The Effect of Cannabis-Based Medicine on Neuropathic Pain and Spasticity in Patients with Multiple Sclerosis and Spinal Cord Injury: Study Protocol of a National Multicenter Double-Blinded, Placebo-Controlled Trial

Disease or acquired damage to the central nervous system frequently causes disabling spasticity and central neuropathic pain (NP), both of which are frequent in multiple sclerosis (MS) and spinal cord injury (SCI). Patients with MS and SCI often request treatment with cannabis-based medicine (CBM). However, knowledge about effects, side effects, choice of active cannabinoids (Δ9-tetrahydrocannabinol (THC), cannabidiol (CBD) alone or in combination), and doses of CBM remains limited. Using a double-blind, parallel design in a national multicenter cohort, this study examines the effect of CBM on spasticity and NP. Patients are randomized to treatment with capsules containing either THC, CBD, THC and CBD, or placebo. Primary endpoints are patient-reported pain and spasticity on a numerical rating scale. Other endpoints include quality of life and sleep, depression and anxiety, and relief of pain and spasticity. Side-effects of CBM are described. In a sub-study, the pharmacodynamics (PD) and pharmacokinetics (PK) of oral capsule CBM are examined. We expect that the study will contribute to the literature by providing information on the effects and side-effects of CBD, THC, and the combination of the two for central neuropathic pain and spasticity. Furthermore, we will describe the PD/PK of THC and CBD in a patient population.

Download Full-text

Mental Imagery as a Rehabilitative Therapy for Neuropathic Pain in People With Spinal Cord Injury: A Randomized Controlled Trial

Neurorehabilitation and Neural Repair ◽

10.1177/1545968320962498 ◽

2020 ◽

Vol 34 (11) ◽

pp. 1038-1049

Author(s):

Jaskirat Kaur ◽

Shampa Ghosh ◽

Asish Kumar Sahani ◽

Jitendra Kumar Sinha

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Neuropathic Pain ◽

Mental Imagery ◽

Rating Scale ◽

Controlled Trial ◽

Brief Pain Inventory ◽

Control Group ◽

Central Neuropathic Pain ◽

Cord Injury

Background Pain of neuropathic origin in spinal cord injury (SCI) is unbearable and challenging to treat. Research studies conducted in the past have shown that mental imagery (MI) techniques have a significant impact on the reduction of symptoms of central neuropathic pain in people with SCI. Objectives The objective of this study was to evaluate the effect of MI training on pain intensity, neuropathic pain symptoms, and interference of pain with function in SCI. Methods A total of 42 SCI participants with central neuropathic pain (duration 6-12 months) were recruited and randomly allocated to MI or control groups. A MI training protocol was administered to MI group and for 30 min/d for 5 days. Outcome measures were assessed at baseline and at the end of 4 weeks. Results There was significant reduction in differences of mean [95% CI] scores of numeric rating scale (−2.1 [CI −2.78 to −1.41]; P < .001) between groups. Mean [95% CI] total scores of Neuropathic Pain Symptom Inventory declined in MI group as compared with control group (−4.52 [CI −5.86 to −3.18]; P < .001). Similarly, Brief Pain Inventory interference scale total dropped significantly ( P < .001) in MI group. Majority of participants in the MI group (55%) reported improvement in scores of Patients’ Global Impression of Change scale as compared with control group where most of the participants (52%) reported no change. Conclusions This study shows the effectiveness of the MI protocol developed as a rehabilitative approach in improving central neuropathic pain in SCI. Trial Registration. Clinical Trials Registry–India under Indian Council of Medical Research; CTRI/2018/07/014884. Registered July 16, 2018.

Download Full-text

Central neuropathic pain

Neuropathic Pain ◽

10.1093/med/9780199563678.003.0007 ◽

2010 ◽

pp. 57-64

Author(s):

David Bowsher

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Neuropathic Pain ◽

Central Neuropathic Pain ◽

Cord Injury ◽

The Uk

Central neuropathic pain can arise following damage to spinothalamocortical pathways in the spinal cord and brain Stroke, multiple sclerosis, and spinal cord injury (trauma or disease) are the predominant causes Central neuropathic pain is wrongly considered a rarity; several tens of thousands of cases exist in the UK and it can develop up to two years after stroke...

Download Full-text