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What is Multiple Sclerosis (MS)?
Multiple sclerosis is an autoimmune disease, inflammatory disease that is caused by an attack from the immune system of the body in the myelin sheath surrounding nerve cells in the central nervous system (CNS). The myelin sheath provides insulation for these cells to enable rapid conduction of signals throughout the body; destruction slows the CNS signals to the body (PNS) peripheral nervous system. This condition can also lead to the destruction of the nerves themselves, which is irreversible.
Due to the fact that the CNS is the “command center” for the body, MS can cause problems in many body systems. Multiple Sclerosis (and current treatments available for treatment) can cause infection and bladder dysfunction, bowel dysfunction, depression, fatigue, itching, emotional changes, pain, sexual problems, tremors, dizziness and vertigo, walking difficulties (walking ), sleep disorders and more.
One of the main symptoms of multiple sclerosis known as spasticity. It can cause overactive reflexes, involuntary movements, difficulty with care and hygiene, abnormal posture, contractures, bone pain and joint deformities, and more. Needless to say, multiple sclerosis causes a severely diminished quality of life of patients. There is currently no cure for multiple sclerosis, which is why research into new treatments for the relief of symptoms and disease progression is essential.
The results of the largest study on cannabis, MS to date
One of the largest studies gauging the effect of medicinal cannabis in multiple sclerosis patients was one of the 630 participants, made by Zajicek et al. in 2003 in 33 centers. The results showed that participants who used the drug based on cannabis whole plant (CBM) extracts did not experience an improvement in objective measures of spasticity measured by the Ashworth scale – a tool used to evaluate objective measures of spasticity, including tone, strength and stiffness in the body’s extremities.
“Patients in the extract CBM or Δ-9-tetrahydrocannabinol (THC) CBM groups reported improvements in” pain, quality of sleep, spasms and spasticity. . “- Zajicek et al
However, self-reports, patients extract CBM or Δ-9-tetrahydrocannabinol (THC) groups CBM reported improvements in” pain, quality Sleep, spasm and spasticity, … although no effect was observed with respect to irritability, depression, fatigue, tremor or energy. “
In the comparison of lack of efficacy for spasticity as measured by the Ashworth scale to other treatment options available for multiple sclerosis, Zajicek et al important to note the following:.
“in evaluating our results, we must recognize that the degree of evidence that many of the drugs commonly used to fight [Multiple Sclerosis] symptoms is weak … One study [of a commonly used medication for Multiple Sclerosis] observed a difference in scores Ashworth active treatment compared with placebo, while the other showed no effect. None of these detailed studies of any difference in time has a style [, another measure of disability caused by Multiple Sclerosis], and even when a significant effect on the Ashworth scale was obtained, it was no different on measures of pain or sleep quality in the active medication. “
In contrast, the medical cannabis did show efficacy in improving pain and sleep quality. Additionally and importantly, at 12 months follow-up,” muscle spasticity as measured by the Ashworth scale it was significantly improved in the group treated with THC [CBM] group. Rivermead Mobility Index [a test of functional mobility] has also improved, indicative of reduced disability. “
The use of objective measures of information in the treatment of MS
So if the medical cannabis showed no immediate effect on the Ashworth scale in such a large-scale study, this option treatment is not effective a good treatment option for multiple sclerosis, right answer to this question is a loud and resounding “no”? understanding of the reasoning for this requires a basic understanding of the tools used in research [
validity tests (which measure whether or not a tool is accurate / if measured that is designed to measure) and reliability tests (which measure the ability of a tool to produce the same results when administers several times in the same conditions) are made in tools like the Ashworth scale, in order to help us understand the real world or clinical utility.
Zajicek et al. they noted in their large study 2003, “the limitations of the Ashworth scale in measuring the complexity of the symptoms of spasticity are well known, and there is a need to develop new scales patient-oriented to allow as much as they care about.”
Due to the fact that the Ashworth scale is not a completely valid measure of spasticity, performance that should not be used in assessing the efficacy of treatment. Whether that medical cannabis is capable of producing a significant change in the Ashworth scale, therefore, it does not adequately measure the effectiveness of medical cannabis on spasticity.
In addition, there are many other symptoms experienced by patients with multiple sclerosis only spasticity (such as pain, weakness, etc.) and treatment effectiveness should not be measured solely on changes that one of the symptoms .
