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Integro Medical Clinics: Living with and managing MS

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In the latest of their ‘Medical Case Book’ series, the team at Integro Medical Clinics explore living with and managing the symptoms of multiple sclerosis with cannabis medicines. 

Multiple sclerosis (MS) is an autoimmune condition, which has several different forms and levels of severity. 

It occurs when the body’s immune system malfunctions and attacks a healthy part of the body, in the case of MS, the brain or spinal cord of the nervous system. 

The attacked layer that surrounds and protects the nerves is called the myelin sheath. This damage to the sheath and underlying nerves, means that messages travelling along the nerves become slowed or disrupted. 

Exactly what causes the immune system to act in this way is unclear, but most experts think a combination of genetic and environmental factors is involved.

MS can affect the brain and spinal cord, causing a wide range of potential symptoms, including problems with vision, speech, arm or leg movement, sensation or balance. It’s a lifelong condition that can sometimes cause serious disability, although it can occasionally be mild. In many cases, it’s possible to treat symptoms. 

It’s most commonly diagnosed in people in their 20s and 30s, although it can develop at any age. It’s about two to three times more common in women than men and is one of the most common causes of disability in younger adults.

The symptoms of MS vary widely from person to person and can affect any part of the body. 

The main ones include fatigue, back and neck pain, difficulty walking, vision problems, problems controlling the bladder, numbness or tingling in different parts of the body, muscle stiffness and spasm, issues with balance and coordination and problems with thinking, learning and planning.

Depending on the type of MS you have, your symptoms may come and go in phases or get steadily worse over time. MS starts in one of two general ways: with individual relapses (attacks or exacerbations) or with gradual progression.

Relapsing remitting MS

More than eight out of every 10 people with MS are diagnosed with the relapsing remitting type. 

Someone with relapsing remitting MS will have episodes of new or worsening symptoms, known as relapses.

These typically worsen over a few days and these relapses can last from as little as a week to many months, then slowly improve over a similar time period. 

Relapses often occur without warning but are sometimes associated with a period of illness or stress. The symptoms of a relapse may disappear altogether, with or without treatment, although some symptoms often persist, with repeated attacks happening over several years.

Periods between attacks are known as periods of remission – these can last for years at a time.

After many years (usually decades), many, but not all, people with relapsing remitting MS go on to develop secondary progressive MS.

In this type of MS, symptoms gradually worsen over time without obvious attacks. Some people continue to have infrequent relapses during this stage.

Around half of people with relapsing remitting MS will develop secondary progressive MS within 15 to 20 years, and the risk of this happening increases the longer you have the condition.

Primary progressive MS

Just over one in 10 people with the condition start their MS with a gradual worsening of symptoms.

In primary progressive MS, symptoms gradually worsen and accumulate over several years, and there are no periods of remission, though people often have periods where their condition appears to stabilise.

There’s currently no cure for MS, but a number of traditional treatments can help control the condition including steroids, specific treatments for individual MS symptoms and disease-modifying therapies and medicines. 

Cannabis medicines & MS symptom control 

Many patients have found that using Cannabis medicines to control their MS symptoms can be incredibly helpful.

Dr Anthony Ordman, senior clinical adviser and hon. clinical director at Integro Medical Cannabis Clinics said: “Over the years I have treated many MS patients in my clinics. Whilst they  generally receive excellent care for their MS, the secondary conditions such as chronic back pain can be neglected.

“Traditional pharmaceutical pain medicines often have unpleasant side effects such as brain fog and constipation and frequently stop working after a few weeks. Cannabis medicines can prove extremely helpful in the pain management of MS patients pain  because they reduce muscle spasm and inflammation.”

The wholistic approach 

In the overall management and improvement in quality of life for a patient, many elements need to be assessed and different approaches tried to see if they work for the individual. 

Emotional support and being monitored and listened to by a trusted healthcare professional are absolutely vital. At Integro Medical Clinics specialist cannabis practise nurse, Sophie Hayes, is very experienced in dealing with MS patients and on call to support and deal with any questions they may have.

“Managing the symptoms of MS often requires a multi-disciplinary approach.  Every individual’s presentation is different and benefits from a combination of pharmacological and non-pharmacological methods,” said Sophie.

“These can include physiotherapy exercises, Transcutaneous Electrical Nerve Stimulation (TENS), cooling and/or heat therapy, supportive braces, alternative therapies and CBT. 

“In addition to this, cannabis medicines can be a useful prescription to help manage the pain and relax the muscles.  This can enable individuals living with MS to engage with these methods and regain a greater sense of control over their symptom management.

There are several organisations in the UK that MS patients can turn to including the National Back Pain Association – BackCare, the MS Society and the MS Trust (see contact details below).

Denice Logan Rose, executive director, BackCare, commented: “BackCare can offer practical and emotional support to MS patients living with back pain through education, information, advice and a small network of UK based branches. 

“Even though it can be one of many side effects of MS it should not be underestimated the distress back pain can cause. Turning to an organisation like BackCare for support can help alleviate the stress, anxiety and discomfort that arises from the added complication of back pain.”

She continued: “Back and neck pain can affect MS patients for a number of  different reasons. For example, spasticity, sitting in one position for too long, incorrect use of mobility aids, struggling with mobility, or possibly the same type of wear and tear that many people without MS experience. 

“These pains can often get neglected within the overall larger framework of an MS diagnosis.

“At BackCare we are constantly investigating new approaches to back pain management to try to help people living with MS to  have an improved quality of life and less discomfort.”

The patient’s story

Sarah Martin is a seasoned cannabis advocate and activist for Project 21.  She is 51-years-old and first began to manifest symptoms of MS in 2002. 

However, it was misdiagnosed for a couple of years as Dion Beret syndrome.

“As time passed the symptoms spread from numb feet and mood swings with depression, to an absolute physical inability to get out of bed or make a cup of tea. Even swallowing and speech became a challenge,” Sarah said.

She was then correctly diagnosed with relapsing and remitting MS but refused to be treated in hospital and struggled on at home.

Sarah was at her lowest ebb, when a friend suggested to her that she try cannabis, as she had heard it could have a positive effect on MS symptoms.  

“At once my leg spasms reduced and the constant ache, I felt in my body decreased,” she added.

“I was finally able to get a good night’s sleep and relax, leading to a huge elevation in my mood.”

Sarah has become a dedicated cannabis proponent and continues to use medical cannabis to improve the quality of her life and control her MS symptoms. 

Dr Anthony Ordman added: “Integro Clinics Ltd always recommend remaining under the care and treatment of your GP and specialist for your condition, while using cannabis-based medicines, and the Integro clinical team would always prefer to work in collaboration with them.”

 

If you would like further information, or to make an appointment for a medical consultation, please contact us at Integro Clinics:  

Website: www.integroclinics.com

Email: Contact@integroclinics.com

Twitter: @clinicsintegro

To contact BackCare: +44 (0) 208 977 5474

Info@backcare.org.uk

Website: www.backcare.org.uk

 

Additional support

https://www.mssociety.org.uk/care-and-support/local-support – @mssocietyuk

https://www.ms-uk.org/ – @MSUK6

https://mstrust.org.uk/about-ms – @MSTrust

https://shift.ms/ – @shiftms

Endometriosis

Does CBD affect endometriosis?

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Illustration of a female ulterus
Statistically one in 10 people with a fertile uterus suffer from endometriosis

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Always Pure Organics’ research assistant Alexandra Gkoutzidou explores the evidence behind the use of CBD to treat and manage the symptoms of endometriosis.

 

What is Endometriosis?

The endometrium is the lining of the uterus that hosts the zygote after fertilisation of the egg[3]. If the egg does not get fertilised, meaning does not embed itself to the endometrium, the endometrium sheds off, causing menstruation.

Then the endometrium will be reconstructed in expectation of the next zygote and shed off again if that does not happen. The endometrium, therefore, is destroyed and reconstructed every month.

