Use of cannabis medicine for the treatment of spasticity-associated pain
O uso da medicina canábica para tratamento da dor associada à espasticidade
Eduardo de Melo Carvalho Rocha; Marcelo Riberto
Abstract
BACKGROUND AND OBJECTIVES: Spasticity refers to the increase of resistance to joint passive movement according to its angular velocity. It is part of the triad of the pyramidal syndrome, along with the exacerbation of myotatic reflexes and muscle weakness, and is present in several lesions of the central nervous system, either in the spinal cord or brain. Pain associated with spasticity is caused by muscle spasms, activation of trigger points, joint deformities, interference with the position of body segments, and difficulty in movement control. For a more precise therapeutic intervention, the detailed physical examination of the locomotor system and spasticity can be completed by using specific spasticity evaluation scales. Multiple sclerosis is the clinical condition for which there are the greatest number of studies using cannabinoids to control spasticity. The objective of this study was to perform a literature review of the possible role of cannabinoid drugs in the control of spasticity and the pain associated with it.
CONTENTS: The literature shows moderate evidence that the combined use of 9-tetrahydrocannabinol and cannabidiol increases the number of people reporting improvement in spasticity.
CONCLUSION: It is possible to believe that the complaint of musculoskeletal pain associated with spasticity accompanies this improvement with the use of nabiximols, but there are still gaps in the literature for this specific topic.
Keywords
Resumo
JUSTIFICATIVA E OBJETIVOS: A espasticidade refere-se ao aumento da resistência ao movimento passivo articular conforme a sua velocidade angular. Ela faz parte da tríade da síndrome piramidal, junto com a exacerbação de reflexos miotáticos e fraqueza muscular, e está presente em diversas lesões do sistema nervoso central, de topografia medular ou encefálica. A dor associada à espasticidade é causada pelos espasmos musculares, ativação de pontos-gatilho, deformidades articulares, interferência na posição dos segmentos corporais e dificuldade para o controle do movimento. Para uma intervenção terapêutica mais precisa, o exame físico detalhado do aparelho locomotor e da espasticidade pode ser completado pelo uso de escalas de avaliação específicas. A esclerose múltipla é a condição clínica para a qual há maior número de estudos com uso de canabinoides para o controle da espasticidade. O objetivo deste estudo foi realizar uma revisão da literatura sobre o possível papel dos fármacos canabinoides no controle da espasticidade e da dor associada a ela.
CONTEÚDO: Há na literatura evidências moderadas de que o uso combinado de 9-tetrahidrocanabinol e canabidiol aumenta o número de pessoas que relatam melhora da espasticidade.
CONCLUSÃO: É possível acreditar que a queixa de dor musculoesquelética associada à espasticidade acompanhe essa melhora com uso de nabiximol, mas ainda há lacunas na literatura para esse tópico específico.
Palavras-chave
References
1 Khan P, Riberto M, Frances JA, Chueire R, Amorim ACFG, Xerez D, Chung TM, Mercuri LHC, Lianza S, Maisonobe P, Ruiz-Schultz VC. The effectiveness of botulinum toxin type A (BoNT-A) treatment in Brazilian patients with chronic post-stroke spasticity: results from the observational, multicenter, prospective B. Cause Study. Toxins (Basel). 2020;4;12(12):770.
2 Zeng H, Chen J, Guo Y, Tan S. Prevalence and risk factors for spasticity after stroke: a systematic review and meta-analysis. Front Neurol. 2021;11;616097.
3 Trompetto C, Marinelli L, Mori L, et al. Pathophysiology of spasticity: implications for neurorehabilitation. Biomed Res Int. 2014;2014:354906.
4 Faleiros F, Marcossi M, Ribeiro O, Tholl A, Freitas G, Riberto M. Epidemiological profile of spinal cord injury in Brazil. J Spinal Cord Med. 2022;10:1-8.
5 Holtz KA, Lipson R, Noonan VK, Kwon BK, Mills PB. Prevalence and effect of problematic spasticity after traumatic spinal cord injury. Arch Phys Med Rehabil. 2017;98(6):1132-8.
6 Bethoux F, Marrie RA. A cross-sectional study of the impact of spasticity on daily activities in multiple sclerosis. Patient. 2016;9(6):537-46.
7 L. Hemmett, J. Holmes, M. Barnes, N. Russell N. What drives quality of life in multiple sclerosis? QJM. 2004;97(10):671-6.
8 Young RR. Spasticity: a review. Neurology. 1994;44(Suppl9):S12-S20.
9 Gracies JM Pathophysiology of spastic paresis. I: paresis and soft tissue changes. Muscle Nerve. 2005;31(5):535-51.
10 Gracies JM. Pathophysiology of spastic paresis. II: emergence of muscle overactivity. Muscle Nerve. 2005;31(5):552-71.
