AAN endorses cannabis for MS(27/03/14)

The American Academy of Neurology has issued new evidence-based complementary and alternative medicine guidelines for multiple sclerosis.

HealthDay News -- The American Academy of Neurology is recommending oral cannabis extract to help ease spasticity symptoms and pain in patients with multiple sclerosis, along with other therapies, in new evidence-based complementary and alternative medicine (CAM) recommendations.

Vijayshree Yadav, MD, of the Oregon Health & Science University in Portland, and other members of the AAN's Guideline Development Subcommittee, conducted a literature search to develop the recommendations, which are published online in Neurology.

Clinicians may offer oral cannabis extract (Level A) or tetrahydrocannabinol (Level B) for spasticity symptoms and pain (excluding central neuropathic pain), but should counsel patients that these agents are probably ineffective for objective spasticity (short-term)/tremor (Level B) and possibly effective for spasticity and pain (long-term; Level C). 

Sativex oromucosal cannabinoid spray (nabiximols) can be suggested for spasticity symptoms, pain and urinary frequency (Level B), but clinicians should counsel patients that these agents are probably ineffective for objective spasticity/urinary incontinence (Level B). Furthermore, the spray is not currently FDA-approved and is unavailable in the United States, the researchers noted. 

"In the United States, caution should be exercised with regard to extrapolation of results of trials of standardized oral cannabis extracts (which are unavailable commercially) to other nonstandardized, nonregulated cannabis extracts (which may be commercially available in states with medical marijuana laws)," Yadav and colleagues wrote.

Magnetic therapy is probably effective for fatigue, but probably ineffective for depression (Level B). Among common supplements, clinicians can counsel patients that fish oil is probably ineffective for relapses, disability, fatigue, magnetic resonance imaging lesions, and quality of life (Level B). Ginkgo biloba is ineffective for cognition (Level A), but possibly effective for fatigue (Level C). Reflexology is possibly effective for paresthesia (Level C). 

Possibly ineffective therapies (Level C) include Cari Loder for disability, depression and fatigue, and bee sting therapy for relapses, disability, fatigue and lesion burden/volume.

"Clinicians should exercise caution regarding standardized versus nonstandardized cannabis extracts and overall CAM quality control/nonregulation," the researchers wrote. "Safety/efficacy of other CAM/CAM interaction with MS disease-modifying therapies is unknown."

Reference 1.Yadav V et al. Neurology. 2014; 82(12): 1083-1092. 

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