When endometrium cells grow in different part of the uterus (other than the endometrium lining) or even the body, this is called endometriosis[2]. The endometrium cells will shed and regrow every month no matter their location in the body, causing lesions, painful periods (dysmenorrhea), pelvic pain, infertility, or subfertility.

Statistically one in 10 people with a fertile uterus suffer from endometriosis, but its cause is not clear yet.

The role of the endocannabinoid system

It appears that the endocannabinoid system (ECS) plays an important role in the normal processes of the female reproductive system[3, 9].

Studies show that proper regulation of the ECS is important to maintain a healthy regulated reproductive system. It has been observed that endocannabinoids’ and their degradative/oxidative enzymes’ expression fluctuate in the female reproductive organ in accordance with the stage of the menstrual cycle[5].

The levels of these endocannabinoids are raised to increase fertility during ovulation and then fall during the luteal phase of the menstrual cycle. Research has shown that this fluctuation of the ECS is not as well-regulated for people suffering from endometriosis.

The results have shown that people with endometriosis have low amount of CB1 receptors in the uterus and abnormal levels of endocannabinoids in their blood during their menstrual cycle.

Evidence shows that in the reproductive system, the use of cannabinoids operates in more than one way.

The way the cannabinoids operate in this system is related to both the amount of expressed cannabinoids and also in the phase of the menstrual cycle. The use of cannabinoids to treat endometriosis, is therefore a complicated case and in such cases it is important to consult a doctor instead of self-medicating, because high levels of the “wrong” cannabinoid, or even at the wrong time of the month could possibly affect ones fertility or cause other gynaecological issues.

What does the evidence say?

McHugh et al [4], researched the effect of THC and N-arachidonyl in the migration of endometrial cells in an animal cell culture. It was observed that while the above two cannabinoids induce migration of the endometrial cells, CBD prohibits it. While this research gives way to more in-depth research for the effect of CBD in human endometriosis, it does not provide sufficient data to claim that CBD is beneficial against endometriosis.

There are two clinical trials currently taking place, researching just that. The first is an open label phase II trial, studying an 1:1 ratio of THC and CBD administered to endometriosis patients to reduce hyperalgesia[6].

The second is a phase III double blind placebo study, where patients will receive norethindrone acetate, a type of hormonal treatment, in accompany with 10 or 20mg of CBD for the management of endometriosis pain[7].

Regardless, a lot of people are already using cannabis and/or CBD to treat the pain derived from endometriosis. Research that took place in Australia investigated the self-management strategies amongst Australian women with endometriosis [8]. This online research was published on social media and invited women to share their own methods of treating their endometriosis symptoms.

The authors suggested that the anonymity of an online research could increase engagement, due to the fact a lot of people use illegal substances to treat pain symptoms. The most common strategies used were self-care and lifestyle choices like heat, rest and meditation, but the most highly effective rated self-reported methods were cannabis, heat, hemp/CBD oil, and dietary changes.

Anecdotal evidence suggests that the use of CBD, THC and possibly other cannabinoids could help treat the pain related to endometriosis, but given the role the ECS has in the uterus there should be more in-depth research in order to realise the factual role CBD plays in endometriosis (if any). The pain sensory system is different to the reproductive system. The role of CBD in pain is well understood and the analgesic effect of CBD in endometriosis pain is probably related to it instead of an effect to the endometrial cells [5, 10, 11].

Nonetheless, CBD has been shown to have positive effects for patients with diseases related to ectopic movement of cells in the body, like cancer and psoriasis. Indeed, CBD has been shown not only to inhibit some cancer cells growth, but also to mediate these cell’s movement to other parts of the body (metastasis) [14, 15, 16].

Similarly, psoriasis is a disease which one of its symptoms is the over production of new skin cells too quickly, that causes the scales. In that case, CBD has been shown to positively affect the skin making it more elastic, better hydrated and reducing the amount of scales by promoting the balanced production of cells and minimising the ectopic production [12]. Similarly, CBD could possibly benefit the ectopic production of endometrial cells but it is yet to be researched.