According to Vaney et al., “… It must be questioned whether the disturbance of muscle tone by strong anti-spastic agents is clinically significant in all cases as a disability in multiple sclerosis patients seems more clearly related to the weakness of spasticity. ”
In a study using CBM capsules with 2.5 mg of THC and 0.9 mg of cannabidiol (CBD), these same researchers found that “there were no statistically significant differences associated with active treatment [i.e. medical cannabis] compared with placebo, but the trends in favor of active treatment were seen by spasm frequency, mobility and sleeping. ”
“Treatment with smoked cannabis resulted in a significant reduction in patients [modified Ashworth Scale] scores.” -. Corey-Bloom et al
In addition, studies have shown improvement in objective spasticity scores. Using the Modified Ashworth Scale (MAS), a study conducted in 2012 by Corey-Bloom et al. found that “smoked cannabis treatment resulted in a significant reduction in scores of patients … In addition, the treatment reduced pain scores on a visual analog scale [a self-report measure].”
No differences between groups of medical cannabis and placebo in a timed walk test found. However, scores on a test of cognitive function showed lower for participants in the active treatment compared to placebo scores.
The use of subjective measures of information in the treatment of MS
So what tools should researchers use to measure improvements in symptoms of spasticity in patients with multiple sclerosis? . In a meta-analysis of the effectiveness of CBM for oral mucosa and MS, Wade et al, 2010 he stated:
“The 0-10 numerical rating scale is recommended as a preferred outcome in the assessment of interventions in chronic pain, but has not been widely used in studies of anti-spasticity. it has the advantage of allowing the patient to express their own daily experience of spasticity and has recently been validated … is a tool appropriate evaluation and possibly an alternative to the Ashworth scale, several research groups have criticized. “
the researchers” found that the overall impression of change (GIC ) has been significantly improved in patients in active treatment [i.e. medical cannabis]. the participants in the active treatments were significantly less likely to experience spasticity compared with participants with placebo, based on self-reports of visual analogue scale and numerical Rating scale. “
In the scientific study, are considered measures of self-report reliable because human beings have bias by nature, often unintentionally. Scientists understandably want facts and not opinions, which it is why objective measures and double blind are used as elements of the reference standard to determine the effectiveness of treatment.
However, a study by Collin et al. (2007), which found effectiveness of CBM using measures self-report addresses this issue in relation to the treatment of CBM and multiple sclerosis. the researchers mentioned in the “Discussion” section of their study that, although his work was criticized for using a self-report measure, which actually it may be superior to the observer-rated measures
One reason for this is the lack of “clinical relevance” that provide objective measurements.; when patients in the “real world” with spasticity going to see the doctor, the doctor often merely asks the patient or caregiver how the patient has been feeling about their spasticity. Very rarely are objective measures such as the Ashworth scale used.
Furthermore, the use of the scale of 11 points Numerical aims to provide a wider experience spasticity patient vision. It does so by measuring spasticity of more than 24 hours, not just at one point in time, thereby obtaining a better idea of the quality of life of patients.
As noted Collin et al., “There is a growing acceptance that a patient reported outcome measure is appropriate for spasticity.” The NRS is frequently used for pain assessment in the clinic, with at least 30% reduction in pain after treatment means that the treatment provided a ‘clinically significant reduction in pain. ”
Although it is unclear whether the same caliber is appropriate to assess whether the NRS can be used to accurately measure spasticity with Reliabilty, 40% of the original CBM group in this study experienced an improvement> 30% in spasticity. This improvement has, in addition to those already provided by participants prescription for combating spasticity, who were forced to continue throughout the trial drugs found.
Researchers have noted, “Small improvements in patients [’] experience can lead to big changes in the quality of life … The ideal objective measure of spasticity does not exist. Using the NRS [for spasticity research] and in pain research seems to be a reasonable compromise. “
Medical evidence of the efficacy of cannabis-Based on MS
Multiple studies have shown the benefits of medical cannabis for patients with multiple sclerosis who experience a range of symptoms. Novotna et al. (2011) conducted a placebo-controlled phase III cannabis-based medicine (CBM) as an adjunct therapy for MS symptoms test. The complement CBM produced “highly significant” in the numerical rating scale, as well as improvements in self-reports spasm frequency, sleep disturbances, and the perspective of the caregiver and clinical with respect to the overall impression of change difference for the patient.
