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An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis.

Abstract

The majority of patients with multiple sclerosis (MS) develop troublesome lower urinary tract symptoms (LUTS). Anecdotal reports suggest that cannabis may alleviate LUTS, and cannabinoid receptors in the bladder and nervous system are potential pharmacological targets. In an open trial we evaluated the safety, tolerability, dose range, and efficacy of two whole-plant extracts of Cannabis sativa in patients with advanced MS and refractory LUTS. Patients took extracts containing delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD; 2.5 mg of each per spray) for eight weeks followed by THC-only (2.5 mg THC per spray) for a further eight weeks, and then into a long-term extension. Assessments included urinary frequency and volume charts, incontinence pad weights, cystometry and visual analogue scales for secondary troublesome symptoms. Twenty-one patients were recruited and data from 15 were evaluated. Urinary urgency, the number and volume of incontinence episodes, frequency and nocturia all decreased significantly following treatment (P <0.05, Wilcoxon's signed rank test). However, daily total voided, catheterized and urinary incontinence pad weights also decreased significantly on both extracts. Patient self-assessment of pain, spasticity and quality of sleep improved significantly (P <0.05, Wilcoxon's signed rank test) with pain improvement continuing up to median of 35 weeks. There were few troublesome side effects, suggesting that cannabis-based medicinal extracts are a safe and effective treatment for urinary and other problems in patients with advanced MS.

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  • Authors+Show Affiliations

    ,

    Dept of Uro-Neurology, Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.

    , , , ,

    Source

    MeSH

    Adult
    Cannabidiol
    Cannabis
    Dose-Response Relationship, Drug
    Dronabinol
    Drug Administration Schedule
    Follow-Up Studies
    Humans
    Medical Records
    Middle Aged
    Multiple Sclerosis
    Pilot Projects
    Plant Extracts
    Sensation
    Surveys and Questionnaires
    Treatment Outcome
    Urinary Bladder
    Urinary Bladder, Neurogenic
    Urinary Incontinence
    Urination
    Urodynamics

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    15327041

    Citation

    Brady, C M., et al. "An Open-label Pilot Study of Cannabis-based Extracts for Bladder Dysfunction in Advanced Multiple Sclerosis." Multiple Sclerosis (Houndmills, Basingstoke, England), vol. 10, no. 4, 2004, pp. 425-33.
    Brady CM, DasGupta R, Dalton C, et al. An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis. Mult Scler. 2004;10(4):425-33.
    Brady, C. M., DasGupta, R., Dalton, C., Wiseman, O. J., Berkley, K. J., & Fowler, C. J. (2004). An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis. Multiple Sclerosis (Houndmills, Basingstoke, England), 10(4), pp. 425-33.
    Brady CM, et al. An Open-label Pilot Study of Cannabis-based Extracts for Bladder Dysfunction in Advanced Multiple Sclerosis. Mult Scler. 2004;10(4):425-33. PubMed PMID: 15327041.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis. AU - Brady,C M, AU - DasGupta,R, AU - Dalton,C, AU - Wiseman,O J, AU - Berkley,K J, AU - Fowler,C J, PY - 2004/8/26/pubmed PY - 2005/2/9/medline PY - 2004/8/26/entrez SP - 425 EP - 33 JF - Multiple sclerosis (Houndmills, Basingstoke, England) JO - Mult. Scler. VL - 10 IS - 4 N2 - The majority of patients with multiple sclerosis (MS) develop troublesome lower urinary tract symptoms (LUTS). Anecdotal reports suggest that cannabis may alleviate LUTS, and cannabinoid receptors in the bladder and nervous system are potential pharmacological targets. In an open trial we evaluated the safety, tolerability, dose range, and efficacy of two whole-plant extracts of Cannabis sativa in patients with advanced MS and refractory LUTS. Patients took extracts containing delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD; 2.5 mg of each per spray) for eight weeks followed by THC-only (2.5 mg THC per spray) for a further eight weeks, and then into a long-term extension. Assessments included urinary frequency and volume charts, incontinence pad weights, cystometry and visual analogue scales for secondary troublesome symptoms. Twenty-one patients were recruited and data from 15 were evaluated. Urinary urgency, the number and volume of incontinence episodes, frequency and nocturia all decreased significantly following treatment (P <0.05, Wilcoxon's signed rank test). However, daily total voided, catheterized and urinary incontinence pad weights also decreased significantly on both extracts. Patient self-assessment of pain, spasticity and quality of sleep improved significantly (P <0.05, Wilcoxon's signed rank test) with pain improvement continuing up to median of 35 weeks. There were few troublesome side effects, suggesting that cannabis-based medicinal extracts are a safe and effective treatment for urinary and other problems in patients with advanced MS. SN - 1352-4585 UR - https://www.unboundmedicine.com/medline/citation/15327041/An_open_label_pilot_study_of_cannabis_based_extracts_for_bladder_dysfunction_in_advanced_multiple_sclerosis_ L2 - http://journals.sagepub.com/doi/full/10.1191/1352458504ms1063oa?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -