Muscle spasms are when a muscle tightens and contracts involuntarily, causing pain and potentially serious joint mobility issues. Studies have shown cannabis effectively reduces the frequency and intensity of spasms, including in patients diagnosed with multiple sclerosis.
Overview of Spasms
Spasms are when your muscles are stiff and experience involuntary contractions. Spasms, or cramps, are most commonly caused by long periods of physical labor or dehydration, but they can also be associated with serious conditions, like multiple sclerosis. Their intensity can range from somewhat uncomfortable tightness to extremely painful and uncontrollable contractions. Spasticity can occur throughout all limbs, but is most common in the legs.
For those with multiple sclerosis, spasms can be stimulated by sudden movements, temperature changes, humidity and from wearing tight clothing.
Muscle spasms will interfere with regular motor function and can cause distressing symptoms. If left untreated, spasms can lead to soft tissue shortening, which in turn can cause frozen or disabling contractures in the hip, knee, ankle, shoulder and elbow joints.
Spasms are most commonly treated with medications and physical and occupational therapy.
Findings: Effects of Cannabis on Spasms
Along with pain, muscle spasm is the most common reason that medical cannabis is recommended and prescribed by medical professionals2. Studies have demonstrated that medical cannabis offers significant improvements in muscle spasticity, both in mice trials and in human subjects1,2.
The two major cannabinoids found in cannabis, tetrahydrocannabinol (THC) and cannabidiol (CBD), are responsible for cannabis’ effectiveness at muscle spasm relief. There’s strong evidence that suggests that cannabinoid-induced reductions in muscle tremors and spasticity are due to the activation of the cannabinoid receptors, CB1 and CB2, of the endocannabinoid system10. THC and CBD have demonstrated that they interact with the CB1 and CB2 receptors and their actions on the two receptors regulates the excitatory and inhibitory neurotransmitters necessary to curtail spasms14.
For those whose spasms and spasms are related to multiple sclerosis, cannabis has demonstrated it can offer relief15. In what was the largest multinational clinical trial of its kind, multiple sclerosis patients suffering from spasms were treated with cannabis containing THC and CBD. After 12 weeks, the patients experienced significantly reduced spasticity severity compared with patients receiving the placebo. While the trial lasted 12 weeks, patients reported significant improvements in spasticity after just four weeks13. The same patients also reported significant improvement in quality-of-life measures over the 16 weeks15. In another study, approximately two-thirds of patients reported improvements in spasticity after 50 weeks of treatment with cannabis containing THC and CBD5.
Cannabis has even shown to be effectively lower the frequency and intensity of spasms in multiple sclerosis patients whose spasms had been previously unrelieved by traditional anti-spasticity therapy. After 15 weeks of treatment, patients saw a significant reduction in spasticity. Improvements were seen within the first four weeks3.
States That Have Approved Medical Marijuana for Spasms
Currently, 17 states have approved medical marijuana for the treatment of spasms. These states include: Arizona, Arkansas, California, Colorado, Delaware, Florida, Hawaii, Louisiana, Maryland, Michigan, Minnesota, Montana, Nevada, New Hampshire, Oregon, Rhode Island and Washington.
If muscle spasms are caused by multiple sclerosis, Alaska, Connecticut, Florida, Georgia, Illinois, Louisiana, Maine, Massachusetts, New Hampshire, New Jersey, New Mexico, New York, Ohio, Pennsylvania, Vermont and West Virginia have approved medical marijuana for treatment purposes.
A number of other states will consider allowing medical marijuana to be used for the treatment of spasms not related to multiple sclerosis with recommendation by a physician. These states include: Connecticut (other medical conditions may be approved by the Department of Consumer Protection) and Massachusetts (other conditions as determined in writing by a qualifying patient’s physician).
In Washington D.C., any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment.
Recent Studies on Cannabis’ Effect on Spasms
- Baker, D., Pryce, G., Croxford, J.L., Brown, P., Pertwee, R.G., Huffman, J.W., and Layward, L. (2000, March 2). Cannabinoids control spasticity and tremor in a multiple sclerosis model. Nature, 404(6773), 84-7. Retrieved from http://www.nature.com/nature/journal/v404/n6773/full/404084a0.html.
- Borgelt, L.M., Franson, K.L., Nussbaum, A.M., and Wang, G.S. (2013, February). The pharmacologic and clinical effects of medical cannabis. Pharmacotherapy, 33(2), 195-209. Retrieved from http://onlinelibrary.wiley.com/wol1/doi/10.1002/phar.1187/full.
- Collin, C., Ehler, E., Waberzinek, G., Alsindi, Z., Davies, P., Powell, K., Notcutt, W., O’Leary, C., Ratcliffe, S., Novakova, I., Zapletalova, O., Pikova, J., and Ambler, Z. (2010, June). A double-blind, randomized, placebo-controlled, parallel-group study of Sativex, in subjects with symptoms of spasticity due to multiple sclerosis. Neurological Research, 32(5), 451-9. Retrieved from http://www.tandfonline.com/doi/pdf/10.1179/016164109X12590518685660?needAccess=true.
