title: Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial.
abstract: BACKGROUND
  Spasticity is a common and poorly controlled symptom of multiple sclerosis. Our objective was to determine the short-term effect of smoked cannabis on this symptom.
  
  
  METHODS
  We conducted a placebo-controlled, crossover trial involving adult patients with multiple sclerosis and spasticity. We recruited participants from a regional clinic or by referral from specialists. We randomly assigned participants to either the intervention (smoked cannabis, once daily for three days) or control (identical placebo cigarettes, once daily for three days). Each participant was assessed daily before and after treatment. After a washout interval of 11 days, participants crossed over to the opposite group. Our primary outcome was change in spasticity as measured by patient score on the modified Ashworth scale. Our secondary outcomes included patients' perception of pain (as measured using a visual analogue scale), a timed walk and changes in cognitive function (as measured by patient performance on the Paced Auditory Serial Addition Test), in addition to ratings of fatigue.
  
  
  RESULTS
  Thirty-seven participants were randomized at the start of the study, 30 of whom completed the trial. Treatment with smoked cannabis resulted in a reduction in patient scores on the modified Ashworth scale by an average of 2.74 points more than placebo (p < 0.0001). In addition, treatment reduced pain scores on a visual analogue scale by an average of 5.28 points more than placebo (p = 0.008). Scores for the timed walk did not differ significantly between treatment and placebo (p = 0.2). Scores on the Paced Auditory Serial Addition Test decreased by 8.67 points more with treatment than with placebo (p = 0.003). No serious adverse events occurred during the trial.
  
  
  CONCLUSIONS
  Smoked cannabis was superior to placebo in symptom and pain reduction in participants with treatment-resistant spasticity. Future studies should examine whether different doses can result in similar beneficial effects with less cognitive impact.
authors.affiliation: Department of Neurosciences, University of California, San Diego, La Jolla, Calif., USA. jcoreybloom@ucsd.edu
authors.forename: Jody
authors.initials: J
authors.lastname: Corey-Bloom
authors.forename: Tanya
authors.initials: T
authors.lastname: Wolfson
authors.forename: Anthony
authors.initials: A
authors.lastname: Gamst
authors.forename: Shelia
authors.initials: S
authors.lastname: Jin
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Marcotte
authors.forename: Heather
authors.initials: H
authors.lastname: Bentley
authors.forename: Ben
authors.initials: B
authors.lastname: Gouaux
mesh_terms: D000328:Adult; D002188:Cannabis; D003071:Cognition / Q000187:drug effects; D018592:Cross-Over Studies; D005221:Fatigue / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008385:Marijuana Smoking; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology; D059352:Musculoskeletal Pain / Q000188:drug therapy / Q000209:etiology; D008517:Phytotherapy; D028321:Plant Preparations / Q000627:therapeutic use*; D016896:Treatment Outcome; D016138:Walking
chemical_list: D028321:Plant Preparations