This is according to new alternative treatment guidelines released by the American Academy of Neurology. The guidelines on complementary and alternative medicine, or CAM, treatments for MS were published Monday in the journal Neurology and are among the first from a national medical organization to suggest that doctors might offer cannabis treatment to patients.
The guideline states the CAM therapies oral cannabis, or medical marijuana pills, and oral medical marijuana spray may ease patients' reported symptoms of spasticity, pain related to spasticity and frequent urination in multiple sclerosis (MS).
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The guideline, which is published in the March 25, 2014, print issue of Neurology®, the medical journal of the American Academy of Neurology, states that there is not enough evidence to show whether smoking marijuana is helpful in treating MS symptoms.
Though advocates of medical marijuana use said the guidelines appeared to be part of a recent national trend in which doctors were seriously evaluating the use of cannabis, they argued that the federal government had stymied marijuana research.
"The reason there's no evidence on inhaled cannabis is because it's very difficult to study," said Dr. Donald Abrams, a professor of clinical medicine at the University of California San Francisco and a marijuana researcher who was not involved in the guideline study. "The government really restricts studies of the plant."
A panel of AAN researchers based their guidelines on a review of 115 clinical studies that examined a variety of alternative MS treatments, including the use of ginkgo biloba, magnets, bee sting venom, reflexology, a low-fat diet and over-the-counter supplements.
The only non-conventional treatment in which authors found "strong evidence" for patient-reported improvements was the use of oral cannabis extracts, or lab-manufactured pills.
"Basically, there is little evidence for the effectiveness of most CAM therapies that people use," said Dr. Vijayshree Yadav, the lead author of the guidelines and an associate professor of neurology at Oregon Health & Science University.
Patient surveys suggest that up to 80% of MS patients employ some form of alternative treatment, including the smoking of "street" marijuana. Yadav said that very few high-quality studies have examined the effectiveness of these treatments, and there was simply too little evidence to support or refute their effectiveness.
"There is really a need for more research," Yadav said.
Yadav and her colleagues noted that nine short-term studies indicated that patients reported improvements in their spasticity or pain as a result of cannabis treatment, although their doctors were not able to objectively verify these improvements through standardized evaluations.
"There was a discordance between the subjective and objective outcome that was kind of consistent," Yadav said.
Yadav said that though most standard FDA-approved MS drugs offer results that are objectively verified, she said it was possible that the improvements that came with cannabis were too small to be detected by physicians.
"Probably the effect was not profound, so doctors really didn't see it, but the patient reported some improvements," Yadav said.
Dr. Timothy Coetzee, of the National MS Society, who was not involved in the research, said the guidelines were "a significant step forward" in helping patients and doctors to understand current alternative therapies.
Spasticity, and pain from spasticity were very common symptoms in MS, he said.
"It is difficult to know if physicians will suggest these treatments to their patients," said Coetzee, the society's chief research officer. "Currently 20 states have legalized the use of marijuana for medical purposes ... There is significant unmet need for therapies that can address complex and painful symptoms often experienced by people with MS."
Yadav and her colleagues wrote that there was "inadequate" data to determine whether smoked marijuana was safe or effective in treating symptoms of pain and spasticity in MS patients.
Abrams, who has researched marijuana's effects on pain, said the reason for this lack of data had to do with the National Institute on Drug Abuse, or NIDA.
"The NIDA is the only source of cannabis for research," Abrams said. "NIDA has a mandate from the federal government to only study substances of abuse as substances of abuse."
That view was echoed by Dr. David Bearman, the executive vice president for the Academy of Cannabinoid Medicine/Society of Cannabis Clinicians, who was not involved in the guideline study.
"Part of the problem in the United States is that the NIDA has blocked almost all meaningful studies on cannabis," Bearman said.
Bearman argues that while synthetic cannabis pills do offer pain relief, marijuana is cheaper, has fewer side effects and can be more effective.
He said the MS guidelines appeared to be part of a trend in the last couple years in which mainstream medicine has begun to look at cannabis as it would any other therapeutic agent.
The guideline looked at CAM therapies, which are nonconventional therapies used in addition to or instead of doctor-recommended therapies. Examples include oral cannabis, or medical marijuana pills and oral medical marijuana spray, ginkgo biloba, magnetic therapy, bee sting therapy, omega-3 fatty acids and reflexology.
"Using different CAM therapies is common in 33 to 80 percent of people with MS, particularly those who are female, have higher education levels and report poorer health," said guideline lead author Vijayshree Yadav, MD, MCR, with Oregon Health & Science University in Portland and a member of the American Academy of Neurology. "People with MS should let their doctors know what types of these therapies they are taking, or thinking about taking."
Among other CAM therapies studied for MS, ginkgo biloba might possibly help reduce tiredness but not thinking and memory problems. Magnetic therapy may also help reduce tiredness but not depression.
Reflexology might possibly help ease symptoms such tingling, numbness and other unusual skin sensations. Bee sting therapy, a low-fat diet with fish oil, and a therapy called the Cari Loder regimen all do not appear to help MS symptoms such as disability, depression and tiredness. Bee stings can cause a life-threatening allergic reaction and dangerous infections.
Summary of evidence-based guideline: Complementary and alternative medicine in multiple sclerosis
Report of the Guideline Development Subcommittee of the American Academy of Neurology
Objective: To develop evidence-based recommendations for complementary and alternative medicine (CAM) in multiple sclerosis (MS).
Methods: We searched the literature (1970–March 2011; March 2011−September 2013 MEDLINE search), classified articles, and linked recommendations to evidence.
Results and recommendations: Clinicians might offer oral cannabis extract for spasticity symptoms and pain (excluding central neuropathic pain) (Level A). Clinicians might offer tetrahydrocannabinol for spasticity symptoms and pain (excluding central neuropathic pain) (Level B). Clinicians 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). Clinicians might offer Sativex oromucosal cannabinoid spray (nabiximols) for spasticity symptoms, pain, and urinary frequency (Level B). Clinicians should counsel patients that these agents are probably ineffective for objective spasticity/urinary incontinence (Level B). Clinicians might choose not to offer these agents for tremor (Level C). Clinicians might counsel patients that magnetic therapy is probably effective for fatigue and probably ineffective for depression (Level B); fish oil is probably ineffective for relapses, disability, fatigue, MRI lesions, and quality of life (QOL) (Level B); ginkgo biloba is ineffective for cognition (Level A) and possibly effective for fatigue (Level C); reflexology is possibly effective for paresthesia (Level C); Cari Loder regimen is possibly ineffective for disability, symptoms, depression, and fatigue (Level C); and bee sting therapy is possibly ineffective for relapses, disability, fatigue, lesion burden/volume, and health-related QOL (Level C). Cannabinoids may cause adverse effects. Clinicians should exercise caution regarding standardized vs nonstandardized cannabis extracts and overall CAM quality control/nonregulation. Safety/efficacy of other CAM/CAM interaction with MS disease-modifying therapies is unknown.
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