Anorexia (loss of appetite) and cachexia (wasting) are diagnosed in more than two-thirds of all cancer patients with advanced disease, and are independent risk factors for morbidity and mortality (1,2). Anorexia, nausea and vomiting are often described as more significant inhibiting factors for quality of life of cancer patients than even intense pain (3). In 1986, delta-9-tetrahydrocannabinol (THC), the main effective constituent of Cannabis, was licensed as an anti-emetic drug in cancer patients receiving chemotherapy (4). In addition, in clinical studies, THC has shown significant stimulation of appetite and increase of body weight in cancer patients and HIV positives and AIDS patients (7,8). The appetite stimulating effects of Cannabis (THC) itself have also been welldocumented in many anecdotal cases. There are strong indications that Cannabis is better tolerated than THC alone, because Cannabis contains several additional Cannabinoids, like Cannabidiol (CBD), which antagonize the psychotropic actions of THC, but do not inhibit the appetite-stimulating effect.

Central cannabinoid receptors are densely located in the output nuclei of the basal ganglia (globus pallidus, substantia nigra pars reticulata), suggesting their involvement in the regulation of motor activity. Furthermore, there is evidence that endogenous cannabinoid transmission plays a role in the manipulation of other transmitter systems within the basal ganglia by increasing GABAergic transmission, inhibiting glutamate release and affecting dopaminergic uptake. Most hyperkinetic and hypokinetic movement disorders are caused by a dysfunction of basal ganglia-thalamo-cortical loops. It has been suggested that an endogenous cannabinoid tone participates in the control of movements and, therefore, the central cannabinoid system might play a role in the pathophysiology of these diseases. During the last years, in humans, a limited number of clinical trials demonstrated that cannabinoids might be useful in the treatment of certain movement disorders. Despite a lack of controlled studies, there is evidence that cannabinoids are of therapeutic value in the treatment of tics in Tourettes syndrome (3,4), the reduction of levodopa-induced dyskinesia in Parkisons disease (1,2), and some forms of tremor and dystonia, like in Huntingtons disease (5). Robert Gorter et al. studied the medical use of Cannabis in the Netherlands. He found that licensed medical doctors (family practitioners, internists, oncologists and surgeons alike, both in private practice as well in General Hospitals and University Medical Centers) would prescribe Cannabis both for inhalation (smoking) and as oral application. Alarge majority (64%) of all patients reported a good or excellent effect on their symptoms. Of these patients, approximately 44% used Cannabis for 5 months and longer. Indications were neurologic disorders, like MS and spinal cord injuries, pains, musculoskeletal disorders, and cancer-related anorexia & cachexia. Inhales Cannabis was preceived as more effective than oral administration. Repported side effects were generally very mild (6).

(1) Snider SR, Consroe P: Beneficial and adverse effects of cannabidiol in a Parkinson patient with sinemet-induced dystonic dyskinesia. Neurology (1985) 35(suppl): 201.

(2) Frankel JP, Hughes A, Lees AJ, Stern GM: Marijuana for Parkinsonian tremor. J Neurol Neurosurg Psychiatry (1990) 53: 436.

(3) Hemming M, Yellowlees PM: Effective treatment of Tourettes syndrome with marijuana. J Psychopharmacol (1993) 7: 389-391.

(4) Sandyk R, Awerbuch G: Marijuana and Tourettes syndrome. J Clin Psychopharmacol (1988) 8: 444-445.

(5) Sandyk R, Consroe P, Snider SR, Bliklen D: Preliminary trial of cannabidiol in Huntingtons disease; in Chester G, Consroe P, Musty R (eds): Marijuana: An International Research Report. National Campaign against Drug Abuse Monograph Series, No. 7 Canberra, Australian Government Publishing Service (1998) pp157-162.

(6) Gorter, R., Butorac, M., Cobian, E., Van der Sluis, W.: Medical Use of Cannabis in the Netherlands. Neurology (2005) 64 (5): 917-919.

Cannabis in the treatment of (chronic) pain

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