a role in the generation of an immune response).

Initial clinical trial data did not support the efficacy of delta-9-THC in reducing spasticity. The first report from the “Cannabinoids in Multiple Sclerosis” (CAMS) trial, a blind and placebo-controlled trial in the UK, suggested that delta-9-THC had no statistically significant effect on spasticity when evaluated by the objective Ashworth scale.

However, in a 12-month follow-up study involving 630 patients, delta-9-THC was shown to have a small but significant effect. Nonetheless, in both studies the patients reported a subjective improvement in spasticity. It is a matter of some controversy whether the initial lack of effect using the Ashworth scale reflects the lack of sensitivity of that scale for quantifying spasticity.

The natural cannabis extract in the pharmaceutical product marketed as Sativex® has been reported to alleviate spasticity in a number of clinical trials. Clearly , since cannabis is illegal a pharmaceutical product would be welcomed.

The most common adverse side effects reported have been oral pain, dizziness, diarrhoea and nausea. Of the other cannabinoids that have been investigated, the synthetic cannabinoid, nabilone, has been reported to reduce pain related to spasticity in one recent study.

There have now been more than 12 clinical trials published on the effects of cannabinoids on spasticity and pain in MS. Although not all of these studies demonstrate a significant improvement in symptoms with delta-9-THC or CBD, evidence is accumulating that cannabinoid drugs may be useful in at least a subset of patients, and at least as an adjuvant therapy.

Long-term studies suggest that cannabinoids are reasonably well tolerated by patients but there is still concern about potential long-term adverse effects, such as cognitive impairment, impaired foetal development and psychiatric side effects. However, it must be recognised that many conventional anti-spasticity drugs such as baclofen also have significant side effects. It should also be noted that in many countries cannabis is an illegal drug, which affects its accessibility.

No tags for this post.

