What Was Known About Cannabis for MS Spasticity and Pain in 2002
A review found growing evidence from 8 clinical trials and animal models that cannabinoids reduced spasticity, pain, tremor, and bladder problems in multiple sclerosis, with effects mediated by both CB1 and CB2 receptors.
Quick Facts
What This Study Found
Clinical evidence from 8 trials in MS patients and 1 in spinal cord injury showed that cannabis, THC, and nabilone produced objective or subjective relief from spasticity, pain, tremor, and nocturia. Animal models using mice with chronic relapsing experimental allergic encephalomyelitis (CREAE) strongly supported cannabinoid receptor involvement in these effects.
Endocannabinoid concentrations were elevated in the brains and spinal cords of mice with spasticity, suggesting the body's own cannabinoid system was responding to the disease. Spasticity could be reduced by inhibiting endocannabinoid breakdown, pointing toward a therapeutic strategy that would enhance the body's natural response rather than introducing external cannabinoids.
Key Numbers
Eight clinical trials in MS and 1 in spinal cord injury were reviewed. Both CB1 and CB2 receptors were implicated in the therapeutic effects.
How They Did This
This was a narrative review synthesizing clinical trial data from 9 trials, questionnaire-based anecdotal evidence, and preclinical research using CREAE mouse models of MS. It evaluated both the clinical evidence and the biological mechanisms underlying cannabinoid effects on MS symptoms.
Why This Research Matters
This review was published at a critical moment when large-scale clinical trials of cannabinoids for MS were being planned. The convergence of patient reports, small clinical trials, and robust preclinical evidence helped justify the investment in larger trials that would ultimately lead to the approval of Sativex.
The Bigger Picture
The research directions outlined here were largely vindicated. Sativex (THC:CBD) was approved for MS spasticity in multiple countries. The discovery that endocannabinoid levels were elevated in spastic conditions opened research into drugs that enhance endocannabinoid signaling, an approach that continues to be explored.
What This Study Doesn't Tell Us
The clinical trials reviewed were small, and the review acknowledged that more conclusive evidence was needed. Animal models of MS do not perfectly replicate human disease. The review did not systematically assess the quality of the included trials.
Questions This Raises
- ?Does increased endocannabinoid production occur in human MS as it does in the mouse model?
- ?Would drugs that inhibit endocannabinoid breakdown be more effective or better tolerated than direct cannabinoid receptor agonists?
Trust & Context
- Key Stat:
- 8 MS trials showed relief from spasticity, pain, tremor, and nocturia
- Evidence Grade:
- This is a narrative review synthesizing clinical and preclinical evidence, providing moderate-level evidence through convergent findings.
- Study Age:
- Published in 2002, before the large CAMS trial and the approval of Sativex for MS spasticity.
- Original Title:
- Cannabinoids and multiple sclerosis.
- Published In:
- Pharmacology & therapeutics, 95(2), 165-74 (2002)
- Authors:
- Pertwee, Roger G(17)
- Database ID:
- RTHC-00127
Evidence Hierarchy
Summarizes existing research on a topic.
What do these levels mean? →Frequently Asked Questions
Is cannabis approved for MS symptoms?
Sativex (nabiximols), a cannabis-based mouth spray containing THC and CBD, was subsequently approved in multiple countries for MS spasticity. This review documented the evidence base that contributed to that approval.
What are endocannabinoids and why were they elevated in MS?
Endocannabinoids are the body's own cannabis-like compounds. Their elevation in spastic conditions suggested the body was attempting to use its own cannabinoid system to fight spasticity, supporting the rationale for cannabinoid treatment.
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Cite This Study
https://rethinkthc.com/research/RTHC-00127APA
Pertwee, Roger G. (2002). Cannabinoids and multiple sclerosis.. Pharmacology & therapeutics, 95(2), 165-74.
MLA
Pertwee, Roger G. "Cannabinoids and multiple sclerosis.." Pharmacology & therapeutics, 2002.
RethinkTHC
RethinkTHC Research Database. "Cannabinoids and multiple sclerosis." RTHC-00127. Retrieved from https://rethinkthc.com/research/pertwee-2002-cannabinoids-and-multiple-sclerosis
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.