The levels of cannabinoids in the uterus are strongly related to the phase of the menstrual cycle and they are formed so to increase fertility [9, 13]. Therefore, it is ill advised to use any cannabinoids if you are trying to get pregnant or have a related health problem without advising your doctor and testing whether the endocannabinoid levels are correct during your cycle. A well balanced ECS is the target so always follow the dosage directions.

 

References

[1] https://www.nhs.uk/conditions/endometriosis/

[2] doi: 10.1002/bies.201100099

[3] doi:10.1093/molehr/gas037

[4] DOI:10.1111/j.1476-5381.2011.01497.x

[5] DOI: 10.1089/can.2016.0035

[6] https://clinicaltrials.gov/ct2/show/NCT03875261

[7] https://clinicaltrials.gov/ct2/show/NCT04527003

[8] doi.org/10.1186/s12906-019-2431-x

[9] DOI: 10.1177/1933719114533730

[10] DOI: 10.11607/ofph.1274

[11] https://doi.org/10.1007/s40122-019-0114-4

[12] doi: 10.7417/CT.2019.2116

[13] DOI              10.1186/1471-2202-11-44

[14] DOI: 10.1007/s13105-018-0611-7

[15] doi: 10.17305/bjbms.2018.3532

[16] DOI: 10.3390/ijms2115540

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Case Studies

“CBD allows me to function” – biker ‘died’ three times after freak road accident

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Gary Brennan pictured with wife Shirley
Gary Brennan and wife, Shirley set up a trauma support service after the accident

After a serious motorbike accident, Gary Brennan almost lost his life, undergoing 54 operations to fix his broken body. Gary speaks to Cannabis Health about the “life-changing” accident and how CBD helps to manage the pain 11 years on.

On February 28th 2010, Gary Brennan collided with a car while riding his motorbike.

He broke both shoulder blades, tore his liver, crushed his kidney, shattered his pelvis fractured his spine and suffered from bleeding on the brain and a collapsed lung.

These are just some of the life-threatening injuries that he sustained in the accident.

So severe were his injuries that he was declared dead at the scene of the incident. Paramedics were able to resuscitate him before he was helicoptered to Leeds General Infirmary where he underwent emergency surgery.

During the operation, his heart stopped twice and his family were told that he may have just a few hours to live. He was put into an induced coma and relied on a life support machine to breathe.

Miraculously, Gary survived.

His condition stabilised enough to come out of the coma, but since then he has undergone a total of 54 operations.

When Gary’s condition stabilised enough to come out of the coma he was in excruciating pain. Having battled injuries that doctors deemed barely survivable, the 63-year-old was administered a plethora of drugs to keep the pain under control and has since undergone a total of 54 operations.

“The accident was life-changing to say the least,” Gary told Cannabis Health.

Gary Brennan underwent more than 50 operations

“I got through the operations and everything else, and then I got to the stage where I was lying in bed, zoomed out my head every day of my life with the drugs that I was taking.”

The cocktail of medications including morphine and ketamine kept the pain at bay but according to the father-of-four, it was “destroying” his brain.

Bed-bound, in pain and suffering from a relentless medication plan, Gary slipped into a period of depression and at one point considered suicide.

“I don’t say this lightly,” he said. “It brings tears to my eyes just thinking about it; that I actually even considered it having been a fit, active father-of-four and grandfather-of-six.

“But that was what the drugs were doing to me.”

Gary recalls waking up in the morning “groggy as hell” and in agonising pain until he took his medication.

“All it would do was numb my mind so that I didn’t feel the pain,” he added.

Knowing he had to find an alternative, he looked into CBD.

Although he was sceptical at first and questioned whether the benefits were merely a placebo effect, Gary found that CBD was helping reduce the pain while still allowing him to keep a “clear” head.

“Now I’ve got clarity, I’ve got a clear head, I can get out of bed in the morning. I still get the twinges but it’s not as severe pain,” he continued.

