Spasticity Qualifies for Medical Marijuana Treatment in Texas

 

Spasticity is a qualifying condition for medical marijuana treatment in Texas, which leads to the question

 

What exactly IS spasticity?

 

Spasticity itself is not a unique medical diagnosis in the way that hypertension or diabetes are considered medical diagnoses.  It is more accurate to view spasticity as a symptom caused by a variety of medical disorders - most of which are caused by pathology in the neural pathways that control muscle movement. 

 

Spasticity is disruption in muscle movement patterns so that muscles contract all at once. Muscle movements are normally controlled by a coordinated system that allows some muscles to contract (tighten) while others relax. Damage to nerves in the central nervous system can disrupt this coordination. As a result, many muscles may contract all at once, and other times they don’t contract at all. This condition can be found in cerebral palsytraumatic brain injurystrokespinal cord injurymultiple sclerosis, and other conditions that affect the brain and/or spinal cord. Spasticity mostly occurs in the legs but can occur in the arms.

 

What are symptoms of spasticity?

Spasticity involves things like increased muscle tone interspersed with periods of weakness.  Involuntary or patterned movements are also seen on in some patients, with twisting, rhythmic movements, restricted motion, and posturing.  Because the muscles are spasming, pain and discomfort can be severe.

 

 

When is spasticity treated?

Spasticity should be treated when it causes pain, interferes with activities of daily living or sleep, or leads to less ability to function. Treatment is developed based on the patients needs, preferences and goals.

 

What are some non-medical treatments for MS-related spasticity?

Spasticity can be reduced by:

 

Can Medical Cannabis Treat Spasticity?

Coping with stiff, aching, cramping muscles is a way of life for most of the 2.5 million people in the world who have multiple sclerosis. Many of the 15 million people with spinal cord injuries also suffer from the same symptoms, which cause pain, limit movement, and rob people of needed sleep. Although several conventional medications can reduce these patients' discomfort, taking them rarely provides complete relief. Often the drugs cause weakness, drowsiness, and other side effects that some patients find intolerable.

 

Given this outlook, it is not hard to understand why some people with multiple sclerosis and spinal cord injuries have sought relief through marijuana. Plenty of anecdotal evidence from patients indicates that muscle spasms decrease after smoking marijuana.  For examples, in a 1982 survey of people with spinal cord injuries, 21 of 43 respondents reported that marijuana reduced muscle spasticity, while nearly every participant in a 1997 survey of 112 regular marijuana users with multiple sclerosis replied that the drug lessened both pain and spasticity.  This is not to say that most people with multiple sclerosis find relief with marijuana but only that the marijuana users among them do.

Animal research, too, suggests that marijuana calms muscle spasticity. Spasms are thought to originate in areas of the brain that control movement, including several sites with abundant cannabinoid receptors. In one experiment, researchers found that rodents became more animated under the influence of small amounts of cannabinoids but less active when they received larger doses. Many marijuana users also note that the drug affects movement, making their bodies sway and their hands unsteady. The exact mechanism(s) by which cannabinoids exert these effects remains unknown.

Some physicians have been studying the benefits of medical marijuana for treatment of spasticity for years.  Dr. Vijayshree Yadav has studied the use of alternative medicine in MS for more than a decade. In 2011, she wrote,

“In a review of six controlled studies evaluating a combination of THC and CBD [the active ingredients in cannabis] for spasticity in MS, it was found that THC–CBD was well tolerated and improved patient self-reports of spasticity.”

Earlier this year, Yadav authored a set of guidelines for the American Academy of Neurology, saying that pill and mouth spray forms of cannabis have shown success in treating spasticity and bladder symptoms in MS patients.

What are some traditional medical treatments used for MS-related spasticity?

Oral medications used to treat spasticity include:

 

What are the pros and cons of oral medications?

Oral medications have benefits as well as disadvantages. Advantages include:

 

Disadvantages include:

 

What are other options for treating spasticity?

Local injections into spastic muscles may be very effective. These shots can reduce tone selectively in muscles that are causing the most spasm. Injections may involve botulinum toxin [Botulinum Toxin A (Botox®) and B (Myobloc®)] or phenol.

During botulinum toxin injections, the toxin is injected directly into the muscle, making spastic muscles weaker. This may improve positioning and function. The effects usually take 7 to 10 days to become noticeable. The effects last from 3 to 6 months.

Surgical treatments

 

The best way to treat spasticity usually means having an active patient or support person and caregivers who work with a team of healthcare professionals with different specialties. Members of this team may include one or more of the following individuals:

 

Resources:

 

  1. Malec J, Harvey, RF, Cayner JJ. 1982.  “Cannabis effect on spasticity in spinal cord injury.”  Archives of Physical Medicine and Rehabilitation 63:116-118.
  2. Consroe, P, Musty R, Rein J, Tillery, W, Pertwee RG.  1997. “The perceived effects of smoked cannabis on patients with multiple sclerosis.” European Neurology 38:44-48.

 

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Author
Dr. Allison Kendrick

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