Cannabinoids for the treatment of spasticity

Abstract

This review summarizes studies that examined the effectiveness of cannabinoids in treating spasticity, with a focus on understanding the relevance of the existing evidence to paediatric populations. MEDLINE, Embase, PsycINFO, and the Cochrane Library were searched to identify studies that examined the use of cannabinoids in spasticity. We identified 32 studies in adult and paediatric populations. Results were summarized by condition, with adult and paediatric studies considered separately. There is evidence from randomized controlled clinical trials that cannabinoids are more effective than placebo in reducing symptoms of spasticity in adults with multiple sclerosis. Most positive effects were based on patient‐rated rather than clinician‐rated measures, were modest in size, and should be considered in the context of the narrow therapeutic index of cannabinoids for spasticity and adverse effects. There were comparatively few, and no large studies, of spasticity in conditions other than multiple sclerosis. Few studies have been conducted in paediatric populations. Paediatric studies of spasticity provide low quality evidence and are inadequate to inform clinical practice. Cannabinoids have modest efficacy in reducing muscle spasticity in adults with multiple sclerosis. There is limited evidence of efficacy for cannabinoid use in other conditions, particularly in paediatric populations. Studies in paediatric populations have been of low quality and are insufficient to inform clinical practice.

Cannabinoids induce latent sensitization in a preclinical model of medication overuse headache

“…Clinical studies demonstrating analgesic actions of marijuana and synthetic cannabinoids, however, have been less certain (13,20,21). Strong evidence for analgesia remains limited to pain in patients with multiple sclerosis (MS) that might arise, in part, from relief of spasticity (22,23). Nevertheless, cannabinoids including medical marijuana are widely used for pain control either with, or without, prescriptions from physicians.…”

Efficacy and safety of nabiximols cannabinoid medicine for paediatric spasticity in cerebral palsy or traumatic brain injury: a randomized controlled trial

“…Widespread societal and clinical interest in medicinal cannabis use to reduce pain and spasticity in patients with demyelinating diseases, such as multiple sclerosis, has intensified over the last two decades 5 . To date, most clinical trials examining the efficacy of treating spasticity with cannabinoids have been conducted in adults 6 …”

“…Primary outcomes looked at levels of spasticity and central pain using a spasticity 0 to 10 Numerical Rating Scale (NRS) and pain 0 to 10 NRS, implemented as self‐reported measures. The trials conducted with nabiximols led to a marketing authorization of Sativex for the treatment of spasticity in adults with multiple sclerosis who did not derive enough benefit from conventional antispasticity medications across a number of major markets 6 …”

Cannabis derived medicinal products in child neurology

“…The review of cannabinoids for the treatment of spasticity by Nielsen et al . is topical and timely.…”

“…The review of cannabinoids for the treatment of spasticity by Nielsen et al 1 is topical and timely. The problem for clinicians, ably highlighted in this review, is that there is a paucity of good quality evidence demonstrating efficacy and safety of CDMPs in human studies.…”