The majority of patients with multiple sclerosis (MS) develop troublesome lower
urinary tract symptoms (LUTS). Anecdotal reports suggest that cannabis may
alleviate LUTS, and cannabinoid receptors in the bladder and nervous system are
potential pharmacological targets. In an open trial we evaluated the safety,
tolerability, dose range, and efficacy of two whole-plant extracts of Cannabis
sativa in patients with advanced MS and refractory LUTS. Patients took extracts
containing delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD; 2.5 mg of
each per spray) for eight weeks followed by THC-only (2.5 mg THC per spray) for
a further eight weeks, and then into a long-term extension. Assessments included
urinary frequency and volume charts, incontinence pad weights, cystometry and
visual analogue scales for secondary troublesome symptoms. Twenty-one patients
were recruited and data from 15 were evaluated. Urinary urgency, the number and
volume of incontinence episodes, frequency and nocturia all decreased
significantly following treatment (P <0.05, Wilcoxon's signed rank test).
However, daily total voided, catheterized and urinary incontinence pad weights
also decreased significantly on both extracts. Patient self-assessment of pain,
spasticity and quality of sleep improved significantly (P <0.05, Wilcoxon's
signed rank test) with pain improvement continuing up to median of 35 weeks.
There were few troublesome side effects, suggesting that cannabis-based
medicinal extracts are a safe and effective treatment for urinary and other
problems in patients with advanced MS.
