A Systematic Review Examining Cannabis Use for the Treatment of Multiple Sclerosis
Bibliographic record
Abstract
Multiple sclerosis (MS) is a neurodegenerative disease that affects over 2 million people worldwide. MS results in disabling and troublesome symptoms due to damage to the brain and spinal cord. Pharmaceutical options exist for the management of MS and its associated symptoms. Some individuals with MS utilize Cannabis to help manage their symptoms. Cannabinoid use in MS animal models have shown promise, and evidence supporting the indication(s) for Cannabis in MS is rapidly evolving and highly relevant to clinical practice. Currently one formulation of Cannabis (Sativex®) has Health Canada approval as an adjunct treatment option for MS-related spasticity and pain. A systematic review was conducted to examine the literature on Cannabis-based medicine (CBM) use in MS. Medline, Embase, and International Pharmaceutical Abstracts were searched for articles related to MS and CBM in February 2018. All human studies, with outcomes specific to MS, and published in English, were eligible for inclusion. There was no publication year limit and no restrictions based on study design. Articles were screened independently by two reviewers, first by title and then by abstract. Two reviewers then independently performed data extraction on all included articles, and a quality assessment using a modified Downs and Black assessment tool. Included articles were categorized by their primary outcome into the following categories: spasticity, tremor, pain, cognition, balance/walking, bladder dysfunction, general symptoms, adverse events/safety, or disease progression. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After removal of duplicates, 2058 articles were identified, with 60 studies meeting the inclusion criteria. Twenty-six articles were randomized controlled studies and 34 utilized a non-randomized study design. Cannabidiol and delta-9-tetrahydrocannabidiol oromucosal spray (Sativex®) was the most commonly studied CBM for MS. The dose size and frequency of administration between studies was inconsistent. Spasticity was the most common MS symptom to be treated with CBM (n=29), followed by pain (n=8) and cognition (n=6). Twenty-three studies were poor quality, 14 were fair quality, and 23 were good/excellent quality. CBM showed a trend of reducing spasticity and pain in individuals with MS; however, the variable quality of the evidence requires consideration when examining results of individual studies. Adverse events were frequent but mild, and CBM was well tolerated. This systematic review outlines the potential of CBM to treat MS spasticity and pain, however more research is needed to examine its use for other MS symptoms. Additionally, the use of other cannabinoid products for MS treatment, the effects of administering CBM with current MS medications, and possible long-term impacts of CBM in those with MS need to be investigated further.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.032 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.011 |
| Bibliometrics | 0.007 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".