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.
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Referências
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Submetido em:
13/06/2022
Aceito em:
11/01/2023
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