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Muscle spasticity

Cannabis for Muscle spasticity

hand with convulsions muscle spasms

Muscle spasticity is a condition characterized by involuntary muscle stiffness or spasms caused by disrupted communication between the brain, spinal cord, and muscles. It is often associated with neurological conditions such as multiple sclerosis (MS), cerebral palsy, spinal cord injuries (SCIs), and strokes or other traumatic brain injuries (TBIs). This debilitating symptom can impair mobility, cause significant pain, and reduce overall quality of life. Spasticity affects over 12 million people worldwide.

While conventional treatments such as physical therapy, muscle relaxants, and antispasmodic medications are often prescribed, medical cannabis is emerging as a promising therapy for managing muscle spasticity, particularly in cases where other treatments have proven inadequate.

Spasticity causes

Muscle spasticity occurs due to damage or dysfunction in the central nervous system (CNS), which interferes with the brain’s ability to regulate muscle movement. Common causes include:

  • Multiple sclerosis (MS): An autoimmune disease that damages nerve fibers in the brain and spinal cord, leading to muscle stiffness and spasms
  • Cerebral palsy: A group of disorders affecting movement and muscle tone caused by brain damage during early development
  • Spinal cord injury (SCI): Trauma to the spinal cord disrupts signals between the brain and muscles, resulting in spasticity
  • Stroke: Reduced blood flow to the brain can cause muscle tightness and involuntary contractions
  • Traumatic brain injury (TBI): Injury to the brain can impair motor control and result in muscle stiffness
  • Neurodegenerative disorders: Conditions such as amyotrophic lateral sclerosis (ALS, aka Lou Gehrig’s disease) can cause progressive muscle spasticity

Spasticity symptoms & health effects

Muscle spasticity presents with a variety of symptoms that can range from mild to severe, depending on the underlying condition:

  • Muscle tightness and stiffness
  • Sudden, involuntary muscle spasms
  • Painful cramps or contractions
  • Reduced range of motion in joints
  • Difficulty with walking, sitting, or other movements
  • Muscle weakness or fatigue

Over time, chronic spasticity can cause significant health effects, including:

  • Joint deformities and contractures
  • Pain and discomfort
  • Loss of independence in daily activities
  • Increased risk of pressure sores due to immobility

Spasticity diagnosis

Diagnosing muscle spasticity involves evaluating a patient’s medical history, symptoms, and physical functioning. Key diagnostic steps include:

  • Clinical evaluation: Assessing muscle stiffness, reflexes, and range of motion
  • Neurological examination: Identifying underlying neurological conditions through nerve and brain assessments
  • Imaging tests: MRI or CT scans to identify brain or spinal cord damage
  • Functional assessments: Evaluating the impact of spasticity on mobility and daily activities

a patient listening to his doctor's explanation outside the MRI machine

Spasticity prognosis

The prognosis for muscle spasticity depends on the underlying cause, severity of the condition, and treatment effectiveness. While some individuals may achieve significant improvement with early diagnosis and treatment, others may experience chronic spasticity requiring long-term management. Comprehensive care involving multiple therapies can help maintain mobility, reduce symptoms, and improve quality of life.

Spasticity treatments

Treatments for muscle spasticity tend to center around medication and physical therapy. However, in some instances, more invasive treatments and surgeries may be required.

First-line treatments

Conventional treatments for muscle spasticity aim to reduce stiffness, improve mobility, and alleviate pain. These include:

  • Physical therapy: Exercises and stretches to maintain muscle flexibility and strength
  • Oral medications:
    • Muscle relaxants, such as baclofen or tizanidine
    • Antispasmodic drugs like diazepam (benzodiazepine)
  • Botulinum toxin (Botox): Injections to block nerve signals and temporarily relax spastic muscles.

Other treatments

For patients who do not respond to first-line therapies, additional treatments may include:

  • Intrathecal baclofen therapy (ITB): Implanting a pump to deliver baclofen (a muscle relaxant medication) directly into the spinal cord
  • Nerve blocks: Injections to temporarily reduce muscle activity in specific areas
  • Orthotic devices: Braces or splints to improve mobility and prevent joint deformities
  • Surgical interventions: Procedures to release tight muscles or reduce nerve activity

Adjunctive therapy & alternative treatments

Adjunctive therapies can complement conventional treatments to enhance symptom relief:

  • Complementary approaches: Yoga, acupuncture, and massage therapy may help reduce muscle stiffness and improve relaxation
  • Behavioral therapy: Techniques to address pain, anxiety, and stress that may exacerbate symptoms

Cannabis for muscle spasticity

Medical cannabis is gaining recognition as an effective alternative or adjunct therapy for muscle spasticity, particularly for those who have not responded to conventional treatments. The cannabinoids found in cannabis, such as tetrahydrocannabinol (THC) and cannabidiol (CBD), interact with the body’s endocannabinoid system (ECS) to regulate muscle tone, reduce inflammation, and alleviate pain.