Medical marijuana

admin — Sat, 27 Jun 2009 13:37:13 +0000

marijuana is one of the most beneficial and therapeutically active substances known to man.
Medical Cannabis refers to the use of the drug cannabis as a physician-recommended herbal therapy, most notably as an antiemetic.
Cannabis has been used for medicinal purposes for approximately 4,000 years. Writings from ancient India confirm that its psychoactive properties were recognized, and doctors used it for a variety of illnesses and ailments. These included a whole host of gastrointestinal disorders, insomnia, headaches and as a pain reliever frequently used in childbirth.
In the 1970s, a synthetic version of THC, the primary active ingredient in cannabis, was synthesized to make the drug Marinol.
Due to the prohibition of marijuana however; it’s use as a medicine is restricted. However, recent Canadian government legislation have made it more available to patients. Patients are now able to apply for personal possession and even a limited cultivation license.
Few herbs offer a wide variety of therapeutic applications like these:
Relief of muscle spasms
Relief of chronic pain
Reduction in interlobular pressure inside the eye
Suppression of nausea
Weight loss – increase and restore metabolism
AIDS – marijuana can reduce the nausea, loss of appetite, vomiting from the condition itself and the medications as well.
Glaucoma – marijuana relieves the internal eye pressure of glaucoma, and therefore relieving the pain and slowing or even stopping the condition.
Cancer- Many side effects of the medication to stop cancer can be relieve with marijuana, some studies suggest that marijuana tends to slow down the progress of some types of cancer.
Multiple Sclerosis – Muscle pain, spasticity, tremors and unsteadiness are some of the effects caused by the disease that can be relieved by marijuana.
Epilepsy – in some patients, epileptic seizures can be prevented with marijuana use.
Chronic pain – marijuana helps to alleviate the pain caused from many types of injuries and disorders.
Anxiety, Depression or Obsession - Even though mild anxiety is a common side effect in some users, cannabis can elevate your mood and expand the mind
“With the expansiveness that occurs with marijuana, the subject may begin to notice infinite possibilities to raise the quality of his/her life that would otherwise have remained hidden from normal, defensive consciousness. And feelings of health and happiness naturally lead to hope, which of itself can be curative.” – Joan Bello
Many obsessions or quick fixes to psychological problems can be eleviated by marijuana as well. Many people eat because they’re depressed. If the depression is treated, the obsession to eat should be gone as well.
Any of these phycological conditions can be treated by a psychiatrist; marijuana should be an alternative therapy, used in conjunction with psychiatric therapy.
Physical Addictions
There have been testimonies from opiate users that report an easing of addiction cravings. Some cannabinoids in cannabis are believed to have similar effects as ibogaine, a medication used to treat heroin addiction.
The cannabinoids in marijuana mimic the healing effects of a naturally occurring chemical in the brain called Anandimide. However, this naturally occurring cannabinoid also produces the negative effects that one would experience from high concentrations of cannabinoids in marijuana.
Medical marijuana can also benefit you psychologically and spiritually.
marijuana can be used to enhance personal Spirituality. The herb tends to reveal your true self. It uncovers inner confusion and reveals your true direction – if you let it. marijuana offers an effect that is both energizing and relaxing at the same time. This balanced effect will help some to think more clearly and more efficiently afterwards.
“marijuana will not tolerate repression. Tranquillizers and depressants relax the body and release tension, but the state of mind associated with these drugs is “unconsciousness” whereby we escape rather than resolve our dilemmas. Alcoholism is an extreme need of both the body and personality sometimes to release the nervousness that has accumulated and continues to build up to an unbearable degree. It serves the same function for the collective personality for the society, as well A culture in which alcohol and tranquillizers are the prevalent form of release prefers not to witness internal confusion and actually choose to act without conscious participation, maintaining a semi-numb condition.” – Joan Bello
“marijuana can act as the loosening agent, so that whatever has been banned from consciousness may come cascading forth. To uncover our deceptions without our usual rationalizations can be unpleasant, an experience that has turned many psychologically fragile individuals away from marijuana despite its therapeutic catharsis.” – Joan Bello.
Cannabis also acts as an antispasmodic and anticonvulsant and is indicated for neurological conditions such as epilepsy especially complex partial seizures, multiple sclerosis, and spasms. As an analgesic and an immunomodulator it is indicated for conditions such as migraine, arthritis, spinal and skeletal disorders.
As a bronchodilator it is beneficial for asthma. It also reduces the intraocular pressure and is indicated for glaucoma.
Recent studies have shown the drug to be efficacious in treating mood disorders and mental health issues such as depression, post traumatic stress disorder, clinical depression, obsessive-compulsive disorder, panic disorder, and bipolar disorder.
It is also indicated for premenstrual syndrome, hypertension, and insomnia. It is also reported to be an effective treatment for constipation and alcohol hangovers.
A pharmaceutical product, Marinol, is widely available through prescription. It comes in the form of a pill and is also being studied by researchers for suitability via other delivery methods, such as an inhaler or patch. The active ingredient of Marinol is synthetic THC, which has been found to relieve the nausea and vomiting associated with chemotherapy for cancer patients and to assist with loss of appetite with AIDS patients.
