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

Hagenbach, U; Luz, Sofia; Ghafoor, Nusrat; Berger, Jennifer; Grotenhermen, Franjo; Brenneisen, Rudolf; Mäder, Mark

doi:10.1038/sj.sc.3101982

Cited by 60 publications

(66 citation statements)

References 40 publications

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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.…”

Section: Discussionmentioning

confidence: 99%

“…The third phase of the study, involved a double blind randomized control trial which included 13 of the previously mentioned individuals receiving either individual maximum treatment dosage previously determined or a placebo dose. In this phase, Hagenbach et al 70 , found individuals in the treatment group had no significant pain reduction compared to those in the placebo group.…”

Section: Cannabinoids For Sci Painmentioning

confidence: 97%

“…Hagenbach et al 70 conducted a study primarily examining the effectiveness of THC in improving spasticity and secondarily, in improving pain with SCI individuals. In the first phase of the study, 22 individuals received 10mg of oral THC which was then dose titrated until maximum tolerance or treatment dose was reached for 6 weeks.…”

Section: Cannabinoids For Sci Painmentioning

confidence: 99%

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

Teasell

Mehta

Aubut

et al. 2010

Archives of Physical Medicine and Rehabilitation

155

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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%

Section: Cannabinoids For Sci Painmentioning

confidence: 97%

Section: Cannabinoids For Sci Painmentioning

confidence: 99%

See 1 more Smart Citation

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

Teasell

Mehta

Aubut

et al. 2010

Archives of Physical Medicine and Rehabilitation

155

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“…It was concluded that this pharmacological agent may reduce symptoms of spasticity in patients with multiple sclerosis, but that further studies are needed to show a significant effect on objective measurements of spasticity. It was recently demonstrated that a decrease in both the Ashworth scale and the spasticity sum score was observed in patients with SCI that were given THC [65]. Nevertheless, further randomized clinical trials are needed to elucidate the efficacy of this class of drugs as anti-spastic medications.…”

Section: Cannabinoidsmentioning

confidence: 99%

Latest Approaches for the Treatment of Spasticity and Autonomic Dysreflexia in Chronic Spinal Cord Injury

Rabchevsky

Kitzman

2011

Neurotherapeutics

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Summary: Two of the most prevalent secondary complications following spinal cord injury (SCI), besides loss of function and/ or sensation below the level of injury, are uncontrolled muscle spasticity and hypertensive autonomic dysreflexia. Despite the desires of the SCI community, there have been few advances in the treatment and/or management of these fundamental impediments to the quality of life associated with chronic SCI. Therefore, the purpose of this review is to focus on current drug treatment strategies that alleviate symptoms of spasticity and autonomic dysfunction. Subsequently, looking ahead, we discuss whether individuals suffering from autonomic dysreflexia and/or muscle spasms can take certain compounds that specifically and rapidly block the neurotransmission of pain into the injured spinal cord to get rapid relief for both aberrant reflexes for which painful stimuli below the level of SCI are common precipitants.

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“…1 The authors have highlighted the difficulty in treating spasticity in SCI patients with the currently available medications, making the point for such trials and researches on this subject. The paper outlines the study objectives as to assess the efficacy and side effects of THC in SCI patients.…”

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confidence: 99%

Use of Δ9-tetrahydrocannabinol in the treatment of spasticity in spinal cord injury patients

Villan

2008

Spinal Cord

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We read this interesting article and appreciate the effort of the authors for exploring the potential of D 9 -tetrahydrocannabinol (THC) in the treatment of spasticity in spinal cord injury (SCI) patients. 1 The authors have highlighted the difficulty in treating spasticity in SCI patients with the currently available medications, making the point for such trials and researches on this subject. The paper outlines the study objectives as to assess the efficacy and side effects of THC in SCI patients. However, the authors did not compare the results of the phase 3 study, which was a randomized controlled trial (RCT). The reason given for this by the authors is that there was a major difference in baseline scores on the summated spasticity score. This could be due to the bias in patient selection (such as wide range of age group from 19 to 73 years) and randomization. The methodology of patient selection, blinding and randomization are not detailed in the paper.The study involved both open labelled study (phases 1 and 2, but without a control group) and an RCT. If the authors had given RCT results of phase 3, then it would have been a stronger (level 1) evidence to prove or disprove the efficacy and adverse effects of THC in the treatment of spasticity in SCI. Instead, the authors just used the placebo group of the RCT (phase 3 study) for comparison with the results of the phase 1 study (open labelled study), making the evidence provided as level 3.Factors such as patients' therapy or exercise programme, bowel care, bladder care, urine infections in the study periods or any other noxious stimuli are well known to affect spasticity. These confounding variables that may affect the results of the study should have been included in the multivariate analysis to make it more credible. Also the costbenefit analysis should have been included to assess the cost effectiveness of THC.Studies on the efficacy of cannabis or THC in SCI patients are very limited to date. There are a few mixed reports on this. 2,3 These studies are small size studies with poor design. The Cochrane review on pharmacological interventions for spasticity following spinal cord injury prepared and published by Cochrane Collaboration in 2007 highlights the difficulties of spasticity management in SCI,the poor quality of the studies published so far on this subject and also the need for further quality trials. 4 The authors in this paper have succeeded in exploring the benefits and possible adverse effects of THC use in SCI and more importantly highlight the need for further studies comparing THC with the currently available spasmolytic medications. So the overall attempt by the authors is laudable, but the outcome of the study does not add much to our current practice. Therefore, proper RCTs comparing with the currently used medications and analysing the costbenefit are needed before making any conclusion. We hope the authors continue the study to add to our present knowledge regarding this important topic. S VillanSpinal Injury Unit, Royal National Ort...

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

Cited by 60 publications

References 40 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

Latest Approaches for the Treatment of Spasticity and Autonomic Dysreflexia in Chronic Spinal Cord Injury

Use of Δ9-tetrahydrocannabinol in the treatment of spasticity in spinal cord injury patients

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