Cannabis and multiple sclerosis (MS)

Multiple sclerosis is one of the most well-researched conditions for which medical cannabis has demonstrated significant therapeutic potential. MS-related spasticity affects approximately 60-80% of individuals with the disease, often causing severe pain and functional impairment. Research shows that medical cannabis can:

  • Reduce spasticity: THC and CBD have been shown to decrease muscle tightness and spasms in patients with MS
  • Alleviate pain: Cannabinoids can reduce neuropathic pain (nerve pain) associated with spasticity
  • Improve sleep and mobility: By alleviating spasms and pain, medical cannabis can enhance overall quality of life

In clinical studies, cannabis-based medications such as nabiximols (Sativex), a THC:CBD oromucosal spray, have been approved in various countries for treating MS-related spasticity. Nabiximols have shown efficacy in reducing muscle stiffness and improving patient-reported outcomes.

Cannabis for other causes of muscle spasticity

Beyond MS, medical cannabis shows promise in managing spasticity caused by other neurological conditions:

  • Cerebral palsy: Studies suggest that cannabis can help reduce muscle rigidity, improve mobility, and alleviate pain in individuals with cerebral palsy
  • Spinal cord injury (SCI): Cannabinoids can regulate overactive muscle signaling, reducing spasms and improving comfort in SCI patients
  • Stroke-related spasticity: Preliminary evidence indicates that medical cannabis may reduce spasticity and associated pain in post-stroke patients
  • ALS (amyotrophic lateral sclerosis): Cannabis may help alleviate spasticity, cramps, and pain associated with ALS, improving patient comfort and sleep quality

Mechanisms of action

Cannabinoids exert their effects on spasticity primarily through the endocannabinoid system (ECS), which plays a role in regulating motor control, pain perception, and inflammation. Key mechanisms include:

  • CB1 receptors: Found in the brain and spinal cord, activation of CB1 receptors by THC reduces excessive nerve signaling, leading to muscle relaxation
  • CB2 receptors: Found in immune cells, activation of CB2 receptors reduces inflammation, which can contribute to spasticity
  • CBD’s modulatory effects: CBD does not directly bind to cannabinoid receptors but influences ECS activity and other pathways, such as serotonin and vanilloid receptors, to reduce anxiety, muscle spasms, and nerve pain

cannabis tinctures

Additional information for patients

When considering medical cannabis for muscle spasticity, patients and healthcare providers should take into account the following factors:

  • THC vs. CBD ratios: Products with balanced THC:CBD ratios, such as nabiximols (Sativex), are often preferred for spasticity management
  • Delivery methods:
    • Oromucosal sprays: Fast-acting and allow for precise dosing
    • Oils and tinctures: Provide longer-lasting effects
    • Vaporized cannabis: Offers rapid relief, but requires caution for lung health
  • Dosing and titration: Start with low doses and gradually increase to find the optimal balance between symptom relief and side effects

Muscle spasticity FAQs

How does medical cannabis help with muscle spasticity?

Cannabinoids like THC and CBD interact with the endocannabinoid system to reduce excessive muscle activity, alleviate pain, and improve mobility.

Is medical cannabis safe for long-term use?

Medical cannabis is generally well-tolerated, but side effects such as drowsiness, dizziness, and dry mouth may occur. Long-term use should be monitored by a healthcare provider.

Can medical cannabis replace conventional treatments for spasticity?

Medical cannabis can be used as an adjunct therapy alongside conventional treatments, particularly for patients who have not achieved relief with other options. There is no evidence that medical cannabis can replace conventional treatments. However, it could reduce the need for opioid-based painkillers and sedatives.

Are there any cannabis-based medications for spasticity?

Yes. Nabiximols (Sativex) is a cannabis-based medication for MS-related spasticity that has been approved in several countries.

Is Sativex (nabiximols) available in the U.S.?

Although nabiximols (Sativex) has been approved for the treatment of spasticity and pain associated with MS in other countries, this is not the case in the U.S. However, this may change in the future.

What is the best delivery method or administration route of medical cannabis for spasticity?

Oromucosal sprays, oils, and tinctures are commonly recommended for spasticity due to their precise dosing and effectiveness.

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