- Corey-Bloom, J., Wolfson, T., Gamst, A., Jin, S., Marcotte, T.D., Bentley, H., and Gouaux, B. (2012). Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial. CMAJ : Canadian Medical Association Journal, 184(10), 1143–1150. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394820/.
- Fernandez, O. (2014). Advanced in the management of multiple sclerosis spasticity: recent clinical trials. European Neurology, 72. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25278117.
- Lahkahn, S.E., and Rowland, M. (2009, December 4). Whole plant cannabis extracts in the treatment of spasticity in multiple sclerosis: a systematic review. BMC Neurology, 9, 59. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2793241/.
- Leussink, V.I., Husseini, L., Warnke, C., Broussalis, E., Hartung, H.P., and Kieseier, B. C. (2012). Symptomatic therapy in multiple sclerosis: the role of cannabinoids in treating spasticity. Therapeutic Advances in Neurological Disorders, 5(5), 255–266. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437528/.
- Lorente Fernandez, L., Monte Boquet, E., Perez-Miralles, F., Gil Gomez, I., Escutia Roig, M., Bosca Blasco, I., Poveda Andres, J.L., and Casanova-Estruch, B. (2014, June). Clinical experiences with cannabinoids in spasticity management in multiple sclerosis. Neurologia, 29(5), 257-60. Retrieved from http://www.elsevier.es/en-revista-neurologia-english-edition–495-articulo-clinical-experiences-with-cannabinoids-in-S2173580814000674.
- Malfitano, A.M., Proto, M.C., and Bifulco, M. (2008). Cannabinoids in the management of spasticity associated with multiple sclerosis. Neuropsychiatric Disease and Treatment, 4(5), 847–853. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626929/.
- Novotna, A., Mares, J., Ratcliffe, S., Novakova, I., Vachova, M., Zapletalova, O., Gasperini, C., Pozzilli, C., Cefaro, L., Comi, G., Rossi, P., Ambler, Z., Stelmasiak, Z., Erdmann, A., Montalban, X., Klimek, A., Davies, P. (2011, September). A randomized double-blind-placebo-controlled, parallel-group, enriched-design study of nabiximols* (Sativex(®), as add-on therapy, in subjects with refractory spasticity caused by multiple sclerosis. European Journal of Neurology, 18(9), 1122-31. Retrieved from http://onlinelibrary.wiley.com/wol1/doi/10.1111/j.1468-1331.2010.03328.x/full.
- Pertwee, R.G. (2002, August). Cannabinoids and multiple sclerosis. Pharmacology & Therapeutics, 95(2), 165-74. Retrieved from http://www.sciencedirect.com/science/article/pii/S0163725802002553.
- Russo, M., Calabro, R.S., Naro, A., Edoardo, S., Rifici, C., D’Aleo, G., Leo, A., De Luca, R., Quartarone, A., and Bramanti, P. (2015). Sativex in the Management of Multiple Sclerosis-Related Spasticity: Role of the Corticospinal Modulation. Neural Plasticity, Article ID 656582, 6 pages. Retrieved from https://www.hindawi.com/journals/np/2015/656582/.
- Spasticity. (n.d.). National Multiple Sclerosis Society. Retrieved from http://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Spasticity.
- Syed, Y.Y., McKeage, K., and Scott, L.J. (2014, April). Delta-9-tetrahydrocannabinol-cannabidiol (Sativex): a review of its use in patients with moderate to severe spasticity due to multiple sclerosis. Drugs, 74(5), 563-78. Retrieved from http://link.springer.com/article/10.1007%2Fs40265-014-0197-5.
- Thaera, G.M., Welik, K.E., Carter, J.L., Demaerschalk, B.M., and Wingerchuk, D.M. (2009, November). Do cannabinoids reduce multiple sclerosis-related spasticity? Neurologist, 15(6), 369-71. Retrieved from http://journals.lww.com/theneurologist/Abstract/2009/11000/Do_Cannabinoids_Reduce_Multiple_Sclerosis_Related.19.aspx.
- Vaney, C., Heinzel-Gutenbrunner, M., Jobin, P., Tschopp, F., Gattlen, B., Hagen, U., Schnelle, M., and Reif, M. (2004, August). Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled, crossover study. Multiple Sclerosis, 10(4), 417-24. Retrieved from http://journals.sagepub.com/doi/pdf/10.1191/1352458504ms1048oa.
- Vermersch, P. (2011, April). Sativex (tetrahydrocannabinol + cannabidiol), an endocannabinoid system modulator: basic features and main clinical data. Expert Review of Neurotherapeutics, 11(4), 15-9. Retrieved from http://www.tandfonline.com/doi/full/10.1586/ern.11.27?needAccess=true.
- Zajicek, J., Fox, P., Sanders, H., Wright, D., Vickery, J., Nunn, A., Thompson, A., and UK MS Research Group. (2003, November 8). Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial. The Lancet, 362(9395), 1517-26. Retrieved from http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)14738-1/abstract.
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