April 2014 Round-up of MS News and Research

Highlights of the evidence-based recommendations for complementary and alternative medicine (CAM) in MS issued by American Academy of Neurology (AAN) include possible effectiveness of different forms of cannabis extracts or synthetic cannabinoids for spasticity symptoms, pain, and urinary frequency; magnetic therapy and ginkgo biloba for fatigue; and reflexology for paresthesia.  Cannabinoids are likely ineffective for short-term spasticity, tremor, and urinary incontinence.  Magnetic therapy is probably ineffective for depression and ginko biloba is ineffective for cognition. Fish oil and bee sting therapies are probably ineffective for relapses, disability, fatigue, MRI lesions, and health-related quality of life (QOL).

A recent study shows that, for many individuals with MS, fatigue is associated with poor sleep quality.  Fatigue is among the most common symptoms of MS, affecting up to 80% of those diagnosed with the disease.  Several factors may contribute to the connection between poor sleep quality and fatigue.  Increased levels of inflammatory cytokines or lesions in the brain may disrupt pathways involved with sleep and daytime alertness.  Sleep apnea, which is common in people with MS, may also result in both fatigue and sleep disruption.  The use of MS disease modifying therapies, particularly beta interferons, may contribute to both fatigue and sleep disturbance. Although depression was associated with both sleep disturbance and fatigue in this study, authors note that exclusion of patients with severe depression and the low incidence of depression in the study participants limits their ability to evaluate a possible connection.

Neuromuscular electrical stimulation cycling benefits people with advanced MS according to a recent study.  Eight women with secondary progressive MS (SPMS) participated in a training program utilizing neuromuscular electrical stimulation (nMES) cycling that resulted in several real and perceived benefits.  Electrodes are placed on the quadriceps, hamstrings, and gluteal muscles of each leg which allows persons with paralyzed legs to exercise on a stationary recumbent bicycle.  The goal of this study was to investigate the feasibility of adapting nMES cycling to suit the needs of persons with MS. Adaptations included a slower pedaling cadence (at a speed of 10 revolutions/minute) which produces greater muscle forces and a slow, gradual increase in stimulation intensity (pulse amplitude) during the first 20 minutes of each exercise session as patients adjusted to the uncomfortable stimulation.  Study outcomes included the stimulation intensity tolerated, thigh circumference changes, and power output and cardiorespiratory response during cycling. 

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Hot Topics and MS Research News for April 2014

Is Medical Marijuana Effective Against RA Pain?

The use of medical marijuana remains a hot topic in the United States.  Although twenty states and the District of Columbia have enacted laws to legalize medical marijuana, in the majority of the country marijuana is still an illicit drug.  Two states, Colorado and Washington, legalized the recreational use of marijuana in 2012.  Despite state laws allowing for medical or recreational use of cannabis, the US federal government continues to list marijuana (cannabis) as a Schedule I substance under the Controlled Substance Act which makes it illegal to possess, use, or sell marijuana throughout the United States.

The Arthritis Foundation, an advocacy organization representing patients with all types of arthritis, featured a discussion on issues related to medical marijuana in its May/June 2013 issue of Arthritis Today. See “Medical Marijuana: RX or Risk?” (pdf) by Camille Noe Pagán.
- See more at: http://www.healthcentral.com/rheumatoid-arthritis/c/72218/168517/marijuana-pain#sthash.WqcLgwoe.dpuf

The use of medical marijuana remains a hot topic in the United States.  Although twenty states and the District of Columbia have enacted laws to legalize medical marijuana, in the majority of the country marijuana is still an illicit drug.  Two states, Colorado and Washington, legalized the recreational use of marijuana in 2012.  Despite state laws allowing for medical or recreational use of cannabis, the US federal government continues to list marijuana (cannabis) as a Schedule I substance under the Controlled Substance Act which makes it illegal to possess, use, or sell marijuana throughout the United States.

The Arthritis Foundation, an advocacy organization representing patients with all types of arthritis, featured a discussion on issues related to medical marijuana in its May/June 2013 issue of Arthritis Today. See “Medical Marijuana: RX or Risk?” (pdf) by Camille Noe Pagán.
RA Pain, Disease Activity, and Cannabis

In a phase II double-blind, randomized, placebo-controlled, 5-week study of 58 rheumatoid arthritis patients, researchers assessed the efficacy of Sativex administered at night up to a maximum of 6 sprays per evening (16.2 mg THC + 15 mg CBD) in 31 patients compared with placebo in 27 patients.  The primary outcome measure was morning pain on movement. Secondary outcomes included measures of pain at rest, sleep quality, morning stiffness, the Short-Form McGill Pain Questionnaire (SF-MPQ) and the 28-joint disease activity score (DAS28).  Baseline scores (an average of the last 4 days of a 14-day baseline period) were compared with the average of the last 14 days of treatment (Blake 2006).

Sativex produced statistically significant improvements in morning pain on movement, morning pain at rest, quality of sleep, disease activity (measured by DAS-28), and SF-MPQ pain at present, as compared to placebo.  However, researchers found that Sativex had no effect on morning stiffness in this group of RA patients (Blake 2006). Authors did point out that baseline scores for morning stiffness had been low initially.  No serious adverse effects occurred in the active treatment group and the large majority of adverse effects were mild or moderate, including dizziness, light-headedness, dry mouth, and nausea.  More studies are warranted.
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Can Medical Marijuana Help Reduce RA Pain?

Medical Marijuana and MS Symptoms

A number of studies have indicated improvement in MS symptoms, particularly for muscle stiffness and spasms, neuropathic pain and sleep and bladder disturbance, in patients with MS treated with cannabinoids. Trials evaluating other symptoms such as tremor and nystagmus have not demonstrated any beneficial effects of cannabinoids. Safety profiles of cannabinoids seem acceptable, although a slow prolonged period of titration improves tolerability. No serious safety concerns have emerged (Zajicek, 2011).

Recent case reports included in a German study indicate that THC:CBD oromucosal spray is useful in individual patients with moderate to severe spasticity resistant to existing therapies. Researchers were excited to note that improvements in Quality of Life and Activities of Daily Living in some patients with resistant MS spasticity allowed them to engage back in physical and social activities (Koehler, 2014).

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Can Medical Marijuana Help Control MS Symptoms?: A HealthCentral Explainer