Medical Cannabis as a treatment option

Multiple Sclerosis (MS)

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Overview

Demyelination in brain tissue of a multiple sclerosis patient
What is Multiple Sclerosis?

Multiple sclerosis (MS) is a chronic (long term) condition of the central nervous system, considered to be an autoimmune disease. In MS, the body’s own immune system attacks the myelin coating or sheath around nerve fibres as well as the nerve fibres themselves in the brain and spinal cord. The individual progress, severity and specific symptoms that develop in an individual cannot be predicted and will depend on the amount of nerve damage and which nerves are affected. Most people with MS experience periods of partial or complete recovery from symptoms (remission) that can last for months or years followed by a relapse where new symptoms develop.

Symptoms

The resulting damage and scarring (sclerosis) caused by MS disrupts the flow of information within the brain and between the brain and body. This can cause symptoms that vary widely from person to person and can affect any part of the body. Most people are diagnosed between the ages of 20-40 with women being about twice as likely as men to develop MS.

The main symptoms include;

  • fatigue difficulty walking
  • visual problems, such as blurred vision
  • problems controlling the bladder
  • numbness or tingling in different parts of the body
  • muscle stiffness and spasms
  • problems with balance and co-ordination
  • problems with thinking, learning and planning
Cause

The cause of MS is still unknown but it is thought that genetic and environmental factors are involved. There is no cure for MS however, treatments can help relieve the effects from attacks, slow the course of the disease and manage symptoms.

Types of MS

Relapsing-remitting MS (RRMS) is the most common form of MS experienced by approximately 3 in every 4 people with the condition. Relapses or attacks are followed by periods of remission. During remission all symptoms may improve or some symptoms may continue and become permanent.
Secondary progressive MS (SPMS) develops in most people with RRMS. Relapses and partial recoveries may continue to occur with disability progressively worsening.

Primary progressive MS (PPMS) is a less common type of MS producing symptoms that gradually worsen and accumulate over several years with no periods of remission or acute attacks.

Clinically Isolated Syndrome (CIS) refers to a first episode of neurologic symptoms caused by inflammatory demyelination in the central nervous system that could become MS if additional activity occurs.

Management of MS

As there is no cure for MS, the focus of treatment is to shorten the duration of relapses, ease specific symptoms and slow the progression of the disease by reducing the rate of the attacks. The types of medications and other treatments prescribed depend on a number of factors. These include the MS type, the nature and severity of symptoms and individual considerations such as other medical conditions a person has.

Established treatments

Treatment for MS should be started and supervised by a specialist doctor called a neurologist. Short term sudden worsening or flare-ups (relapses) of MS may be treated with corticosteroids, such as methylprednisolone injection. Longer term prevention of relapses of MS may be treated with immunomodulators. These are medicines that help to suppress the immune system to help slow down the progression and severity of relapses of MS. Immunomodulator medicines include alemtuzumab, daclizum,ab, dimethyl fumarate, fampridine, fingolimod, glatiramer, interferon beta, natalizumab Other symptoms of MS such as muscle spasticity, bladder dysfunction, constipation and fatigue may also require treatment as follows: muscle spasticity, treated with dantrolene, diazepam, botulinum toxins, baclofen, biperiden, trihexiphenidyl or medicinal cannabis bladder dysfunction treated with darifenacin, oxybutynin, solifenacin, tolterodine constipation, treated with laxatives fatigue, treated with stimulants like caffeine.

Treatment with Medical Cannabis

MS can have a significant impact on every aspect of a person’s life.8 Research shows that medical cannabis may help to relieve some of the debilitating symptoms associated with MS, particularly pain, muscle spasticity, bladder spasm causing urinary frequency and poor sleep quality. Medical cannabis has been shown to have the potential to enhance the overall quality of life for a person with MS.

Muscle Spasticity

Spasticity is one of the most difficult symptoms of MS to treat and occurs in up to 90 of people with MS at one point.10 Spasticity can cause muscles to feel stiff, weak and heavy along with a wide range of involuntary, painful muscle spasms (sustained muscle contractions or sudden movements).9 Muscle spasticity can be a very real issue for a person living with MS, impacting significantly on their ability to stay mobile and live independently without pain. Medical cannabis has been shown to relieve the severity of muscle spasticity and sudden spasms, reducing pain, improving sleep and allowing a person’s arms and legs to move more freely.11 Medical cannabis fills an urgent need for a safe and effective alternative to standard medications that have limited data to support their effectiveness in the management of muscle spasticity, can be sedating and produce other unwanted side effects.12

Pain

Pain resulting from spasticity and neuropathic (following the path of a nerve) pain have been cited as the most common symptoms amongst people with MS.13 Clinical studies indicate that a person with MS experiencing chronic pain can derive benefits from treatment with medical cannabis, particularly as neuropathic pain often fails to respond to the standard pharmacologic treatments available.14,15 Currently, opioids are the analgesics often prescribed for the symptoms of pain caused by MS with limited efficacy and serious toxicity, such as tolerance development, physical dependence, sedation, respiratory depression and gastrointestinal symptoms.16

More research is required to determine the exact mechanism by which medical cannabis works to relieve chronic discomfort, however it is thought to be due to the natural endocannabinoid system including cannabinoid receptors, that we all have within our bodies.15 The added benefits of safely and effectively managing pain with medical cannabis are improved mood, the ability to perform daily tasks more easily and better quality of sleep as painful muscle spasms are relieved.

Bladder Problems

Bladder dysfunction is commonly reported by people with MS. MS lesions block or delay transmission of nerve signals that control the bladder and urinary sphincters, causing symptoms such as;

  • Frequency and/or urgency of urination
  • Hesitancy in starting urination
  • Frequent urination during the night (nocturia)
  • Incontinence (the inability to hold in urine)
  • Inability to empty the bladder completely

Studies indicate that medical cannabis may help to relieve the symptoms of a spastic (overactive) bladder where a person is unable to hold the normal amount of urine in their bladder, causing more frequent urination. This benefit is thought to be due to the presence of naturally occurring cannabinoid receptors in the bladder.17


References available at end of page.


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Research Articles

Related Advocacy Groups

These are some of the organisations offering information and support for people with MS, their carers and friends.

MS Australia - https://www.msaustralia.org.au/

MS Peer Support - https://www.ms.org.au/support-services/connect-with-others/ms-peer-support.aspx

Brain Foundation - http://brainfoundation.org.au/disorders/multiple-sclerosis

Health Direct - https://www.healthdirect.gov.au/multiple-sclerosis-ms

MS Clinical Trials - https://mstrials.org.au/

MS Network of Care Australia - http://www.msnetwork.org/networking.htm