The other paradox is the huge disconnect between the generally quite favorable subjective patient self-reports of improvement in spasticity and the largely negative objective results. The explanation may lie in part in the inadequacy of the Ashworth score as an outcome measure. It has come under frequent criticism, since some approved antispasticity medications have shown only modest or no improvement in Ashworth scores. But the limitations of the Ashworth score are probably only part of the story, in Dr. Bowling’s view.
"Patients’ assessments are 24/7; ours is a brief clinical visit at a prespecified time. Also, there is a pain component to spasticity, so for some patients who feel their spasticity is improving with the use of marijuana it may just be the pain aspect of the spasticity, or a euphoric view of the world that’s changing their perception of how severe the spasticity is. But for some patients, maybe it doesn’t matter whether it’s a subjective or objective assessment that’s improving, especially for those who don’t have high physical or cognitive demands during the day," he said.
Dr. Bowling reported having no conflicts of interest. Dr. Ware has received lecture fees from the Canadian Consortium for the Investigation of the Cannabinoids and a research grant and honoraria from Valeant for conducting a randomized trial of nabilone in fibromyalgia patients.