Spinal cord injuries involve the compression or crushing of the spinal cord following a traumatic blow. Studies have shown marijuana effectively can limit the neurological damage when administered shortly after the injury and can help manage pain and muscle spasms.
Overview of Spinal Cord Injuries
A spinal cord injury is a bruise or tear into the spinal cord following a sudden, traumatic blow that fractures or dislocates vertebrae. Most spinal cord injuries involve a fracture or compression of the vertebrae within the spine, which causes the axons of the cord to be crushed and destroyed. If axons are damaged, permanent changes in strength, sensation and other functions below the site of the injury can occur.
A spinal cord injury is classified as complete, which means almost all sensory feeling and the ability to control movement below the injury are lost, or incomplete, which means to have some sensory feeling and motor function below the affected area.
Depending on the severity of the injury, symptoms can include loss of sensation, loss of movement, loss of bowel or bladder control, spasms, changes in sexual function, pain and difficulty breathing.
Currently, there’s no way to reverse damage done to the spinal cord, so the focus of treatment is on preventing further injury with medications, immobilization and surgery, empowering those with an injury to return to an active life with rehabilitation and technology devices, and to help patients manage undesirable symptoms like pain.
Findings: Effects of Cannabis on Spinal Cord Injuries
Cannabis and its cannabinoids have demonstrated that they can help limit the neurological damage if administered shortly after a spinal cord injury. Following trauma, a series of pathological events contribute to the spread of spinal cord damage and further provokes neurological losses (Arevalo-Martin, Garcia-Ovejero & Molina-Holgado, 2010). However, administering cannabinoids soon after the injury has been shown to reduce proinflammatory cytokines and delay neuronal atrophy and degeneration, thus preserving the white matter around injured area and protecting the myelin sheath that surrounds the cord (Latini, et al., 2014) (Arevalo-Martin, Garcia-Ovejero & Molina-Holgado, 2010). In one study, a reduction in swelling and a preservation of white matter and myelin were shown when cannabinoids were administered 20 minutes following a spinal cord injury (Arevalo-Martin, et al., 2012). In another, rats with spinal cord injuries saw improvements in locomotor functional recovery (Kwiatkoski, Guimaraes & Del-Bel, 2012). A third study found, in addition to an improvement in neurological function, saw a decrease in compression lesion volume (Hong, et al., 2015).
By acting through the CB1 and CB2 receptors of the endocannabinoid system, the cannabinoids provide a neuro-protective response, prompting researchers to conclude that they can be a useful treatment for acute spinal cord injuries (Arevalo-Martin, Garcia-Ovejero & Molina-Holgado, 2010) (Arevalo-Martin, et al., 2012) (Arevalo-Martin, Molina-Holgado & Garcia-Ovejero, 2016).
In addition, cannabis has long been determined as effective for addressing neuropathic pain. Its use has been found to be among the most effective pain relief treatments for people with spinal cord injuries (Wilsey, et al., 2013) (Heutink, Post, Wollaars & van Asbeck, 2011). A survey analyzing the effectiveness of pain relief treatments in spinal cord injured individuals found that few medications seldom offer relief, while massage therapy and marijuana use were the most helpful alternative treatments reported (Warms, Turner, Marshall & Cardenas, 2002) (Cardenas & Jensen, 2006).
For spinal cord injury patients experiencing spasms, cannabis may offer relief. Along with pain, muscle spasm is the most common reason that medical cannabis is recommended and prescribed by medical professionals (Borgelt, Franson, Nussbaum & Wang, 2013). Studies have demonstrated that medical cannabis offers significant improvements in muscle spasticity, both in mice trials and in human subjects (Borgelt, Franson, Nussbaum & Wang, 2013) (Baker, et al., 2000).
States That Have Approved Medical Marijuana for Spinal Cord Injuries
A number of other states will consider allowing medical marijuana to be used for the treatment of spinal cord injuries with the recommendation from a physician. These states include: California (any debilitating illness where the medical use of marijuana has been recommended by a physician), Connecticut (other medical conditions may be approved by the Department of Consumer Protection), Massachusetts (other conditions as determined in writing by a qualifying patient’s physician), Nevada (other conditions subject to approval), Oregon (other conditions subject to approval), Rhode Island (other conditions subject to approval), and Washington (any “terminal or debilitating condition”).
In Washington D.C., any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment.
Several states have approved medical marijuana specifically to treat “chronic pain,” a symptom commonly associated with spinal cord injuries. These states include: Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Maryland, Michigan, Montana, New Mexico, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, and West Virginia. The states of Nevada, New Hampshire, North Dakota, Ohio and Vermont allow medical marijuana to treat “severe pain.” The states of Arkansas, Minnesota, Ohio, Pennsylvania, Washington, and West Virginia have approved cannabis for the treatment of “intractable pain.”
Seventeen 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.
