The Ohio medical marijuana program recognizes Spasticity as a qualifying condition for medical marijuana treatment. Emerging research suggests that many patients with conditions such as Cerebral Palsy (CP) or Multiple Sclerosis (MS) might consider cannabis to help relieve symptoms related to spasticity.

It’s thought that medical marijuana might calm muscle spasticity. 

What is Spasticity?

Spasticity is a condition associated with damage to the brain, spinal cord or motor nerves, or neurological conditions. Spasticity causes increased involuntary, velocity-dependent muscle tightening that causes resistance to movement. The condition is typically a result of insult to the central nervous system or motor neurons. It may occur as a primary condition such as with degenerative conditions or as a result of secondary causes such as spinal cord injury, trauma to the brain, or inflammatory conditions such as multiple sclerosis.

Spasticity can range from mild feelings of muscle tightness to painful, uncontrollable spasms of extremities, often in the legs, around the joints, and in the lower back. Spasticity patients may experience  symptoms such as: 

  • Abnormal posture
  • Carrying a shoulder, arm, wrist, and finger at an abnormal angle due to muscle tightness
  • Exaggerated deep tendon reflexes (knee-jerk or other reflexes)
  • Repetitive jerky motions, especially when touched or moved
  • Pain or deformity of the affected area of the body

Spasticity may also affect speech. Severe, long-term spasticity may lead to contracture of muscles. This can reduce range of motion or leave the joints bent.

What Conditions Cause Spasticity?

Spasticity is generally caused by damage or disruption to the area of the brain and spinal cord that are responsible for controlling muscle and stretch reflexes. These disruptions can be due to an imbalance in the inhibitory and excitatory signals sent to the muscles, causing them to lock in place. Some of the conditions that can cause spasticity include: 

  • Adrenoleukodystrophy, which is a genetic condition that damages the membrane (myelin sheath) that covers nerve cells in the brain and spinal cord
  • Brain damage caused by lack of oxygen, as can occur in near drowning or near suffocation
  • Cerebral palsy 
  • Traumatic Brain Injury (TBI)
  • Multiple sclerosis
  • Neurodegenerative illness, which are incurable and debilitating conditions that result in progressive degeneration and / or death of nerve cells. Examples include Parkinson’s, Alzheimer’s, and Huntington’s disease.
  • Phenylketonuria, which is a disorder in which the body can’t break down the amino acid phenylalanine
  • Spinal cord injury
  • Stroke

Patients should seek medical care when spasticity is experienced for the first time with no known cause. Patients should also alert their doctor when their spasticity is worsening or becoming more frequent to the point their condition is preventing performance of everyday tasks. 

How is Spasticity Treated?

Your primary care doctor may order further examination and testing. A physical exam with neurological testing can test for spasticity and the severity of it. A magnetic resonance imaging (MRI) can provide more information on the source of spasticity and the extent of the damage that has caused it. 

Doctors have a variety of treatments they can use to help patients experiencing spasticity symptoms. Oral medications used in combination with physical or occupational therapy can often prove most effective. Medications known to help treat spasticity include the muscle relaxers Baclofen or Dantrolene sodium, Benzodiazepines, Imidazolines, and Gabapentin (which is an anticonvulsant).

In cases of spasticity, doctors sometimes recommend casting or bracing as it can prevent involuntary spasms and reduce tightening of the muscles. In severe cases, a patient may consider one of two types of surgery to treat their spasticity:

  • Intrathecal Baclofen (ITB) Pump: A pump is placed in the abdomen to release a steady dose of Baclofen directly to the spinal fluid. This can provide more significant relief with fewer side effects than when taking Baclofen orally. Only considered in extreme cases of spasticity, an ITB can effectively treat spasticity in the lower and upper extremities.
  • Selective Dorsal Rhizotomy (SDR): This surgery,  done in severe spasticity of the legs, rebalances the electrical signals sent to the spinal cord by cutting selective nerve roots. Cutting these roots can decrease a patient’s muscle stiffness while helping them maintain other functions. Commonly, SDR can help patients with cerebral palsy.

Alternative Spasticity Treatments

Botox: Botulinum Toxin (Botox) Injections injected into a patient’s muscle paralyze it, preventing it from contracting and potentially easing pain. Botox targets selected sites determined based on the pattern of spasticity. Despite Botox’s success in some patients, the effect typically wears off in 6 to 12 weeks and cannot be administered frequently enough for some patients to find a benefit.

Medical Marijuana: New research suggests that medical marijuana can calm muscle spasticity. A recently submitted complex botanical medication formulated from extracts of the cannabis plant currently awaits to the FDA for approval. The self-administered oral spray called Nabiximols has gained approval in over 25 countries outside the United States under the brand name Sativex. The formula contains tetrahydrocannabinol (THC) and cannabidiol (CBD), which work together to rebalance the brain’s endocannabinoid system. THC has been observed to impact CB1 and CB2 receptors, found in the nociceptive and spasticity pathways of the brain and spinal cord, as well as in the peripheral nervous system. The phase 3 trial of Sativex commenced in late 2020. This pivotal Phase 3 trial is one of five trials GW Pharmaceuticals is planning to launch assessing Sativex’s safety and efficacy in MS spasticity. The four other studies focusing on the effects of Sativex’s treatment on muscle tone and muscle spasm frequency have begun as well.

While FDA approval of Sativex may still take some time, patients experiencing spasticity symptoms may now legally try medical marijuana for their symptoms. Spasticity patients have reported that they benefit from cannabis because it can be taken several times a day on an as-needed and as-tolerated basis. Currently available anti-spasticity treatments are administered on a set daily schedule. Medical marijuana gives patients an opportunity to adjust their dosing schedule based on their needs.

Wondering what strains might help? Compiled from patient experiences, Leafly recommends these strains to consider for spasticity.

If you’ve been diagnosed with spasticity, you may want to consider medical marijuana to help ease your symptoms. Talk to your care team to decide whether cannabis may help in your treatment. Reach out to us at medicateOH@gmail.com to be matched with a physician in your area that can help with your condition.

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