Archive for the ‘Spinal Cord Injury’ Category

We are presenting the preliminary results of a pilot study. THC was administered over a period of 6 weeks. In 15 patients with spastic spinal cord injury the effect of THC on the overactive bladder has been investigated. The effect of THC was compared with urodynamic and clinical parameters, first without any bladder medication and after 6 weeks medication with THC. There are no data of invasive investigation in literature up till now.
Patients and methods:
THC was administered for 6 weeks in two different groups orally as Dronabinol (Marinol®) in 9 patients and rectally as THC-Hemisuccinate suppositories (THC-HS-supp) in 6 patients in several individual dosages per day. An urodynamic investigation, urine analysis and urine bacteriology was performed at the beginning of the study (without any bladder medication and without any spasmolytic therapy) and in the end after 6 weeks treatment. On the last day of medication all patients have been administered either 10 mg Dronabilon or 10 mg THC-HS-supp 2 h before the urodynamic investigation (relating to the group they were in).
Investigated parameters: first desire to void (FDV), maximum cystometric capacity (MCC), intravesical pressure (IVP), bladder compliance (CPL), post void residual urine volume (RV), volume at first detrusor contraction (VFC).
Results:
The dronabinol group showed an increase of the CPL from mean 34.3 ml/cm H2O (9 – 100) to mean 52.2 ml/cm H2O (11 – 200). All other parameters have not been changed essentially.
The THC-HS-supp group showed a trend with increase of MCC from mean 227 ml (143 – 323) to mean 278 ml (121 – 322) (p value = 0.075), and an increase of the VFC from mean 191.3 ml (121 – 322) to mean 224.6 ml (96 – 407), CPL increased from mean 21.3 ml/cm H2O (6 – 60) to mean 40 ml/cm H2O (10 – 120) significantly
(p value = 0.028). All other parameters have not been changed essentially.
Conclusion:
These preliminary results indicate a reduction of the overactivity of the detrusor of the bladder especially in the THC-HS-supp group with potential therapeutic consequences. The different results between oral and rectal application may demonstrate their different bioavailability.

Introduction:
Spasticity is a common complaint after traumatic SCI. 9–THC the main psychoactive cannabinoid of cannabis has been shown to have beneficial effects in the treatment of spasticity of different origin. The aim of the study was to assess the effectiveness and safety of 9–THC (Dronabinol, Marinol® capsules) and THC-hemisuccinate suppositories (THC-HS) for the treatment of spasticity in patients with SCI as a homogeneous population of patients. We are presenting the results of spasticity as partial results of a finished study with a wide spectrum of other investigations.

Methods:
Phase 1: open trial, six weeks treatment of 22 patients with Dronabinol (7 drop outs)
Phase 2: open trial, six weeks treatment of 8 patients with THC-HS (1 drop out)
Phase 3: randomized, double-blind, placebo controlled clinical trial with 13 patients (Marinol/placebo)
25 patients mean age 42.3 years with spasticity due to SCI (11 para- and 14 tetraplegics) were included. Mean time since injury was 13.4 years. Inclusion criteria for spasticity were minimum of 3 points on the Ashworth scale without therapy, negative urine drug screening, age > 18 years.
Spasticity was investigated using the modified Ashworth scale (MAS) after administration of 10 mg Dronabinol (Marinol®) or 10 mg THC-HS at day one and after one and six weeks treatment with an individual dose. Self-rating of spasticity was performed every day using a seven point scale from absent to unbearable.

Results:
Phase 1: Dronabinol (Marinol®) significantly decreased the mean spasticity sum score (± SD) (summed Ashworth scores divided by four) in 15 patients after a single dose of 10 mg (day 1) from 16.72 ± 7.60 to 7.75 ± 7.00 points (p<0.001) and after 6 weeks of treatment with an individual symptom oriented mean dose of 30 mg Dronabinol to 8.92 ± 7.14 points (p<0.05).
Phase 2: THC-HS significantly decreased the mean spasticity sum score (± SD) in 7 patients after a single dose of 10 mg (day 1) from 22.71 ± 11.68 to 9.86 ± 8.15 points (p<0,05) and after 6 weeks of treatment with an individual symptom oriented mean dose of 43 mg THC-HS to 9.21 ± 9.25 points (p<0.05).
The comparison of oral and rectal application in five patients showed no difference.
Phase 3: summed spasticity scores for the Dronabinol group (7.21 points) differed significantly from summed scores of the placebo group (12.10 points) as a treatment effect of Dronabinol during the entire 6 weeks (p=0.001).

Conclusion:
The results demonstrate a significant therapeutic effect of &#61508;9–THC (Dronabinol, Marinol ®) as well as THC-HS in patients with SCI. However the antispastic efficacy is significant the treatment often is limited by side effects.

Acknowledgement:
The research was supported by ElSohly Laboratories Inc., Oxford, Mississippi

Although cannabinoids have anti-hyperalgesic e.ects in animal models of nerve injury, there are currently very few prospective trials of the efficacy of cannabinoids in neuropathic pain in humans. This open label prospective study investigated the safety, tolerability and analgesic benefit of oral delta-9-tetrahydrocannabinol (THC) titrated to a maximal dosage of 25 mg/day in 8 consecutive patients with chronic refractory neuropathic pain. Spontaneous ongoing and paroxysmal pain, allodynia and paresthesias were assessed. The sensory and affective components of pain using the McGill pain questionnaire, quality of life, mood, anxiety and functionality were also evaluated. Seven patients suffered from side effects necessitating premature arrest of the drug in 5 of them. THC (mean dosage: 16.6±6.5 mg/day) did not induce any significant effects on ongoing and paroxysmal pain, allodynia, quality of life, anxiety/depression scores and functional impact of pain. These results do not support an overall benefit of THC in pain and quality of life in patients with refractory neuropathic pain.