Medical Cannabis and Muscle Spasms

A muscle spasm (cramp) is a sudden and involuntary contraction of a muscle.

Spasms may affect a number of different muscles in the body, resulting in a variety of symptoms and presentations.  Common muscle spasms may be due to dehydration and electrolyte disturbances.  Common spasms occur abruptly, are painful, and can usually be relieved by gently stretching the muscle and replenishing fluids.

Chronic muscle spasms may be a sign of a more serious underlying condition.  Medical conditions that are commonly associated with muscle spasms include:

  • Multiple sclerosis
  • Fibromyalgia
  • Myofascial pain syndrome
  • Muscular dystrophy
  • Myopathy
  • Low back pain, mid back pain, upper back pain
  • Neck pain (cervicalgia)

Muscle spasms may also results as a side effect of certain pharmaceutical drugs.  Medications that can cause muscle cramps include:

  • Furosemide (Lasix), hydrochorothiazide (Microzide), and other diuretics (“water pills”)
  • Donepezil (Aricept) – Alzheimer’s drug
  • Neostigmine (Prostigmine) – Myasthenia gravis drug
  • Nifedipine (Procardia) – Angina and high blood pressure drug
  • Raloxifene (Evista) – Osteoporosis drug
  • Terbutaline (Brethine), albuterol (Proventil, Ventolin) – Asthma drugs
  • Tolcapone (Tasmar) – Parkinson’s drug
  • Atorvastatin (Lipitor), simvastatin (Zocor), pravastatin (Pravachol), rosuvastatin (Crestor), fluvastatin (Lescol), lovastatin (Mevacor) – Cholesterol-lowering drugs

Muscle spasms may perpetuate themselves through a “spasm-pain-spasm” phenomenon.  An initial event causes a muscle spasm.  The muscle spasm causes pain.  The pain causes further muscle spasm.  And so on.  Treatment focuses on breaking this cycle.

Conventional Pharmaceutical Medications

Muscle spasms are treated with a variety of pharmaceutical medications, including muscle relaxants, pain medications [e.g., NSAIDs], anti-seizure medication [e.g., pregabalin (Lyrica)], and even botulinum toxin injections.

Examples of muscle relaxants

  • Carisoprodol (Soma)
  • Cyclobenzaprine (Flexeril)
  • Diazepam (Valium)
  • Metaxolone (Skelaxin)
  • Methocarbamol (Robaxin)

Possible side effects of muscle relaxants include drowsiness, dizziness, dry mouth, urinary retention dependence, and possible addiction.  Many patients also report a hangover feeling following the use of muscle relaxants.

Complementary and Alternative Medicine

Natural ways to relax muscles and stop tension

  • Stretching
  • Massage
  • Heat/ice
  • Physical therapy
  • Acupuncture
  • Progressive relaxation exercises

Herbs and supplements for muscle cramps

  • Cramp bark (Viburnam opulus)
  • Valerian (Valeriana officinalis)
  • Arnica (Arnica Montana)
  • Passion Flower (Passiflora incarnata)
  • Vitamin B complex

Dietary strategies

  • Get enough potassium-rich foods: bananas, potatoes, prune juice, dried fruits
  • Get calcium-rich foods: fish and seafood, almonds, flaxseed, oats, parsley, prunes, sesame seeds, tofu, kale
  • Avoid acid foods and drinks: tomatoes, vinegar (which block calcium absorption by the body)

Medical Cannabis

Many patients report that medical cannabis is effective in relieving their muscle spasms.  Medical cannabis may also be effective in alleviating uncontrollable and debilitating muscle tremors.  Some patients with severe spasticity report that medical cannabis is the only treatment that allows them to function.

Sativex® is a natural marijuana plant extract that contains equal parts tetrahydrocannabinol (THC) and cannbidiol (CBD).  Sativex® is produced by United Kingdom-based GW Pharamaceuticals.  The product is available for use in Canada, the UK, and throughout much of Europe.  Sativex® is indicated for use in the treatment of MS symptoms such as pain due to nerve injury and spasticity.  The medication was found to have minimal side effects in human clinical trials.  GW’s pharmaceutical business partners include Otsuka, Novartis, Almirall, Neopharm, and Bayer.