Illegal, Legal, and Semi Legal marijuana use by country and state
Australia
Medical Cannabis – Politicians in the Australian Capital Territory voted to allow doctors to determine when marijuana is medically appropriate. The decision enraged the Australian Federal Police and intensive lobbying efforts began to reverse the legislative action. Legislators caved-in to the demands of the police, reversed their earlier action, and voted to block doctors from legally prescribing marijuana.
Australian Capital Territory – possession of up to 25 grams, or two plants, is not a criminal offence but carries a $100 fine.
South Australia – Possession of cannabis is a moderate offense, with fines ranging from $150 to $300 for possession and cultivation of small amounts.
Western Australia – Possession of up to two plants is accepted for private use, excess of the latter can face fines of over $150.
New South Wales and Tasmania – Cannabis use is illegal and attracts fines.
Queensland – It is a criminal offence to be in possession of any amount of cannabis, people charged must face court and can be convicted. Possession of cannabis or any schedule 1 or 2 drug specified in the Drugs Misuse Regulation 1987 carries a maximum prison sentence of 15 years in Queensland. Possession of smoking utensils or anything used to smoke cannabis is also a criminal offence in Queensland.
Belgium
Individual use of marijuana by adults has the lowest priority to police, if the use doesn’t cause any problems to his environment. Which basically means the use in public places, possession of more than 3 grams, or the sale are pursued in court.
Medical Cannabis – the Belgian government has recently initiated trials to determine the effectiveness of medical cannabis, and may soon decriminalize possession of small amounts.
Canada
Medical Cannabis – A court declared Canada’s marijuana Medical Access Regulations unconstitutional “in not allowing seriously ill Canadians to use marijuana because there is no legal source of supply of the drug.” In effect, this means that Canadians cannot be prosecuted for using marijuana medically because the marijuana Medical Access Regulations gives patients the right to do so, but does not set up any legal apparatus for obtaining cannabis.
Canada produces about 400 kg of medical cannabis annually, in an abandoned mine in Flin Flon, Manitoba. On April 19, 2005, the Canadian government additionally licensed the prescription sale of a natural marijuana extract – effectively liquid marijuana – called Sativex.
The federal department Health Canada now provides detailed advice (for its own citizens), including not only the medical information needed to make an informed choice, but the law enforcement aspects, and how to apply for authorization to possess marijuana for medical purposes. There is also information that may be of help to the patient’s health professional. Apply to the Office of Cannabis Medical Access (OCMA) or Medical Marihuana Access Division (MMAD).
Germany
Medical Cannabis – Consumption is legal, possession of small amounts is treated differently between federal states. In most cases possession of less than 5g Cannabis herb or resin is not prosecuted. There are no special laws for medical Cannabis. In November 2007 some patients get an exception approval for using medical marijuana from the public health authority.
Ireland
Under Irish law cannabis is not recognised as having any medical benefits. The most recent Misuse of Drugs lists cannabis, cannabis resin, cannabinol and its derivatives as schedule 1 drugs under the Misuse of Drugs Acts of 1977 and 1984.
Netherlands
The possesion/purchase of Cannabis is “tolerated” in small amounts. One can purchase cannabis in special shops (called “coffee shops”) if one is age eighteen and over. Cultivation and wholesale of cannabis is likewise “tolerated” in small amounts (guidelines here are no more than five plants).
Medical Cannabis – Since 2003 it is a legal prescription drug known as “Mediwiet”, available at pharmacies. However laws remain on the books classifying possession and sale as illegal, but due to a non-enforcement policy, it has been de facto legalized.
New Zealand
Possession of any amount of cannabis is illegal in New Zealand and can result in a fine of up to $500 or even a 3-month prison sentence. Anyone caught in possession of more than 28 grams of cannabis or 100 cannabis joints is classed as a dealer unless s/he can prove they are not.
Medical Cannabis – Health Minister Annette King has stated that she is not “unsympathetic to using cannabis in a medicinal form, but that’s different to saying we should let everybody smoke it.” Her official position is that more conclusive studies are needed, and a method of regulating dosage is necessary before she support medical access to cannabis.
United Kingdom
Cultivation and use of cannabis was generally outlawed in 1928. Cannabis was downgraded from a Class B to a Class C drug in January 2004. Possession: If one is caught with even a “small” amount of cannabis on him or her person or premises, the person is liable to be prosecuted.
Medical Cannabis – In 1999, a House of Lords inquiry recommended that cannabis be made available with a doctor’s prescription. Though the government of the U. K. has not accepted the recommendations, new long-term clinical trials have been authorized. Sometimes juries have returned verdicts of “not guilty” for people charged with marijuana possession for medical use.
USA
Medical Cannabis – The United States federal government does not currently recognize any legitimate medical use. However 12 state laws currently allow for the medicinal use of cannabis but the United States Supreme Court has later ruled that the federal government has the right to regulate and criminalize marijuana also in these states, even for medical purposes. Smoked cannabis is today not approved by the United States Food and Drug Administration (FDA). Since 1996, Alaska, California, Colorado, Hawaii, Maine, Nevada, Oregon, and Washington have passed laws to let sick people who qualify use marijuana.
