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Cannabinoids in the treatment of pain and spasticity in multiple sclerosis.

Abstract

There is a large amount of evidence to support the view that the psychoactive ingredient in cannabis, delta9-tetrahydrocannabinol (delta9-THC), and cannabinoids in general, can reduce muscle spasticity and pain under some circumstances. Cannabinoid (CB1) receptors in the CNS appear to mediate both of these effects and endogenous cannabinoids may fulfil these functions to some extent under normal circumstances. However, in the context of multiple sclerosis (MS), it is still questionable whether cannabinoids are superior to existing, conventional medicationsfor the treatment of spasticity and pain. In the case of spasticity, there are too few controlled clinical trials to draw any reliable conclusion at this stage. In the case of pain, most of the available trials suggest that cannabinoids are not superior to existing treatments; however, few trials have examined chronic pain syndromes that are relevant to MS. Whether or not cannabinoids do have therapeutic potential in the treatment of MS, a further issue will be whether synthetic cannabinoids should be used in preference to cannabis itself. Smoking cannabis is associated with significant risks of lung cancer and other respiratory dysfunction. Furthermore, delta9-THC, as a broad-spectrum cannabinoid receptor agonist, will activate both CB1 and CB2 receptors. Synthetic cannabinoids, which target specific cannabinoid receptor subtypes in specific parts of the CNS, are likely to be of more therapeutic use than delta9-THC itself. If rapid absorption is necessary, such synthetic drugs could be delivered via aerosol formulations.

Authors+Show Affiliations

Department of Pharmacology and Toxicology, School of Medical Sciences, University of Otago, Dunedin, New Zealand. paul.smith@stonebow.otago.ac.nz

Source

MeSH

Analgesics, Non-Narcotic
Animals
Cannabinoid Receptor Modulators
Cannabinoids
Cannabis
Disease Models, Animal
Dronabinol
Fatty Acids, Unsaturated
Humans
Multiple Sclerosis
Muscle Weakness
Pain
Receptors, Cannabinoid
Receptors, Drug
Spasm

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

12137404

Citation

Smith, Paul F.. "Cannabinoids in the Treatment of Pain and Spasticity in Multiple Sclerosis." Current Opinion in Investigational Drugs (London, England : 2000), vol. 3, no. 6, 2002, pp. 859-64.
Smith PF. Cannabinoids in the treatment of pain and spasticity in multiple sclerosis. Curr Opin Investig Drugs. 2002;3(6):859-64.
Smith, P. F. (2002). Cannabinoids in the treatment of pain and spasticity in multiple sclerosis. Current Opinion in Investigational Drugs (London, England : 2000), 3(6), pp. 859-64.
Smith PF. Cannabinoids in the Treatment of Pain and Spasticity in Multiple Sclerosis. Curr Opin Investig Drugs. 2002;3(6):859-64. PubMed PMID: 12137404.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cannabinoids in the treatment of pain and spasticity in multiple sclerosis. A1 - Smith,Paul F, PY - 2002/7/26/pubmed PY - 2003/2/27/medline PY - 2002/7/26/entrez SP - 859 EP - 64 JF - Current opinion in investigational drugs (London, England : 2000) JO - Curr Opin Investig Drugs VL - 3 IS - 6 N2 - There is a large amount of evidence to support the view that the psychoactive ingredient in cannabis, delta9-tetrahydrocannabinol (delta9-THC), and cannabinoids in general, can reduce muscle spasticity and pain under some circumstances. Cannabinoid (CB1) receptors in the CNS appear to mediate both of these effects and endogenous cannabinoids may fulfil these functions to some extent under normal circumstances. However, in the context of multiple sclerosis (MS), it is still questionable whether cannabinoids are superior to existing, conventional medicationsfor the treatment of spasticity and pain. In the case of spasticity, there are too few controlled clinical trials to draw any reliable conclusion at this stage. In the case of pain, most of the available trials suggest that cannabinoids are not superior to existing treatments; however, few trials have examined chronic pain syndromes that are relevant to MS. Whether or not cannabinoids do have therapeutic potential in the treatment of MS, a further issue will be whether synthetic cannabinoids should be used in preference to cannabis itself. Smoking cannabis is associated with significant risks of lung cancer and other respiratory dysfunction. Furthermore, delta9-THC, as a broad-spectrum cannabinoid receptor agonist, will activate both CB1 and CB2 receptors. Synthetic cannabinoids, which target specific cannabinoid receptor subtypes in specific parts of the CNS, are likely to be of more therapeutic use than delta9-THC itself. If rapid absorption is necessary, such synthetic drugs could be delivered via aerosol formulations. SN - 1472-4472 UR - https://www.unboundmedicine.com/medline/citation/12137404/Cannabinoids_in_the_treatment_of_pain_and_spasticity_in_multiple_sclerosis_ L2 - https://ClinicalTrials.gov/search/term=12137404 [PUBMED-IDS] DB - PRIME DP - Unbound Medicine ER -