Recent Studies on Cannabis’ Effect on Spinal Cord Injuries
Adhikary, S., Li, H., Heller, J., Skarica, M., Zhang, M., Ganea, D., and Tuma, R.F. (2011). Modulation of Inflammatory Responses by a Cannabinoid-2–Selective Agonist after Spinal Cord Injury. Journal of Neurotrauma, 28(12), 2417–2427. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3235339/.
Arevalo-Martin, A., Garcia-Ovejero, D., and Molina-Holgado, E. (2010, May). The endocannabinoid 2-arachidonoylglycerol reduces lesion expansion and white matter damage after spinal cord injury. Neurobiology of Disease, 38(2), 304-12. Retrieved from http://www.sciencedirect.com/science/article/pii/S0969996110000409.
Arevalo-Martin, A., Garcia-Ovejero, D., Sierra, Palomares, Y., Paniagua-Torija, B., Gonzalez-Gil, I., Oretega-Gutierrez, S. and Molina-Holgado, E. (2012). Early endogenous activation of CB1 and CB2 receptors after spinal cord injury is a protective response involved in spontaneous recovery. PLos One, 7(11), e49057. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3496738/.
Arevalo-Martin, A., Molina-Holgado, E., and Garcia-Ovejero, D. (2016, January 4). Cannabinoids to treat spinal cord injury. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 64, 190-9. Retrieved from http://www.sciencedirect.com/science/article/pii/S0278584615000573.
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.
Baty, D.E., Zhang, M., Li, H., Erb, C.J., Adler, M.W., Ganea, D., Loftus, C.M., Jallo, J.I., and Tuma, R.F. (2008). Cannabinoid CB2 receptor activation attenuates motor and autonomic function deficits in a mouse model of spinal cord injury. Clinical Neurosurgery, 55, 172-7. Retrieved from http://journals.lww.com/neurosurgery/Citation/2007/07000/Cannabinoid_CB2_Receptor_Activation_Attenuates.192.aspx.
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.
Cardenas, D.D., and Jensen, M.P. (2006). Treatments for chronic pain in persons with spinal cord injury: A survey study. The Journal of Spinal Cord Medicine, 29(2), 109-17. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1864800/.
Heutink, M., Post, M.W., Wollaars, M.M., and van Asbeck, F.W. (2011). Chronic spinal cord injury pain: pharmacological and non-pharmacological treatments and treatment effectiveness. Disability and Rehabilitation, 33(5), 433-40. Retrieved from http://www.tandfonline.com/doi/full/10.3109/09638288.2010.498557?needAccess=true.
Hong, J., Nandiwada, V., Jones, V., Lu, M., Warner, D.S., Mukhopadhyay, S., and Sheng, H. (2015, June 15). CB1 cannabinoid receptor agonist inhibits matrix metalloproteinase activity in spinal cord injury: A possible mechanism of improved recovery. Neuroscience Letters, 597, 19-24. Retrieved from http://www.sciencedirect.com/science/article/pii/S0304394015002979.
Kwiatkoski, M., Guimaraes, F.S., Del-Bel, E. (2012, April). Cannabidiol-treated rats exhibited higher motor score after cryogenic spinal cord injury. Neurotoxicity Research, 21(3), 271-80. Retrieved from http://link.springer.com/article/10.1007%2Fs12640-011-9273-8.
Latini, L., Bisicchia, E., Sasso, V., Chiurchiu, V., Cavallucci, V., Molinari, M., Maccarrone, M., and Viscomi, M.T. (2014, September 4). Cannabinoid CB2 receptor (CB2R). stimulation delays rubrospinal mitochondrial-dependent degeneration and improves functional recovery after spinal cord hemisection by ERK1/2 inactivation. Cell Death & Disease, e1404. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4540196/.
NINDS Spinal Cord Injury Information Page. (2015, July 27). National Institute of Neurological Disorders and Stroke. Retrieved from http://www.ninds.nih.gov/disorders/sci/sci.htm.
Spinal cord injury. (2014, October 8). Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/spinal-cord-injury/basics/definition/con-20023837.
Warms, C.A., Turner, J.A., Marshall, H.M., and Caredenas, D.D. (2002, May-June). Treatments for chronic pain associated with spinal cord injuries: many are tried, few are helpful. The Clinical Journal of Pain, 18(3), 154-63. Retrieved from http://journals.lww.com/clinicalpain/pages/articleviewer.aspx?year=2002&issue=05000&article=00004&type=abstract.
Wilsey, B., Marcotte, T.D., Deutsch, R., Gouaux, B., Sakai, S., and Donaghe, H. (2003, February). Low dose vaporized cannabis significantly improves neuropathic pain. Journal of Pain, 14(2), 136-148. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3566631/.
Wilsey, B., Marcotte, T.D., Deutsch, R., Zhao, H., Prasad, H., and Phan, A. (2016) An Exploratory Human Laboratory Experiment Evaluating Vaporized Cannabis in the Treatment of Neuropathic Pain from Spinal Cord Injury and Disease. Journal of Pain, doi: 10.1016/j.pain.2016.05.010. Retrieved from http://www.jpain.org/article/S1526-5900(16)30072-4/fulltext.
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