Updated on January 28, 2019.
Medical content reviewed by Dr. Richard Koffler, MD, Board Certified Physiatrist
The spinal cord is a delicate organ, and damage to it through an accident or illness can result in serious long-term complications. More than 12,500 new cases of spinal cord injuries occur each year, resulting in more than 250,000 Americans who are currently living with these injuries. Under specific circumstances, these spinal cord injuries can lead to a condition called quadriplegia, which leaves people unable to move parts of the body below the neck. This condition can lead to severe long-term pain for the patient, as well as muscular spasticity, where affected muscles suddenly move without a stimulus.
Patients suffering from quadriplegia or tetraplegia will find an essential form of comfort and alleviation with medical marijuana, which can help them discover a better sense of well-being and relieve some of the pain and symptoms associated with their condition. Read on to learn more about how medical marijuana for quadriplegia can be beneficial.
What Is Quadriplegia?
Quadriplegia is a condition where the soft bundle of nerves called the spinal cord gets disrupted or severed, resulting in a disconnect between the brain and the limbs. Patients with these types of injuries may experience total or partial loss of sensation and control of their legs, and in some cases their arms as well, depending on the location and severity of the spinal cord injury. Do not confuse this with a broken spine — it is possible to fracture or dislocate vertebrae in the skeletal spine without severing the spinal cord, and vice versa.
Sudden physical injuries to the spinal cord are the most common cause of quadriplegia and are often the result of accidents. The leading causes of spinal cord injuries and quadriplegia are as follows:
- Car accidents — 37 percent
- Falls — 30 percent
- Violence — 28 percent, with gunshot wounds accounting for 14 percent of all spinal cord injuries
- Sports and recreational activities — 9 percent
- Medical and surgical accidents — 4 percent
A sudden injury is not the only circumstance under which a patient can experience quadriplegia, however. Some diseases, including transverse myelitis, polio, muscular dystrophy and multiple sclerosis, often result in quadriplegia. Additionally, untreated spinal cord infections, lesions, and even brain tumors can result in quadriplegia. In some cases, these non-traumatic factors can be treatable and reversible.
Symptoms of Quadriplegia
The primary manifestation of quadriplegia is a loss of motor or sensory function in the limbs. In many cases, quadriplegia primarily affects the legs, though patients may experience motor impairment in the arms and torso as well. In some cases, patients can move their arms, but lose fine motor control in their hands, which affects their level of independence.
Additional symptoms of quadriplegia depend on several factors. Most symptoms will primarily depend on the location of the patient’s spinal cord injury and the extent of their sensory and motor function loss. While patients with low spinal cord injuries may lose sensation in their legs and some bowel control, patients with damage to the spinal cord at the cervical spine may lose all function from the neck down and may experience issues with digestive, respiratory, bladder control and other autonomic functions. However, the specific combination of symptoms for each patient may change based on the overall health of the individual, their age, and additional health factors.
Here are some potential symptoms of quadriplegia beyond a loss of motor control.
- Chronic pain: Chronic pain is a significant problem for people with spinal cord injuries — four out of five people with spinal cord injuries report significant chronic pain, and a third of these people say the pain interferes with their quality of life. For many spinal cord injury patients with quadriplegia, disuse of limbs and changes in sensory perception can cause them to experience moderate to severe chronic pain. For example, quadriplegia patients who have retained or regained some sensation in their limbs may experience pain due to muscle atrophy.
- Numbness: Loss of sensation is a common symptom associated with quadriplegia, but can manifest in multiple ways. In some cases, the loss of sensation is complete and permanent, but in others, their sense of feeling becomes reduced to a point where they experience some sensations, but not others. For example, many patients experience a “pins-and-needles” sensation or even a mild burning in their extremities.
- Muscle spasticity: In many cases, patients experience sudden, uncontrolled movements in the areas most affected by their paralysis. These movements are often a nuisance, but in some cases, can cause injuries to the patient.