11 Bareyre FM, Kerschensteiner M, Raineteu O, Mettenleiter TC, Weinmann O, Schwab ME. The injured spinal cord spontaneously forms a new intraspinal circuit in adult rats. Nat Neurosci. 2004;7(3):269-77.
12 Mayer NH. Clinicophysiologic concepts of spasticity and motor dysfunction in adults with an upper motoneuron lesion. Muscle Nerve. 1997;6(S):S1-S13.
13 Boakes JL, Foran J, Ward SR, Lieber RL. Muscle adaptation by serial sarcomere addition 1 year after femoral lengthening. Clin Orthop Relat Res. 2007;456:250-3.
14 Gomes ALS, Mello FF, Cocicov Neto J, Benedeti MC, Modolo LFM, Riberto M. Can the positions of the spastic upper limb in stroke survivors help muscle choice for botulinum toxin injections? Arq Neuropsiquiatr. 2019;77(8):568-73.
15 Kheder A, Nair K P. Spasticity: pathophysiology, evaluation and management. Pract Neurol. 2012;12(5):289-98.
16 Rosales RI, Cuffe L, Regnault B, Trosch RM. Pain in cervical dystonia: mechanisms, assessment and treatment. Expert Rev Neurother. 2021;21(10):1125-34.
17 Riberto M, Lopes KA, Chiappetta LM, Lourenção MIP, Battistella LR. The use of the comprehensive International Classification of Functioning, Disability and Health core set for stroke outpatients in three Brazilian rehabilitation facilities. Disabil Rehabil. 2013;35(5):367-74.
18 Liporaci FM, Mourani MM, Riberto M. The myofascial component of the pain in the painful shoulder of the hemiplegic patient. Clinics. 2019;74:e905.
19 Alfieri FM, Riberto M, Lopes JA, Filippo TR, Imamura M, Battistella LR. Postural control of healthy elderly individuals compared to elderly individuals with stroke sequelae. Open Neurol J. 2016;15:1-8.
20 Pierson SH. Outcome measures in spasticity management. Muscle Nerve. 1997;6(Suppl 1):S37-S60.
21 Platz T, Eickhof C, Nuyens G, Vuadens P. Clinical scales for the assessment of spasticity, associated phenomena, and function: a systematic review of the literature. Disabil Rehabil. 2005;7-21;27(1-2):7-18.
22 Sposito MMM, Riberto M. Functionality evaluation of children with spastic cerebral palsy. Acta Fisiatr. 2010;17(2)50-61.
23 Yablon SA, Stokic DS. Neurophysiologic evaluation of spastic hypertonia: implications for management of the patient with the intrathecal baclofen pump. Am J Phys Med Rehabil. 2004;83(10 Suppl):S10-8.
24 Smania N, Picelli A, Munari D, Geroin C, Ianes P, Waldner A, Gandolfi M. Rehabilitation procedures in the management of spasticity. Eur J Phys Rehabil Med. 2010;46(3):423-38.
25 Haugh AB, Pandyan AD, Johnson GR. A systematic review of the Tardieu scale for the measurement of spasticity. Disabil Rehabil. 2006;28(15):899-907.
26 Riberto M, Miyazaki MH, Jucá SSH, Sakamoto H, Pinto PPN, Battistella. Validação da versão brasileira da Medida de Independência Funcional. Acta Fisiatr 2004;11(2):72-6.
27 Almeida C, Coelho JN, Riberto M. Applicability, validation and reproducibility of the spinal cord independence measure version III (SCIM III) in patients with non-traumatic spinal cord lesions. Disabil Rehabil. 2016;38(22):2229-34.
28 Riberto M, Tavares DA, Rimoli JR, Castineira C P, Dias RV, Franzoi AC, Vall J, Lopes KA, Chueire RH, Battistella LR. Validation of the Brazilian version of the Spinal Cord Independence Measure III. Arq Neuropsiquiatr. 2014;72(6):439-44.
29 Gracies JM, Elovic E, McGuire J, Simpson D. Traditional pharmacological treatments for spasticity: part I-local treatments. Muscle Nerve. 1997;6(Suppl 1):S61-S91.
30 Watanabe T. The role of therapy in spastic management. Am J Phys Med Rehabil. 2004;10(Suppl):S45-S49.
31 Riberto M, Wu LJL, Souza DR. Rehabilitation and wheelchair users after spinal cord injury: an overview. In: Rajendram R, Preedy VR, Martin CR, editors. Cellular, molecular,physiological, and behavioral aspects of spinal cord injury. London: Academic Press; 2022. 65-77p.
