A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms

Wade, Derick T; Robson, Philip; House, Heather; Mäkelä, Petra; Aram, Julia

doi:10.1191/0269215503cr581oa

Cited by 380 publications

(288 citation statements)

References 18 publications

(15 reference statements)

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“…84,86 Hagenbach et al 70 , showed that THC may have some analgesic properties to help SCI patients with spasticity related pain. Wade et al 87 conducted an RCT of sublingual 2.5 mg THC and/or cannabidiol and found that it significantly reduced pain, muscle spasm, spasticity and sleep difficulties in a group consisting largely of multiple sclerosis patients with neuropathic pain. Unfortunately, only a small number of the patients in this study had a SCI, so it did not meet our inclusion criteria.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Pharmacologic Treatments of Pain After Spinal Cord Injury

Teasell

Mehta

Aubut

et al. 2010

Archives of Physical Medicine and Rehabilitation

149

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Objective-To conduct a systematic review of published research on the pharmacological treatment of pain after spinal cord injury (SCI).Data Sources-Medline, CINAHL, EMBASE and PsycINFO databases were searched for articles published 1980 to June 2009 addressing the treatment of pain post SCI. Randomized controlled trials (RCTs) were assessed for methodological quality using the PEDro assessment scale, while non-RCTs were assessed using the Downs and Black evaluation tool. A level of evidence was assigned to each intervention using a modified Sackett scale.Study Selection-The review included randomized controlled trials and non-randomized controlled trials which included prospective controlled trials, cohort, case series, case-control, prepost and post studies. Case studies were included only when there were no other studies found.Data Extraction-Data extracted included the PEDro or Downs and Black score, the type of study, a brief summary of intervention outcomes, type of pain, type of pain scale and the study findings.. Data Synthesis-Articles selected for this particular review evaluated different interventions in the pharmacological management of pain post SCI. 28 studies met inclusion criteria: there were 21 randomized controlled trials of these 19 had Level 1 evidence. Treatments were divided into five Conclusions-Most studies did not specify participants' types of pain; hence making it difficult to identify the type of pain being targeted by the treatment. Anticonvulsant and analgesic drugs had the highest levels of evidence and were the drugs most often studied. Gabapentin and pregabalin had strong evidence (five Level 1 RCTs) for effectiveness in treating post-SCI neuropathic pain, as did intravenous analgesics (lidocaine, ketamine and morphine) but the latter only had short term benefits. Tricyclic antidepressants only showed benefit for neuropathic pain in depressed individuals. Intrathecal baclofen reduced musculoskeletal pain associated with spasticity; however there was conflicting evidence for the reduction in neuropathic pain. Studies assessing the effectiveness of opioids were limited and revealed only small benefits. Cannabinoids showed conflicting evidence in improving spasticity related pain. Clonidine and morphine, when given together, had a significant synergistic neuropathic pain-relieving effect.

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Section: Discussionmentioning

confidence: 99%

A Systematic Review of Pharmacologic Treatments of Pain After Spinal Cord Injury

Teasell

Mehta

Aubut

et al. 2010

Archives of Physical Medicine and Rehabilitation

149

View full text Add to dashboard Cite

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“…Neuropathic pain may be an important indication for the treatment with THC and cannabis. There are several reports of pain reduction in MS by THC 19,41,42 and cannabis, 38,19 in central neuropathic pain from brachial plexus avulsion 43 and in neuropathic pain in HIV positives. 44 However, Attal et al 45 were not able to confirm the efficacy of THC in chronic refractory neuropathic pain in an open study with eight patients who received daily doses of up to 25 mg dronabinol.…”