Interestingly, some patients with Tourette’s syndrome report remarkable success in treating their symptoms with medical cannabis.  Tourette’s syndrome is a neurological disorder that has spastic-type components.

Scientifically, there is basis for the use of cannabis in the treatment of muscle spasms.  Cannabis’ key medicinal ingredients, tetrahydrocannabinol (THC) and cannabidiol (CBD), have been shown to have beneficial effects in the treatment of muscle spasms and spasticity.

Highlights from the Scientific Literature

Sastre-Garriga J, et al. (2011):  THC and CBD oromucosal spray (Sativex®) in the management of spasticity associated with multiple sclerosis.

  • Conclusion: Results from randomized, controlled trials have reported a reduction in the severity of symptoms associated with spasticity, leading to a better ability to perform daily activities and an improved perception of patients and their careers regarding functional status when Sativex (1:1 mix of 9-delta-tetrahydrocannabinol and cannabidiol extracted from cloned Cannabis sativa chemovars) was added to the current treatment regimen.
  • Conclusion: Adverse events such as dizziness, diarrhea, fatigue, nausea, headache and somnolence occur quite frequently with Sativex, but they are generally of mild-to-moderate intensity and their incidence can be markedly reduced by gradual ‘uptitration’.

Collin, et al. (2007):  Randomized controlled trial of cannabis-based medicine in spasticity caused by multiple sclerosis.

  • Randomized, placebo-controlled study of 189 human subjects with definite MS and spasticity.
  • Conclusion: Cannabis-based medicine [medicine containing delta-9 tetrahydrocannabinol (THC) and cannabidiol (CBD)] may represent a useful new agent for treatment of the symptomatic relief of spasticity in MS.

Petro DJ, Ellenberger C Jr. (1981):  Treatment of human spasticity with delta 9-tetrahydrocannabinol.

  • Conclusion: THC significantly reduced spasticity by clinical measurement.

Medical Marijuana Patient Information

Besides smoking, delivery methods for the use of medical cannabis include vaporization, tinctures, teas, and edible products.  Edible cannabis products generally have the longest duration of action (up to 6-8 hours) and may be useful in managing chronic spasticity.  Topical applications may also be beneficial.

The most commonly reported side effects from the use of medical cannabis include dry mouth, red eyes, increased appetite, and tiredness.   There has never been a death attributable to a medical cannabis overdose.  Medical cannabis should be used in consultation with a physician who specializes in cannabinoid medicine.

Prevention of Muscle Cramps

  • Avoid dehydration
    – Fluids help keep cells hydrated and less irritable
    – During activity, replenish fluids at regular intervals
  • Stretch your muscles
    – Stretch before and after extended periods of activity
    – Light exercise (e.g., a few minutes on a stationary bike) for a few minutes before bedtime may   help to prevent cramps while you are sleeping.

Contact Dr. Rabe

References and Resources

Collin, et al. Randomized controlled trial of cannabis-based medicine in spasticity caused by multiple sclerosis. European Journal of Neurology.  2007;14(3):290-296. http://www.ncbi.nlm.nih.gov/pubmed/17355549

Mayo Clinic Health Information. Muscle cramp.  http://www.mayoclinic.com/health/muscle-cramp/DS00311 

Petro DJ, Ellenberger C Jr. Treatment of human spasticity with delta 9-tetrahydrocannabinol. Journal of Clinical Pharmacology. 1981;21(8-9 Suppl):413S-416S.  http://www.ncbi.nlm.nih.gov/pubmed/6271839

Project CBD.  http://projectcbd.com/

Sastre-Garriga J, et al. THC and CBD oromucosal spray (Sativex®) in the management of spasticity associated with multiple sclerosis. Expert Review of Neurotherapeutics. 2011;11(5):627-637.  http://www.ncbi.nlm.nih.gov/pubmed/21456949

About markrabe

Mark L. Rabe, MD, ABIHM Integrative Holistic Medicine Centric Wellness 2308 6th Avenue San Diego, CA 92101 Telephone: (619) 546-0420 Fax: (619) 615-2346 E-Mail: info@CentricWellness.com

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