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Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial.

Abstract

BACKGROUND

Spasticity is a common and poorly controlled symptom of multiple sclerosis. Our objective was to determine the short-term effect of smoked cannabis on this symptom.

METHODS

We conducted a placebo-controlled, crossover trial involving adult patients with multiple sclerosis and spasticity. We recruited participants from a regional clinic or by referral from specialists. We randomly assigned participants to either the intervention (smoked cannabis, once daily for three days) or control (identical placebo cigarettes, once daily for three days). Each participant was assessed daily before and after treatment. After a washout interval of 11 days, participants crossed over to the opposite group. Our primary outcome was change in spasticity as measured by patient score on the modified Ashworth scale. Our secondary outcomes included patients' perception of pain (as measured using a visual analogue scale), a timed walk and changes in cognitive function (as measured by patient performance on the Paced Auditory Serial Addition Test), in addition to ratings of fatigue.

RESULTS

Thirty-seven participants were randomized at the start of the study, 30 of whom completed the trial. Treatment with smoked cannabis resulted in a reduction in patient scores on the modified Ashworth scale by an average of 2.74 points more than placebo (p < 0.0001). In addition, treatment reduced pain scores on a visual analogue scale by an average of 5.28 points more than placebo (p = 0.008). Scores for the timed walk did not differ significantly between treatment and placebo (p = 0.2). Scores on the Paced Auditory Serial Addition Test decreased by 8.67 points more with treatment than with placebo (p = 0.003). No serious adverse events occurred during the trial.

INTERPRETATION

Smoked cannabis was superior to placebo in symptom and pain reduction in participants with treatment-resistant spasticity. Future studies should examine whether different doses can result in similar beneficial effects with less cognitive impact.

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  • Authors+Show Affiliations

    ,

    Department of Neurosciences, University of California, San Diego, La Jolla, Calif., USA. jcoreybloom@ucsd.edu

    , , , , ,

    Source

    MeSH

    Adult
    Cannabis
    Cognition
    Cross-Over Studies
    Fatigue
    Female
    Humans
    Male
    Marijuana Smoking
    Middle Aged
    Multiple Sclerosis
    Muscle Spasticity
    Musculoskeletal Pain
    Phytotherapy
    Plant Preparations
    Treatment Outcome
    Walking

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    22586334

    Citation

    Corey-Bloom, Jody, et al. "Smoked Cannabis for Spasticity in Multiple Sclerosis: a Randomized, Placebo-controlled Trial." CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, vol. 184, no. 10, 2012, pp. 1143-50.
    Corey-Bloom J, Wolfson T, Gamst A, et al. Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial. CMAJ. 2012;184(10):1143-50.
    Corey-Bloom, J., Wolfson, T., Gamst, A., Jin, S., Marcotte, T. D., Bentley, H., & Gouaux, B. (2012). Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial. CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, 184(10), pp. 1143-50. doi:10.1503/cmaj.110837.
    Corey-Bloom J, et al. Smoked Cannabis for Spasticity in Multiple Sclerosis: a Randomized, Placebo-controlled Trial. CMAJ. 2012 Jul 10;184(10):1143-50. PubMed PMID: 22586334.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial. AU - Corey-Bloom,Jody, AU - Wolfson,Tanya, AU - Gamst,Anthony, AU - Jin,Shelia, AU - Marcotte,Thomas D, AU - Bentley,Heather, AU - Gouaux,Ben, Y1 - 2012/05/14/ PY - 2012/5/16/entrez PY - 2012/5/16/pubmed PY - 2012/9/20/medline SP - 1143 EP - 50 JF - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne JO - CMAJ VL - 184 IS - 10 N2 - BACKGROUND: Spasticity is a common and poorly controlled symptom of multiple sclerosis. Our objective was to determine the short-term effect of smoked cannabis on this symptom. METHODS: We conducted a placebo-controlled, crossover trial involving adult patients with multiple sclerosis and spasticity. We recruited participants from a regional clinic or by referral from specialists. We randomly assigned participants to either the intervention (smoked cannabis, once daily for three days) or control (identical placebo cigarettes, once daily for three days). Each participant was assessed daily before and after treatment. After a washout interval of 11 days, participants crossed over to the opposite group. Our primary outcome was change in spasticity as measured by patient score on the modified Ashworth scale. Our secondary outcomes included patients' perception of pain (as measured using a visual analogue scale), a timed walk and changes in cognitive function (as measured by patient performance on the Paced Auditory Serial Addition Test), in addition to ratings of fatigue. RESULTS: Thirty-seven participants were randomized at the start of the study, 30 of whom completed the trial. Treatment with smoked cannabis resulted in a reduction in patient scores on the modified Ashworth scale by an average of 2.74 points more than placebo (p < 0.0001). In addition, treatment reduced pain scores on a visual analogue scale by an average of 5.28 points more than placebo (p = 0.008). Scores for the timed walk did not differ significantly between treatment and placebo (p = 0.2). Scores on the Paced Auditory Serial Addition Test decreased by 8.67 points more with treatment than with placebo (p = 0.003). No serious adverse events occurred during the trial. INTERPRETATION: Smoked cannabis was superior to placebo in symptom and pain reduction in participants with treatment-resistant spasticity. Future studies should examine whether different doses can result in similar beneficial effects with less cognitive impact. SN - 1488-2329 UR - https://www.unboundmedicine.com/medline/citation/22586334/full_citation L2 - http://www.cmaj.ca/cgi/pmidlookup?view=long&amp;pmid=22586334 DB - PRIME DP - Unbound Medicine ER -