Thaera Greg M, Wellik Kay E, Carter Jonathan L, Demaerschalk Bart M, Wingerchuk Dean M
Departments of Neurology, and daggerLibrary Services, Mayo Clinic, Scottsdale, AZ 85259, USA.
Neurologist. 2009 Nov;15(6):369-71. doi: 10.1097/NRL.0b013e3181bf5572.
The plant Cannabis sativa contains numerous cannabinoids, which are aromatic hydrocarbons that have central nervous system effects mediated through specific cannabinoid receptors. Some patients with multiple sclerosis (MS) report symptomatic relief from spasticity, pain, and other symptoms when using smoked cannabis, and small trials have suggested some symptomatic benefit.
Do cannabinoids improve spasticity in patients with MS?
We addressed the question through the development of a structured, critically appraised topic. Participants included consultant and resident neurologists, clinical epidemiologists, medical librarian, and clinical content experts in the field of MS. Participants started with a clinical scenario and a structured question, devised search strategies, located and compiled the best evidence, performed a critical appraisal, synthesized the results, summarized the evidence, provided commentary, and declared bottom-line conclusions.
The largest randomized, placebo-controlled trial of oral cannabinoid therapy detected no improvement for MS-related spasticity as measured by the Ashworth scale. However, subjective participant reports indicated improvement in spasticity (P = 0.01), spasms (P = 0.038), sleep quality (P = 0.025), and pain (P = 0.002) without detriment to depression, fatigue, irritability, or walk time. A second randomized controlled trial, which used subjective participant report as the primary outcome, revealed the same discrepancy between subjective and objective spasticity outcome measures.
Randomized controlled trials have failed to confirm objective evidence for a beneficial effect of cannabinoids on MS-related spasticity. However, improvement in subjective assessments of spasticity and other related symptoms have been consistently noted, raising questions about the sensitivity and validity of current objective outcome instruments. Further research is warranted with regards to both outcome instrument development and the effects of cannabinoids on MS-related spasticity.
植物大麻含有多种大麻素，这些大麻素是具有中枢神经系统作用的芳香烃，通过特定的大麻素受体介导。一些多发性硬化症（MS）患者报告称，吸食大麻后痉挛、疼痛和其他症状得到了缓解，一些小型试验也显示出了一定的症状改善效果。
大麻素能否改善MS患者的痉挛症状？
我们通过制定一个结构化的、经过严格评估的主题来解决这个问题。参与者包括顾问和住院神经科医生、临床流行病学家、医学图书馆员以及MS领域的临床内容专家。参与者从一个临床病例和一个结构化问题开始，设计搜索策略，查找并汇编最佳证据，进行严格评估，综合结果，总结证据，提供评论，并得出最终结论。
口服大麻素治疗的最大规模随机安慰剂对照试验未发现按Ashworth量表测量的与MS相关的痉挛有改善。然而，参与者的主观报告表明痉挛（P = 0.01）、痉挛发作（P = 0.038）、睡眠质量（P = 0.025）和疼痛（P = 0.002）有所改善，且对抑郁、疲劳、易怒或步行时间无不利影响。第二项随机对照试验以参与者的主观报告作为主要结果，揭示了主观和客观痉挛结果测量之间存在同样的差异。
随机对照试验未能证实大麻素对与MS相关的痉挛有有益作用的客观证据。然而，一直有人指出，痉挛和其他相关症状的主观评估有所改善，这引发了人们对当前客观结果工具的敏感性和有效性的质疑。关于结果工具的开发以及大麻素对与MS相关的痉挛的影响，都需要进一步研究。