- Bladder difficulties: The spinal cord plays an essential role in controlling the bladder wall and the sphincter muscle, which determine when urine and fecal matter exit the body. With spinal cord injuries, control of these muscles is much more difficult, resulting in bladder control problems, such as fecal or urinary incontinence, difficulty eliminating without assistance and even infections in the urinary tract.
- Respiratory difficulties: Respiratory issues can pose a problem, especially for patients with quadriplegia that affects the torso. In fact, in the months immediately following an injury, infections in the respiratory system are the leading cause of death in spinal cord injury survivors. Over the long term, some patients with quadriplegia at the cervical spine may require permanent assistance from a ventilator.
- Problems with fertility and sexual function: Men and women may discover problems in sexual function following a spinal cord injury. Men may struggle to get erections, while women may find they cannot easily self-lubricate. Both men and women may lose sexual function entirely depending on the location of their injury, but most discover changes in libido, difficulties with orgasms and decreases in fertility.
- Secondary infections and issues: Reduction of movement in quadriplegia patients often results in secondary infections, primarily due to bedsores. Blood clots are also a common issue due to lack of movement.
- Psychological issues: Depression and anxiety are common psychological problems among patients with quadriplegia, regardless of the extent of their injury. These conditions can lead to feelings of despair and can contribute to other conditions and problems like weight gain and insomnia.
- Bodily awareness: Depending on the extent of their condition, patients with quadriplegia may experience difficulty with bodily awareness, and may find it difficult to know where their arms or legs are without looking.
- Weight gain: Since many patients with quadriplegia may be unable to exercise, they may experience moderate to severe weight gain, which is often exacerbated by overeating due to depression. In most cases, patients with weight gain can moderate it with a combination of psychological therapy, physical therapy and a reduction in calorie intake.
Not all these conditions are permanent, however. Spinal cord injuries are unpredictable, since they involve numerous structures, and doctors still don’t completely understand the complex nature of the brain and spinal cord. Some patients regain certain functions after their swelling has gone down, and others find they start recovering after an even longer period. Sometimes, surgery and treatment can be of help as well, mainly if a surgeon removes something that is compressing the spinal cord or impeding brain function.
How Do Doctors Treat Quadriplegia?
Medical professionals treat quadriplegia on a case-by-case basis, often targeting the source and location of the spinal cord injury. No single drug, procedure or therapy can guarantee a return to full function, though some quadriplegics do attain this with treatment. Primarily, treatment focuses on improving a patient’s outcomes in the long term, reducing life-threatening conditions and helping the patient adapt to their new situation. Currently, the most common treatment options include the following.
- Surgery: Brain and spinal cord surgeries can often reduce bleeding, manage swelling and address any physical obstructions to the spinal cord and brain function.
- Medication: Drugs like blood thinners and blood pressure medications can help manage secondary problems, while other medications help reduce the risk of infection that is common in quadriplegia patients.
- Education: Education is helpful for patients in the long term, helping them know their rights under the Americans with Disabilities Act and other laws, and even helping them gain occupational skills training. Education may also be beneficial for the families of patients, helping them understand how best to help the patient.
- Therapy: Specific types of therapy will depend on the extent and effects of the patient’s injury. Some patients may require speech and language therapy to retain or regain their ability to speak, while most require physical or exercise therapy to regain function and maintain health. Many also need psychotherapy to deal with the psychological effects of quadriplegia.
- Support: Support groups are essential for patients with quadriplegia and their families, helping them learn from the experiences of others who have gone through similar circumstances, while also giving them an opportunity to build a community.
On top of these treatments, health researchers are currently looking into the benefits of cannabis as a potential new medication for many patients living with quadriplegia.
Why Use Medical Cannabis for Quadriplegia?