In 2007, Collin et al. He conducted a study on the effects of CBM in patients with multiple sclerosis and found that the CBM for oral mucosa recorded subject daily significantly improved numerical scale rating spasticity. However, there was no significant difference between placebo and active treatment [i.e. medical cannabis] Ashworth Score and Motricity Index [an objective measure of muscle power]. 57% of participants in active treatment compared with 48% of participants in the control group had a better overall impression of change in symptoms.
Numerous studies have also demonstrated the efficacy of medicinal cannabis in the treatment of neuropathic pain, which is the most common type of pain experienced by patients with multiple sclerosis. These include “A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain” byWilsey et al. (2008) and “smoked for cannabis chronic neuropathic pain: a randomized controlled trial” by Ware et al. (2010), which also showed improvements in the ability to fall improving quality sleep, sleep and well tolerated and minimal adverse events.
In addition, “Controlled A preliminary study to determine whether the whole cannabis plant extracts can improve neurogenic symptoms resistant to treatment,” Wade et al. (2003), which uses the CBM oromucosal, found improvements in pain, impairment of bladder control, muscle spasms and spasticity treatment with medicinal cannabis.
CBM as treatment of disease, not just the symptoms
There is some evidence suggesting that medical cannabis can be useful beyond the control of symptoms in patients with multiple sclerosis, and you may be able to act as a direct treatment of the disease.
“Preclinical evidence has emerged supporting [e] hypothes [is] … that … the activation of CB 2 receptors expressed by T cells in the central nervous system decrease inflammation in MS and possibly also slow the progression of the disease. “-. Pertwee et al
A study by Pertwee et al. (2007) conducted a review of cannabinoids and their effect on multiple sclerosis, found no evidence to suggest that cannabinoids may function not only as a treatment for MS symptoms, but also the direct treatment of disease.
This is believed to occur through activation of cannabinoid receptors, which “can suppress some of the pathological changes leading to these signs and symptoms”.
Researchers have pointed out, “the signs and symptoms of this disease can be improved by agonists of cannabinoid receptors at doses that do not cause unacceptable serious adverse effects. Preclinical evidence has emerged supporting [e] hypothes [is] … … that activation of CB 2 receptors expressed by T cells in the central nervous system decrease inflammation in multiple sclerosis and possibly slow progression of the disease.
cognitive effects of cannabis in people with MS
to date, some of the evidence suggesting that medical cannabis is an option of harmful treatment for patients with multiple points sclerosis to the fact that on cognitive tests, patients with MS who use medical cannabis can perform worse compared with patients with multiple sclerosis who can not use medical cannabis.
Given that the disease itself can cause cognitive declines, these results represent an understandable concern. However, when it comes to diseases such as multiple sclerosis with debilitating symptoms, optimal maintenance of cognition is not the most important issue.
A patient using medical cannabis with decreased pain, easier to sleep, decreased self-reports of spasticity, and / or an increase in the overall perception of their health, is a medical success .
CBM is A, option safe effective treatment for patients with MS
Given its low risk of negative side effects and low risk of dependence, CBM may be an effective treatment option for use in conjunction with other effective for patients with typical and difficult symptoms of multiple sclerosis treatments. However, medical cannabis is not an optimal treatment option for each.
“It would be beneficial for MS patients to have safe and legal access of various forms of medicinal cannabis, with the authorized and supervised by a health professional use.”
For a better understanding of the CBM and its effects in multiple sclerosis, more research needs to be carried out using appropriate to assess their effects tools.
That said, further investigation for any medication always justified – even for those who have been legal and commonly used for decades. Therefore, this is not a strong enough reason to maintain the ban on medical cannabis for patients with multiple sclerosis.
Global security is evidence of medicinal cannabis in various forms, along with their efficacy shown by various symptoms of multiple sclerosis, it seems to support its use for patients who are suffering. This is especially true for people with intractable symptoms that can not be improved by other therapies.
turn, would be beneficial for MS patients to have safe and legal access of various forms of medicinal cannabis, with the authorized and supervised by their medical use.