Lately a leading US doctors group has endorsed using marijuana for medical purposes, urging the US government to roll back a prohibition on using it to treat patients and supporting studies into its medical applications.
The federal government of the United States continues to argue that smoked cannabis has no recognized medical purpose (pointing to a definition of “medical purpose” published by the DEA, not the Food and Drug Administration, the National Institutes of Health, the Centers for Disease Control, or the office of the U. S. Surgeon General and the U. S. Public Health Service).
Alaska – 1 oz usable; 6 plants (3 mature, 3 immature) – Approved Conditions: Cachexia, cancer, chronic pain, epilepsy and other disorders characterized by seizures, glaucoma, HIV or AIDS, multiple sclerosis and other disorders characterized by muscle spasticity, and nausea. Other conditions are subject to approval by the Alaska Department of Health and Social Services.
California – 8 oz usable; 18 plants (6 mature, 12 immature) – California was one of the first. In 1996 California voters passed Proposition 215, the Compassionate Use Act, legalizing marijuana for medical use. Proposition 215 permits seriously ill Californians to use marijuana, provided they first obtain a doctor’s recommendation. Proposition 215 also gives doctors a legal defense against professional or legal sanctions for recommending marijuana use. Approved Conditions: AIDS, anorexia, arthritis, cachexia, cancer, chronic pain, glaucoma, migraine, persistent muscle spasms, including spasms associated with multiple sclerosis, seizures, including seizures associated with epilepsy, severe nausea; Other chronic or persistent medical symptoms.
Colorado – 2 oz usable; 6 plants (3 mature, 3 immature) – Approved Conditions: Cancer, glaucoma, HIV/AIDS positive, cachexia; severe pain; severe nausea; seizures, including those that are characteristic of epilepsy; or persistent muscle spasms, including those that are characteristic of multiple sclerosis. Other conditions are subject to approval by the Colorado Board of Health.
Hawaii – 3 oz usable; 7 plants (3 mature, 4 immature) – Approved conditions: Cancer, glaucoma, positive status for HIV/AIDS; A chronic or debilitating disease or medical condition or its treatment that produces cachexia or wasting syndrome, severe pain, severe nausea, seizures, including those characteristic of epilepsy, or severe and persistent muscle spasms, including those characteristic of multiple sclerosis or Crohn’s disease. Other conditions are subject to approval by the Hawaii Department of Health.
Maine – 1.25 oz usable; 6 plants (3 mature, 3 immature) – Approved diagnosis: epilepsy and other disorders characterized by seizures; glaucoma; multiple sclerosis and other disorders characterized by muscle spasticity; and nausea or vomiting as a result of AIDS or cancer chemotherapy.
Maryland – Passed a medical marijuana affirmative defense law in 2003 which dictates that if a person is arrested for marijuana use but is found to be using marijuana out of medical necessity, she or he will only face a modest fine.
Montana – 1 oz usable; 6 plants – A qualifying patient and a qualifying patient’s caregiver may each possess six marijuana plants and one ounce of usable marijuana. “Usable marijuana” means the dried leaves and flowers of marijuana and any mixture or preparation of marijuana.
Nevada – 1 oz usable; 7 plants (3 mature, 4 immature) – Approved Conditions: AIDS; cancer; glaucoma; and any medical condition or treatment to a medical condition that produces cachexia, persistent muscle spasms or seizures, severe nausea or pain. Other conditions are subject to approval by the health division of the state Department of Human Resources.
New Mexico – 6 oz usable; 7 plants (4 mature, 3 immature) – Approved Conditions: Under current state law, the only qualifying conditions for the medical cannabis program are cancer, glaucoma, multiple sclerosis, epilepsy, spinal cord damage with intractable spasticity, HIV/AIDS. Also, any patient in hospice care could qualify.
Oregon – 24 oz usable; 24 plants (6 mature, 18 immature) – Approved Conditions: Cancer, glaucoma, positive status for HIV/AIDS, or treatment for these conditions; A medical condition or treatment for a medical condition that produces cachexia, severe pain, severe nausea, seizures, including seizures caused by epilepsy, or persistent muscle spasms, including spasms caused by multiple sclerosis. Other conditions are subject to approval by the Health Division of the Oregon Department of Human Resources.
Rhode Island – 2.5 oz usable; 12 plants – Approved Conditions: Cancer, glaucoma, positive status for HIV/AIDS, Hepatitis C, or the treatment of these conditions; A chronic or debilitating disease or medical condition or its treatment that produces cachexia or wasting syndrome; severe, debilitating, chronic pain; severe nausea; seizures, including but not limited to, those characteristic of epilepsy; or severe and persistent muscle spasms, including but not limited to, those characteristic of multiple sclerosis or Crohn’s disease; or agitation of Alzheimer’s Disease; or any other medical condition or its treatment approved by the state Department of Health.
Vermont – 2 oz usable; 9 plants (2 mature, 7 immature) – Approved Conditions: Cancer, AIDS, positive status for HIV, multiple sclerosis, or the treatment of these conditions if the disease or the treatment results in severe, persistent, and intractable symptoms; or a disease, medical condition, or its treatment that is chronic, debilitating and produces severe, persistent, and one or more of the following intractable symptoms: cachexia or wasting syndrome, severe pain or nausea or seizures.
Washington – 60-day supply – Approved Conditions: Cachexia; cancer; HIV or AIDS; epilepsy; glaucoma; intractable pain (defined as pain unrelieved by standard treatment or medications); and multiple sclerosis. Other conditions are subject to approval by the Washington Board of Health.

Tags:Cannabis,marijuana

A Voice For MS » marijuana

Spasticity in MS – Treatment

Related posts

Medical marijuana

Related posts