Section: Discussionmentioning

confidence: 99%

The treatment of spasticity with Δ9-tetrahydrocannabinol in persons with spinal cord injury

et al. 2006

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Study design: Open label study to determine drug dose for a randomized double-blind placebocontrolled parallel study. Objectives: To assess the efficacy and side effects of oral D 9 -tetrahydrocannabinol (THC) and rectal THC-hemisuccinate (THC-HS) in SCI patients. Setting: REHAB Basel, Switzerland. Method: Twenty-five patients with SCI were included in this three-phase study with individual dose adjustment, each consisting of 6 weeks. Twenty-two participants received oral THC open label starting with a single dose of 10 mg (Phase 1, completed by 15 patients). Eight subjects received rectal THC-HS (Phase 2, completed by seven patients). In Phase 3, six patients were treated with oral THC and seven with placebo. Major outcome parameters were the spasticity sum score (SSS) using the Modified Ashworth Scale (MAS) and self-ratings of spasticity. Results: Mean daily doses were 31 mg with THC and 43 mg with THC-HS. Mean SSS for THC decreased significantly from 16.72 (77.60) at baseline to 8.92 (77.14) on day 43. Similar improvement was seen with THC-HS. We observed a significant improvement of SSS with active drug (P ¼ 0.001) in the seven subjects who received oral THC in Phase 1 and placebo in Phase 3. Major reasons for drop out were increase of pain and psychological side effects. Conclusion: THC is an effective and safe drug in the treatment of spasticity. At least 15-20 mg per day were needed to achieve a therapeutic effect.

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“…The putative beneficial effects of combined THC and CBD also have been investigated recently in several clinical trials for multiple sclerosis, neuropathic pain, and varied neurogenic symptoms (Berman et al, 2004;Brady et al, 2004;Rog et al, 2005;Wade et al, 2004;Wade et al, 2003). In addition, Sativex®, a 1:1 THC: CBD ratio oromucosal spray formulation, is currently marketed in Canada for treatment of neuropathic pain associated with multiple sclerosis.…”

Section: Preclinical and Clinical Interactions Between Thc And Cbdmentioning

confidence: 99%

Divergent effects of cannabidiol on the discriminative stimulus and place conditioning effects of Δ9-tetrahydrocannabinol

Vann

Gamage

Warner

et al. 2008

Drug and Alcohol Dependence

110

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Cannabis sativa (marijuana plant) contains myriad cannabinoid compounds; yet, investigative attention has focused almost exclusively on Δ 9 -tetrahydrocannabinol (THC), its primary psychoactive substituent. Interest in modulation of THC's effects by these other cannabinoids [e.g., cannabidiol (CBD)] has been stimulated anew by recent approval by Canada of Sativex (a 1:1 dose ratio combination of CBD:THC) for the treatment of multiple sclerosis. The goal of this study was to determine the degree to which THC's abuse-related effects were altered by co-administration of CBD. To this end, CBD and THC were assessed alone and in combination in a two-lever THC discrimination procedure in Long-Evans rats and in a conditioned place preference/aversion (CPP/ A) model in ICR mice. CBD did not alter the discriminative stimulus effects of THC at any CBD:THC dose ratio tested. In contrast, CBD, at CBD:THC dose ratios of 1:1 and 1:10, reversed CPA produced by acute injection with 10 mg/kg THC. When administered alone, CBD did not produce effects in either procedure. These results suggest that CBD, when administered with THC at therapeutically relevant ratios, may ameliorate aversive effects (e.g., dysphoria) often associated with initial use of THC alone. While this effect may be beneficial for therapeutic usage of a CBD:THC combination medication, our discrimination results showing that CBD did not alter THC's discriminative stimulus effects suggest that CBD:THC combination medications may also produce THC-like subjective effects at these dose ratios.

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A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms

Abstract: Cannabis medicinal extracts can improve neurogenic symptoms unresponsive to standard treatments. Unwanted effects are predictable and generally well tolerated. Larger scale studies are warranted to confirm these findings.

Cited by 380 publications

References 18 publications

A Systematic Review of Pharmacologic Treatments of Pain After Spinal Cord Injury

A Systematic Review of Pharmacologic Treatments of Pain After Spinal Cord Injury

The treatment of spasticity with Δ9-tetrahydrocannabinol in persons with spinal cord injury

Divergent effects of cannabidiol on the discriminative stimulus and place conditioning effects of Δ9-tetrahydrocannabinol

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