Medical marijuana offers numerous benefits to patients with quadriplegia, from pain management to nerve healing. Much of this has to do with the two primary compounds in cannabis: tetrahydrocannabinol (THC) and cannabidiol (CBD). Doctors increasingly recognize CBD as a powerful painkilling agent, while THC is helpful for pain management, as well as muscular relaxation. For patients with spinal cord injuries, specifically, medical cannabis has shown promise in helping with numerous outcomes, including the following.
- Muscle spasticity: Muscle spasms can negatively impact the speech and movement of a patient with quadriplegia, and 65 to 78 percent of spinal cord injury patients have experienced muscle spasticity of some sort. For quadriplegic patients, reducing these spasms is desirable, and studies have shown cannabinoids can have this effect. One study from the University of Manitoba in Canada studied the results of the synthetic cannabinoid Nabilone on 12 spinal cord injury patients and found 11 of them showed significant decreases in muscle spasticity. Another study out of the Switzerland Centre for Spinal Cord Injuries examined THC and its effects on muscle spasticity and found the 25 participants experienced reduced spasticity after ingesting THC.
- Pain management: Spinal cord injuries can often lead to lifelong chronic pain, and while many doctors prescribe opioids for pain management, these drugs can lead to addiction and other problematic side effects. Unlike opiates, cannabis offers pain relief without side effects. One study from the Journal of Pain studied the pain-relieving effects of vaporized cannabis for spinal cord injury patients and found cannabis treatment significantly improved pain relief for patients.
- Neuroprotection: On top of treating the symptoms of spinal cord injuries, marijuana for quadriplegia shows promise as a way of preventing further damage after the trauma has taken place. One study showed cannabis could have a role as a neuroprotectant. In the study, researchers found the activation of the CB1 and CB2 receptors in rats as a result of cannabis ingestion triggered a neuroprotective response that helped the rats recover from incomplete lesions. While researchers have yet to replicate this study with humans, the implications are promising for spinal cord injury patients hoping to heal some nerve damage.
These initial studies and results have led many doctors in marijuana-friendly states to pursue medical marijuana for quadriplegia patients and push for continued research. Even if the development of marijuana-based medications for spinal cord injury patients remains stalled in most locations across the United States, these results show promise that cannabis can be an effective means of long-term treatment and management of quadriplegia symptoms for spinal cord injury patients.
Best Practices for Marijuana for Quadriplegia
Physicians prescribing marijuana for quadriplegia have suggested several best practices for patients. One doctor who advocates prescribing marijuana for spinal cord injury patients recommended the following best practices.
- Use medical strains: While recreational marijuana has high levels of THC compound to elicit a psychoactive effect, medical strains have higher amounts of cannabidiol and cannabinol, which are more helpful for pain management and spasticity reduction. Not only will these strains elicit better results, but they will get the patient less high, allowing them to go about their lives normally. For specific suggestions, talk to a marijuana-friendly physician.
- Consider the dosage: With marijuana, it is particularly important to start low and gradually increase dosage as needed to achieve the desired benefit. In the previously mentioned study from the Journal of Pain, researchers found a low dosage of THC, at 2.9 percent, offered the majority of patients the best ratio of pain relief to side effects. However, it is important to realize dosage will vary from patient to patient.
- Use a vaporizer: Smoking marijuana plant material directly can have similar side effects as smoking tobacco, introducing tar and plant matter to the respiratory system. Instead, doctors tend to recommend a vaporizer, so the patient inhales a mist instead of smoke. Patients who prefer not to inhale their medication may also choose to ingest a tincture, though this method tends to take longer to have a significant effect.
In all cases, you should speak with a physician before introducing marijuana into your treatment regimen.
Find Treatment Near You
Interested in learning more about cannabis and quadriplegia as a treatment option for a spinal cord injury? MarijuanaDoctors.com can help you find a physician and a dispensary near you, so you can find the relief and support you need. Use our search engine to find a doctor near you, or find your nearest trusted dispensary.
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