Neurofibromatosis and Cannabidiol


Neurofibromatosis – Medical Marijuana Research Overview

8 December, 2015
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Neurofibromatosis is a genetic disorder that causes neurofibromas, or tumors, to form on nerve tissue throughout the body. Studies have shown cannabis has anti-tumor effects and can help manage pain associated with the disorder.

Overview of Neurofibromatosis

Neurofibromatosis is a group of genetic disorders that cause tumors to form on nerve tissue. The tumors, which can develop anywhere in the nervous system, including the brain, spinal cord, and nerves, are typically benign. However, in some cases the tumors can become malignant. The disorder, typically diagnosed during childhood or early adulthood, can cause hearing loss, learning impairments, heart and blood vessel complications, vision loss and severe pain.

There are three types of neurofibromatosis, including neurofibromatosis 1, neurofibromatosis 2, and schwannomatosis. Neurofibromatosis 1 (NF1) is the most common and typically develops during childhood. Symptoms associated with NF1 include six or more light brown spots on the skin that measure more than 5 millimeters in diameter in children and more than 15 millimeters across in adolescents and adults, freckling in the armpit or groin, two or more growths on the iris of the eye, soft bumps on or under the skin, bone deformities like a curved spine and learning disabilities. Neurofibromatosis 2 (NF2) is much less common and can cause gradual hearing loss, ringing in the ears and poor balance. Schwannamatosis is rare and causes severely painful tumors to develop on cranial, spinal and peripheral nerves.

The mutated gene that causes neurofibromatosis is commonly inherited, but it can also result from spontaneous mutations.

There is no cure for neurofibromatosis, so treatment focuses on ongoing pain management and dealing with complications as they develop. In some cases, surgery may be necessary to remove large tumors or tumors that press on a nerve. Once tumors are removed, pain often subsides, but will recur once new tumors form.

Findings: Effects of Cannabis on Neurofibromatosis

Cannabis has been found to have anti-tumor efforts, which suggests it may be helpful in limiting the development and growth of tumors caused by neurofibromatosis. One study found that two children with neurofibromatosis 1 saw their tumors clearly regress during a three-year period where no conventional treatment was used but cannabis was consumed via inhalation (Foroughi, Hendson, Sargent & Steinbok, 2011). Two major cannabinoids found in cannabis, tetrahydrocannabinol (THC) and cannabidiol (CBD), have shown to be beneficial for inhibiting tumors. CBD has demonstrated that by activating the CB1 and CB2 receptors, it inhibits tumor cell viability, invasion, spreading and growth (McAllister, Soroceanu & Desprez, 2015). One study found that both THC and CBD have antitumor effects, but that CBD is the most potent inhibitor (Ligresti, et al., 2006).

Cannabis can help those with neurofibromatosis manage pain. Cannabis has demonstrated the ability to significantly lower pain, even showning it can help curtail pain that has proven refractory to other treatments (Boychuck, Goddard, Mauro & Orellana, 2015) (Wallace, et al., 2015) (Lynch & Campbell, 2011). Cannabis use has been found to be prevalent among the chronic pain population, with improvements in pain, sleep and mood being the most frequently reported reasons for use (Ware, et al., 2003). THC and CBD have shown to help in the management of pain. They activate the CB1 and CB2 receptors, which regulate the release of neurotransmitter and central nervous system immune cells to manage pain levels (Woodhams, Sagar, Burston & Chapman, 2015).

States That Have Approved Medical Marijuana for Neurofibromatosis

Currently, only the state of Illinois has approved medical marijuana specifically for the treatment of neurofibromatosis. However, in Washington D.C., any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment. In addition, a number of other states will consider allowing medical marijuana to be used for the treatment of neurofibromatosis with the recommendation from a physician. These states include: California (any debilitating illness where the medical use of marijuana has been recommended by a physician), Connecticut (other medical conditions may be approved by the Department of Consumer Protection), Massachusetts (other conditions as determined in writing by a qualifying patient’s physician), Nevada (other conditions subject to approval), Oregon (other conditions subject to approval), Rhode Island (other conditions subject to approval), and Washington (any “terminal or debilitating condition”).

Several states have approved medical marijuana specifically to treat “chronic pain,” a symptom commonly associated with neurofibromatosis. These states include: Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Maryland, Michigan, Montana, New Mexico, Ohio, Oregon, Pennsylvania, Rhode Island and Vermont. The states of Nevada, New Hampshire, North Dakota, Montana, Ohio and Vermont allow medical marijuana to treat “severe pain.” The states of Arkansas, Minnesota, Ohio, Pennsylvania and Washington have approved cannabis for the treatment of “intractable pain.”

Recent Studies on Cannabis’ Effect on Neurofibromatosis

References

Boychuck, D.G., Goddard, G., Mauro, G., and Orellana, M.F. (2015 Winter). The effectiveness of cannabinoids in the management of chronic nonmalignant neuropathic pain: a systematic review. Journal of Oral & Facial Pain and Headache, 29(1), 7-14.

Foroughi, M., Hendson, G., Sargent, M.A., and Steinbok, P. (2011, April). Spontaneous regression of septum pellucidum/forniceal pilocytic astrocytomas–possible role of Cannabis inhalation. Child’s Nervous System, 27(4), 671-9.

Ligresti, A., Moriello, A.S., Starowicz, K., Matias, I., Pisanti, S., De Petrocellis, L., Laezza, C., Portella, G., Bifulco, M., and Di Marzo, V. (2006, September). Antitumor activity of plant cannabinoids with emphasis on the effect of cannabidiol on human breast carcinoma. Journal of Pharacologogy and Experimental Therapeutics, 318(3), 1375-87.

Lynch, M.E., and Campbell, F. (2011, November). Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials. British Journal of Clinical Pharmacology, 72(5), 735-744.

McAllister, S.D., Soroceanu, L., and Desprez, P.Y. (2015, June). The Antitumor Activity of Plant-Derived Non-Psychoactive Cannabinoids. Journal of Neuroimmune Pharmacology, 10(2), 255-67.

Neurofibromatosis. (2013, January 3). Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/neurofibromatosis/basics/definition/con-20027728.

Neurofibromatosis Fact Sheet. (2015, July 27).National Institute of Neurological Disorders and Stroke. Retrieved from http://www.ninds.nih.gov/disorders/neurofibromatosis/detail_neurofibromatosis.htm.

Wallace, M.S., Marcotte, T.D., Umlauf, A., Gouaux, B., and Atkinson, J.H. (2015, July). Efficacy of Inhaled Cannabis on Painful Diabetic Neuropathy. Journal of Pain, 16(7), 616-27.

Ware, M.A., Doyle, C.R., Woods, R., Lynch, M.E., and Clark, A.J. (2003, March). Cannabis use for chronic non-cancer pain: results of a prospective survey. Pain, 102(1-2).

Woodhams, S.G., Sagar, D.R., Burston, J.J., and Chapman, V. (2015). The role of the endocannabinoid system in pain. Handbook of Experimental Pharmacology, 227, 119-43.

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