“The pain is always going to be there, but it’s handled in a different way. It doesn’t numb your brain, but the actual place that’s aching. It gives me relief and allows me to function.

“It changed my outlook on pharmaceutical drugs.”

Gary has now come off all prescription drugs apart from one, which he takes “now and then” to lower his blood pressure. Instead, he takes four capsules of CBD each day, equating to 720 milligrams.

Eleven years on from the crash, he has founded his own CBD brand, Brain Body Balance, and is working with US company, Ananda Scientific, to bring its patented Liquid Structure CBD formulation to the UK.

Ananda claims that the nano-sized technology makes its CBD formulation up to 20 times more bioavailable in the first 30 minutes than standard CBD. This is down to its “non-destructive” shell which contains the CBD and is able to pass through the gut and liver without being broken down. The shell only disintegrates when it reaches the small intestine, allowing for a greater amount of CBD to enter the bloodstream.

Ananda’s pharmaceutical-grade CBD is currently undergoing clinical trials to test its efficacy for treating pain, diabetes and mental health conditions including PTSD and anxiety.

Meanwhile, the nutraceutical arm of the company has launched over-the-counter products in the UK and the US through brands like Brain Body Balance.

Gary with one of his six grandchildren.

For Gary, producing a product with high bioavailability was a priority.

“I knew the product itself worked, but actually getting it into the bloodstream where it does its job is the hardest thing to do,” Gary said.

“You have to use stronger and stronger doses in order to get it into your bloodstream.”

Alongside his CBD venture, Gary set up the charity, Day One Major Trauma Support to limit the impact of trauma on patients and families in hospitals across Leeds and the wider Yorkshire area.

“When I was lying in hospital, the doctors would come around once a day and say, ‘how are you feeling, Gary?’, ‘can you feel your toes?’. Then they would say, ‘see you tomorrow’ and off they go,” he said.

“The nurse comes around, gives you your pills, then your family come in, pat you on the head and say it’ll be okay. Basically, that’s all you get.”

Aware of the lack of support, Gary set out to create a service that helped those like him who had suffered from major trauma. The charity provides financial assistance, legal advice and practical and emotional support.

Off the back of its success at Leeds General Infirmary, the charity will now be rolling out its services in all 27 major trauma centres in the UK.

Gary added: “Any help is there first-hand, no matter what, so nobody’s left in the lurch.”

 

 

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Pain

How cannabis medicines can help relieve back pain

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A new webinar will focus on how cannabis medicines can help relieve back pain

Sponsored feature

A stand-alone webinar event will focus on the role that cannabis medicines can play in relieving back pain.

This new field of medicine can offer life-changing help to those patients who find that traditional pain medicines and clinical intervention are no longer helping or have unpleasant side effects.

The discussion will explore the potential benefits of the addition of cannabis medicines into a chronic pain management regime for this diverse patient group.

Dr Anthony Ordman

Including injury, wear and tear, musculoskeletal disorders such as scoliosis, axial spa or spina bifida or as a consequence of another underlying health condition such as multiple sclerosis, fibromyalgia, arthritis, Parkinson’s disease or cancer.

The healthcare professionals taking part have many years experience between them in complex pain management and expertise in the treatment of back pain for a variety of conditions.


The panel

Dr Anthony Ordman – consultant pain specialist at Integro Clinics and former president of the Pain Medicine Section of the Royal Society of Medicine

Dr Basil Almahdi – consultant pain specialist at Complex Spine Clinics London

Dr Brian Hammond, PhD – chiropractor & osteopath, CEO National Back Pain Association (BackCare)

Dr Basil Almahdi

The event, hosted by The National Back Pain Association (more commonly known as BackCare or BackPain UK) and Integro Medical Clinics will take place on Thursday 25 May from 7pm-8.30pm.

Click here to book your free place or email jessicasmith@integroclinics.com

For information and support visit Integro Medical Clinics and BackCare

 

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