Research news - February 2007
Open Door - February 2007 pages 4-5
- TENS for back pain
- Incidence of MS increasing in women
- The Bobath concept for balance and gait
- Day time or night time treatment with steroids?
- Cannabis usage by people with MS
- Agreeing goals for rehab
- Sativex – safety and effectiveness
1. TENS for back pain
A TENS (Transcutaneous Electrical Nerve Stimulation) machine delivers a small current through pads that are applied to the skin and is used for the relief of pain.
To study the effect of TENS on lower back pain, 90 people with MS were split into three groups to compare low and high frequency TENS and placebo over a six week period. A number of measures were used to assess pain, physical function and quality of life during treatment and again after 32 weeks. Although not statistically significant, high frequency TENS was more effective for pain relief during the initial six weeks, with low frequency TENS showing more long-lasting pain relief. During treatment improvements in physical function were also noted in the low frequency group with both active TENS groups showing the greatest improvements in quality of life scores. There was also a clear placebo effect throughout the trial.
Warke K, et al.
Efficacy of transcutaneous electrical nerve stimulation (TENS) for chronic low-back pain in a multiple sclerosis population: a randomized, placebocontrolled clinical trial.
Clinical Journal of Pain 2006;22(9):812-819.
2. Incidence of MS increasing in women
An analysis of data for more than 27,000 Canadians with MS has shown that the ratio of female to male by year of birth has been increasing for at least 50 years and now exceeds 3.2:1. The increase appears to be due to a greater incidence in women rather than a decrease in men. This finding should encourage efforts to identify environmental causes for the increased disease susceptibility in women.
Orton SM, et al.
Sex ratio of multiple sclerosis in Canada: a longitudinal study.
Lancet Neurology 2006;5(11):932-936.
3. The Bobath concept for balance and gait
The Bobath concept is a form of neurorehabilitation used for conditions such as cerebral palsy, strokes and brain or spinal injuries. It is based on the brain's ability to reorganise so that healthy parts of the brain learn and take on the functions that were previously carried out by the damaged regions of the brain. The Bobath concept was used to treat two people with MS with gait and balance problems. Various tests were performed before, during and after three weeks of individualised, tailored treatment and revealed improvements in both balance and gait. The researchers conclude that the Bobath concept should be evaluated further in larger controlled trials of people with MS.
Smedal T, et al.
Balance and gait improved in patients with MS after physiotherapy based on the Bobath concept.
Physiotherapy Research International 2006;11(2):104-116.
4. Day time or night time treatment with steroids?
The immune system has been shown to follow a 24 hour cycle. Treatment tailored to these daily cycles may lead to improved efficacy, safety and tolerability. In this small pilot study, day time vs night time intravenous steroid treatment for acute relapses was compared in 17 people with MS. After night time treatment, clinical recovery was significantly better and the average number of side effects was significantly lower. The majority of patients preferred night time treatment.
Glass-Marmor L, et al.
Chronotherapy using corticosteroids for multiple sclerosis relapses.
Journal of Neurology, Neurosurgery and Psychiatry 2006 Oct 20; [Epub ahead of print]
5. Cannabis usage by people with MS
Anecdotal evidence suggests that many people with MS use cannabis for medicinal purposes. The study aimed to assess the extent and patterns of cannabis use amongst people with MS in south east London. 75% of questionnaires (254 out of 337) were completed. While a large proportion (43%) had tried cannabis at some stage, a relatively small number had used cannabis in the last month (18%). Cannabis use was most likely in people with increased disability (eg wheelchair users or people walking with an aid). Pain and spasms were common reasons for cannabis use and a large proportion reported benefit. Over half of the cannabis users had tried cannabis to treat sleep problems and 88% found it helpful. The researchers highlight concerns about the long-term safety of cannabis and the risk of developing psychiatric disorders with prolonged use and note that further study is needed.
Chong MS, et al.
Cannabis use in patients with multiple sclerosis.
Multiple Sclerosis 2006; 12(5): 646-651.
6. Agreeing goals for rehab
This study compared the agreement between 27 people with MS and their multidisciplinary team on the identification of goals for an inpatient rehabilitation stay. People with MS and their clinical team independently rated 55 predefined goals and selected their five most important rehab goals. The patient and the team agreed on an average of 1.7 of the patient's five top-rated goals.
Patients had greater expectations of how much improvement could be made and of the likelihood of achieving their goals. People who had high expectations on admission did in fact report greater success at discharge. The study shows that a gap can exist between clinicians and people with MS in their understanding of what is to be achieved in rehabilitation; there is a need for a more collaborative method of goal setting between patients and the clinical team to help define the treatment plan.
Bloom LF, et al.
Concordance in goal setting between patients with multiple sclerosis and their rehabilitation team.
American Journal of Physical Medicine & Rehabilitation 2006;85(10):807-813.
7. Sativex – safety and effectiveness
137 people who had previously taken part in a six week placebocontrolled study, entered this open-label trial, using Sativex to control spasticity and a number of other symptoms. Patients were assessed every eight weeks and follow up continued for an average of 14 months to monitor the safety and effectiveness of this cannabis-based medicine. In total, 58 patients (42%) withdrew from the trial. 24 of these did so due to lack of efficacy; 17 due to adverse events, 6 withdrew consent and 11 for other reasons. The majority of adverse events were mild, including dizziness, diarrhoea, nausea and sore mouth. Serious adverse events included first-ever seizures (epilepsy) in four people. The trial found no consistent withdrawal syndrome, even if medication was stopped suddenly. Researchers conclude that long-term use of Sativex remains effective in those who perceive initial benefit. The precise nature and rate of risks with longer-term use, especially epilepsy, require larger and longer-term studies.
Wade DT, et al.
Long-term use of a cannabis-based medicine in the treatment of spasticity and other symptoms in multiple sclerosis.
Multiple Sclerosis 2006; 12(5): 639-645.
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