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UK: No miracle, but cannabis does ease MS patients' pain

Nigel Hawkes, Health Editor

The Times

Friday 07 Nov 2003

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CANNABIS has no measurable effect on muscle stiffness or jerkiness in
multiple sclerosis patients but most of them feel as if it does, according
to a medical trial.

The first big trial of cannabis-based pills for MS patients ended with a
mixed message. Objectively, it seems to have no effect on muscle
spasticity, but subjectively, patients said that it had reduced their
symptoms and improved their mobility.

The results of a major British trial of 630 patients, supported by the
Medical Research Council (MRC) and the Multiple Sclerosis Society, and
published in The Lancet, showed that cannabis-based medicines were no
miracle- pill for MS.

But Dr John Zajicek of the University of Plymouth, who led the study, said
that the results provide some evidence that cannabinoids could be
clinically useful in treatment of symptoms of MS. More research was needed
to prove this, he said.

The Multiple Sclerosis Society said that on the evidence now available
those who might benefit from the drug should be able to have the treatment
provided for them on the NHS.

Two independent scientists, Luanne Metz and Stacey Page from the University
of Calgary, commenting on the results in Lancet, said that they provided as
much evidence of benefit as many standard therapies for MS, including the
drug baclofen.

However, because we do not know how these cannabinoids compare to other
anti-spasticity treatments, they should generally only be considered when
other therapy has failedthey say.

There has long been a campaign by some MS sufferers to be allowed to use
cannabis to relieve their symptoms, based largely upon the benefits claimed
by those that have tried it. Some have run the risk of criminal prosecution
by using it.

The three-year trial was designed to show if it really does work. The main
measurement was the degree of muscle spasticity or stiffness, rated by
trained assessors on a one-to-five scale, the Ashworth Scale.

The patients, from 33 neurology and rehabilitation centres across Britain,
were divided into three groups and given either harmless placebos, pills
containing cannabis extract or pills containing one of the active
ingredients in cannabis, tetrahydrocannibinol. They were assessed after 15
weeks.

The researchers found that there was no overall change in muscle stiffness
or jerky movements in the patients taking cannabis.

In interviews, however, around two thirds of patients on the cannabis
treatments said that they felt their spasticity had improved. But half the
patients taking the placebo also believed that their condition got better.

Dr Zajicek said: The results of this study present an interesting and
complex picture of the value of cannabis-derived medicines for treating MS.

The primary aim of the trial was to measure, as objectively as possible,
the actual physical changes in limb spasticity in MS patients, and we found
no evidence of this.

Dr Zajicek said that they had also wanted to capture treatment effects
among the other important symptoms.

When patients were asked to describe how they felt their symptoms,
including spasticity, had been affected, the picture was very different.

They felt some of the impact of their painful and distressing symptoms had
been eased.

Patients experienced very few side-effects from the treatments and, given
that how a patient feels is an important part of improving health,
cannabis-based treatments may be of benefit to some patients.

Unfortunately, although the trial was supposed to be double-blind with
neither doctors nor patients aware of what was being taken many patients
realised that they were on active pills because of side-effects. This means
that the trial was unblinded and reduces the value to be placed on the
patients' subjective impressions.

Professor Colin Blakemore, MRC chief executive, said: Science isnt always
black and white and this work underlines the importance of funding
large-scale clinical trials of possible treatments so the evidence can be
weighed up.

Mike ODonovan, chief executive of the MS Society, said that the results
showed the difficulty in assessing treatments for a variable and
fluctuating condition like MS.

Current methods of measurement do not always detect significant benefits
patients may feel.

Around two thirds of those on the cannabis-derived drugs felt their
spasticity was improved by them, even though that could not be shown
clinically.

More people on the drugs found relief from other very distressing symptoms
like pain, spasm and sleeping problems than those taking a placebo.

These improvements to quality of life can make a significant difference to
people with MS, whose choice of treatments is very limited,Mr ODonovan said.

 

 

 

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