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The Medical Use of Marijuana in Multiple Sclerosis
Note: See the spasticity module for discussion of spasticity in multiple sclerosis (MS).
The popularity of cannabis use among MS patients is likely explainable on the basis of the importance of the endocannabinoid system in the pathophysiology of the disease. CB1 receptors are integral in the control of muscle tone and tremor mechanisms (Baker et al., 2000), and both THC and CBD may inhibit neurodegeneration in the disorder, at least in animal models (Pryce et al., 2003). This module will review the available clinical evidence for the use of cannabis in the treatment of multiple sclerosis.
In one survey from the UK (Chong et al., 2006), 75% of 337 surveyed patients responded. Among responders 68% had used cannabis with 12% using it contemporaneously for symptom relief, with pain and spasm the most common reason, and 71% indicating that they would employ it if available on prescription. A survey of 112 MS patients in the USA and UK smoking cannabis (Consroe et al., 1997) revealed subjective reported response rates, maximal with spasticity at 97% > limb pain> acute paroxysms > tremor > emotional issues > anorexia/weight loss > fatigue > diplopia > sexual dysfunction > bowel/bladder dysfunction > visual dimming > ambulatory impairment and least with memory loss (30%).
In an RCT of 10 MS patients (Greenberg et al., 1994), smoking one NIDA cigarette with 1.54% THC (cigarette weight and CBD content unspecified, presumably negligible) vs placebo increased postural tracking errors with eyes open or closed in both groups, but more so for those receiving cannabis (p=0.0025), supporting the contention cannabis impaired posture and balance in MS patients.