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MS Series
ing the diaries appeared to be representative of the
whole population. It was reported that these will
reduce the likelihood of the bias.
The change in pad weight was not clinical significant in either study due to underpowered size numbers in both studies.
Kavia et al (2010) introduced other outcome measures accordingly to typical symptoms of bladder dysfunction in people with MS; however, most of them
did not reach statistical significance. This study
showed no effect of Sativex® on incontinence; however, it demonstrated favourable effects on other bladder
dysfunction symptoms such as frequency, urgency and
nocturia that were not measured in the Freeman et al
(2006) study.
There were a number of limitations in both studies;
however, both studies showed some evidence that cannabinoids provided some benefit in different symptoms of bladder dysfunction in people with MS.
Further research into the effectiveness of cannabinoids on MS-related bladder dysfunction it is recommended. High level evidence RCTs which should
include all aspects of bladder dysfunction and differentiate between the different types of bladder incontinence has been recommended.
This review has not focused on tolerability or
adverse side-effects. It is also important to consider
that this mini-review is limited in a number of ways.
Sackett et al (2000) suggested that two people should
assess each trial, but only the author searched and
assessed the quality of both RCTs. A structured
framework for critical appraisal was used to minimize
the potential bias but time restrictions did not allow

Key Points
■■ Bladder dysfunction is one of the most common symptoms in people

with MS—90% develop lower urinary tract symptoms within 10 years of
disease activity (Koldewijn et al, 1995)
■■ It has been reported that cannabinoids and cannabinoids agonists

decreased motility in normal and inflamed bladders (Merriam et al, 2008).
This mini-review looks into new evidence of bladder management with
cannabinoids that has been recently published in order to add new data
and identify if cannabinoids are more effective than placebo in
decreasing MS-related bladder dysfunction
■■ There were a number of limitations in the studies and considering that

the main outcome for both was the number of incontinence episodes,
there were slightly different however it can be observed that the studies
showed some evidence that cannabinoids provided some benefit in
different symptoms of bladder dysfunction in people with MS
■■ Although there is a low evidence for the efficacy of cannabinoids based

medicines in the treatment of bladder dysfunction in MS, there is no
licensed form of this medication currently available in the UK so costs
and long term results have not been assessed and clinical usefulness is
hard to determine

8

for a full systematic review of references lists or contact to other experts for more available unpublished
papers.
BJNN
AQ- conflict of interest?
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British Journal of Neuroscience Nursing

April/May 2012

Vol 8 No 2