32 Riberto M, Frances JA, Chueire R, Amorim ACFG, Xerez D, Chung TM, Mercuri LHC, Lianza S, Rocha ECM, Maisonobe P, Cuperman-Pohl T, Khan P. Post hoc subgroup analysis of the because study assessing the effect of abobotulinumtoxina on post-stroke shoulder pain in adults. Toxins (Basel). 2022;14(11):809.
33 O’Dell M W, Lin CC, Harrison V. Stroke rehabilitation: strategies to enhance motor recovery. Annu Rev Med. 2009;60:55-68.
34 Zafonte R, Lombard L, Elovic E. Antispasticity medications: Uses and limitations of enteral therapy. Am J Phys Med Rehabil. 2004;10(Suppl):S50-S58.
35 Crema CMT, Santos APBC, Magario LPT, Caldas CACT, Riberto M. Neuromuscular block practice in the treatment of spasticity in Brazil. Acta Fisiatr. 2016;23(3):150-4.
36 Francisco GE. The role of intrathecal baclofen therapy in the upper motor neuron syndrome. Eura Medicophys. 2004;40(2):131-43.
37 Chambers HG. The surgical treatment of spasticity. Muscle Nerve. 1997;6(Suppl 1):S121-S128.
38 Nielsen S, Germanos R, Weier M, Pollard J, Degenhardt L, Hall W, Buckley N, Farrell M. The Use of cannabis and cannabinoids in treating symptoms of multiple sclerosis: a systematic review of reviews. Curr Neurol Neurosci Rep. 2018;18(2):8.
39 Nielsen S, Murnion B, Campbell G, Young H, Hall W. Cannabinoids for the treatment of spasticity. Dev Med Child Neurol. 2019;61(6):631-8.
40 Filippini G, Minozzi S, Borrelli F, Cinquini M, Dwan K. Cannabis and cannabinoids for symptomatic treatment for people with multiple sclerosis. Cochrane Database System Rev. 2022;5(CD013444).
41 Langford RM, Mares J, Novotna A, Vachova M, Novakova I, Notcutt W, Ratcliffe S. A double-blind, randomized, placebo-controlled, parallel-group study of THC/ CBD oromucosal spray in combination with the existing treatment regimen, in the relief of central neuropathic pain in patients with multiple sclerosis. J Neurol. 2013;260(4):984-97.
42 Dan B. Cannabinoids in paediatric neurology. Dev Med Child Neurol 2015;57(11):984.
43 Busse JW, Vankrunkelsven P, Zeng L, Heen A F, Merglen A, Campbell F, Granan L P, Aertgeerts B, Buchbinder R, Coen M, Juurlink D, Samer C, Siemieniuk RAC, Kumar N, Cooper L, Brown J, Lytvyn L, Zeraatkar D, Wang L, Guyatt GH, Vandvik PO, Agoritsas T. Medical cannabis or cannabinoids for chronic pain: a clinical practice guideline. BMJ. 2021;374:n2040.
44 Akgün K, Essner U, Seydel C, Ziemssen T. Daily practice managing resistant multiple sclerosis spasticity with delta-9-tetrahydrocannabinol: cannabidiol oro-mucosal spray: a systematic review of observational studies. J Cent Nerv Syst Dis. 2019;11:1179573519831997.
45 Torres-Moreno MC, Papaseit E, Torrens M, Farre M. Assessment of efficacy and tolerability of medicinal cannabinoids in patients with multiple sclerosis: a systematic review and meta-analysis. JAMA Netw Open. 2018;1(6):e183485.
46 Jones E, Vlachou S. A critical review of the role of the cannabinoid compounds Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD) and their combination in multiple sclerosis treatment. Molecules. 2020;25(21):4930.
47 D’hooghe M, Willekens B, Delvaux V, D’haeseleer M, Guillaume D, Laureys G, Nagels G, Vanderdonckt P, Van Pesch V, Popescu V. Sativex® (nabiximols) cannabinoid oromucosal spray in patients with resistant multiple sclerosis spasticity: the Belgian experience. BMC Neurol. 2021;21(1):227.
48 Erku D, Shrestha S, Scuffham P. Cost-effectiveness of medical cannabis for the management of refractory symptoms associated with chronic conditions: a systematic review of economic evaluations. Value Health. 2021;24(10):1520-30.
Submitted date:
06/13/2022
Accepted date:
01/11/2023
Facebook
Google+
Twitter
LinkedIn
Mendeley
Email