The Danish Medicines Agency allows doctors to lawfully prescribe a new type of cannabis product to individuals with the following four relevant indications and other pain-related conditions where the doctor can argue that the product will help.


Multiple Sclerosis

What is it?

 Multiple Sclerosis (MS) is a chronic progressive degenerative disorder of the central nervous system (CNS) characterized by disseminated demyelination of nerve fibers in the brain and spinal cord.  It is an inflammatory disease affecting the axons of the brain and spinal cord.  The fatty myelin sheaths around the axons are damaged due to an inflammatory process and results in demyelination and scarring (gliosis). There are approximately 500 new cases of MS per year in Denmark. 

The pathophysiology is related to infections, immunologic, and genetic factors.  The inflammatory process starts with the movement of T cells across the blood-brain barrier into the nervous system. The blood-brain barrier under normal circumstances prevents T cells from crossing the barrier into the nervous system. However, when there is an infection or a virus, the blood-brain barrier becomes permeable to T cells. The T-cell is part of the autoimmune response as an antigen-antibody response resulting in an attack in the nervous system and the production of plaques and lesions.  The process involves myelin loss, destruction of oligodendrocytes, and astrocyte proliferation, resulting in demyelization and plaque formation throughout the CNS.  The attack on the myelin triggers an inflammatory process which again impacts the blood-brain barrier causing swelling and activation of cytokines and antibodies.  The demyelination process results in slowing or total blockage of nerve impulses and permanent nerve loss.

The clinical findings associated with MS include motor, sensory, neuropathic pain, cerebellar, bladder spasms, and emotional problems, especially depression.  Motor problems include weakness of limbs, trunk and head, double vision, scanning speech, and muscle spasticity.  Sensory problems include numbness and tingling, altered vision, vertigo, decreased hearing, and chronic neuropathic pain.  The cerebellar manifestations include nystagmus, ataxia, dysarthria, and dysphagia.  The emotional manifestations include anger, depression, and euphoria.

MS is not curable, and treatment includes medications to treat the inflammatory process and immunosuppressive therapy. The treatment is directed at the management of disability and slowing the progression of the disease.

 

How can medical cannabis help? 

Medicinal cannabis has been shown to relieve pain and muscle spasms associated with some disease states, including multiple sclerosis, spinal cord injury, and nerve pain. The endocannabinoid system is where the medicine begins taking action.  It targets the neuronal and immune system functions to regulate pain and muscle spasms.

Oral cannabis extract is beneficial for reducing symptoms of spasticity and pain.  


Neuropathic Pain

What is it?

Neuropathic pain or nerve pain is a result of nerve damage or nerve dysfunction involving the central nervous system or peripheral nerves.   Pain is usually considered out of proportion to the level of tissue injury and is described as “pins and needles,” burning or tingling.

There are different categories of neuropathic pain and they include:

  • Diabetic neuropathy

  • Degenerative disk disease

  • Sciatica

  • Trigeminal neuralgia

  • HIV-associated sensory neuropathy

  • Complex regional pain syndrome

  • Postsurgical pain syndromes

  • Cubital, Tarsal and Carpal Tunnel Syndrome

 

How can medical cannabis help?

Medicinal cannabis has been shown to relieve pain and muscle spasms associated with some disease states, including multiple sclerosis, spinal cord injury, and nerve pain.  The mechanism of action is through the endocannabinoid system and its regulating impact on pain and muscle spasm is produced by targeting neuronal and immune system functions. 

Oral cannabis extract is beneficial for reducing symptoms of spasticity and pain.  


Spinal Cord Damage

What is it?

Spinal cord injuries involve damage at some point along the spinal cord or the nerves come off the spinal cord. These injuries are associated with irreversible physical limitations, spasms, and chronic pain. Physical limitation includes altered gait, strength, bodily function, altered sensation, that impact the persons' activities of daily living. Physical limitations and symptoms varied based on the site of the damage along the level of the spinal cord.

Injury-related symptoms include, but are not limited to:

  • Loss of sensation in areas of the body below the level along the spinal cord.

  • Loss or limited ability for movement

  • Difficulty breathing and coughing

  • Painful muscle spasms

  • Nerve pain (neuropathy)

  • Loss of bowel or bladder control

  • Sexual dysfunction

 

How can medical cannabis help?

Medicinal cannabis has been shown to relieve pain and muscle spasms associated with some disease states, including multiple sclerosis, spinal cord injury, and nerve pain. The mechanism of action is through the endocannabinoid system and its regulating impact on pain and muscle spasm is produced by targeting neuronal and immune system functions. 

Oral cannabis extract is beneficial for reducing symptoms of spasticity and pain. Other related symptoms associated with medical cannabis use include dizziness, drowsiness, difficulty concentrating and memory disturbance.


Chemotheraphy-Induced Nausea

What is it?

The most frequent side effects of chemotherapy are nausea and vomiting. 

These symptoms fall into three categories:

  • Acute emesis – occurring within two hours of treatment.

  • Delayed emesis – occurring after 24 hours following a chemotherapy session.

  • Anticipatory emesis – occurring within 24 hours of the next chemotherapy session. This category of emesis is the most feared and is associated to prior nausea and vomiting from previous sessions.

  • Note: The physicians are not restricted from prescribing medical cannabis to patients with other illnesses not included in the guidelines.

It is important to assess risk and institute preventive strategies for these patients.   

 

How can medical cannabis help?

Medical cannabis has been shown to have a very rapid onset of anti-emetic effect associated with chemotherapy.  The mechanism of action is through the endocannabinoid system and it being regulating by CB1 agonism which suppresses vomiting.   

Both inhaled (most rapid onset), oral cannabis extract is beneficial for reducing symptoms of nausea.  

 

To learn more, consult your doctor
or visit a pain clinic.

Pain clinics in Denmark are private medical clinics that offer medical treatment for pain.  If your doctor is not comfortable prescribing medical cannabis, consider making an appointment with a pain specialist at a pain clinic to see if medical cannabis is the right option for you.

Current pain clinics in Denmark: