Autonomic Dysfunction – Medical Marijuana Research Overview

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Autonomic dysfunction refers to a collection of diseases that develop when nerves that control involuntary bodily functions are damaged. Studies suggest that cannabis’ neuroprotective and antioxidant effects, as well as its ability to interact with the body’s endocannabinoid system, could be beneficial for treating and preventing the progress of autonomic dysfunction.

Overview of Autonomic Dysfunction

Autonomic dysfunction, also commonly called autonomic neuropathy or dysautonomia, describe many conditions caused by damage to the autonomic nervous system (ANS). The ANS is the division of the peripheral nervous system that is responsible for controlling body functions that we don’t have to consciously think about, such as breathing, heart rate, blood pressure control, temperature regulation, and digestion.

The most common type of autonomic dysfunction is neurocardiogenic syncope (NCS), which is when the nerves controlling heart rate or vascular tone are damaged, causing a lack of blood pressure and repeated fainting. Another type, postural orthostatic tachycardia syndrome (POTS), is when the ANS is unable to properly control blood pressure or heart rate when a person stands up, causing them to feel dizzy and lightheaded, and possibly faint. Multiple system atrophy (MSA), a fatal form of autonomic dysfunction, impairs your body’s ability to manage blood pressure, heart rate, bladder function and digestion. Other types of autonomic dysfunction include hereditary sensory and autonomic neuropathies (HSAN), a group of genetic disorders that often begin in infancy, and Holmes-Adie syndrome, which mostly affects the nerves controlling the muscles of the eye.

If the nerves of the ANS become damaged, autonomic dysfunction can develop and cause an array of problems that can range from mild to life threatening. Some common symptoms of autonomic neuropathy include urinary dysfunction, sexual dysfunction, lightheadedness, weakness, impaired sweating, diarrhea or constipation, and numbness or tingling.

Autonomic dysfunction is often caused by an underlying disease or condition. Diabetes and Parkinson’s disease are two chronic conditions that can lead to autonomic neuropathy. Riley-Day syndrome, progressive autonomic failure, Shy-Drager syndrome, human immunodeficiency virus (HIV), Lyme disease, toxicity, medications, and physical trauma are some other conditions or events that can cause autonomic dysfunction.

The conditions that damage the ANS can sometimes be temporary and reversible, while others may be chronic and continue to worsen over time. Focus of treating autonomic dysfunction is on addressing that underlying cause. In some cases, by treating the underlying cause, the damaged ANS nerves may be able to repair and regenerate. A doctor may also help treat the dysfunction by addressing the symptoms. Exercises, medications and dietary recommendations are used to increase blood volume, help manage heart rate, and improve blood pressure.

Findings: Effects of Cannabis on Autonomic Dysfunction

Studies indicate that cannabis could be beneficial for preventing and treating autonomic dysfunction. Cannabis has shown to have antioxidant and neuroprotective properties, indicating it supports the health of the nervous system and could limit or prevent nerve damage6,11. Two major cannabinoids found in cannabis, cannabidiol (CBD) and tetrahydrocannabinol (THC), have demonstrated efficacy at limiting neuron damage and encouraging neuroregeneration7,10,12.

Cannabinoids like CBD and THC have also shown to potentially be effective for autonomic neuropathy through their interaction with the endocannabinoid system, a complex system responsible for regulating several body processes to maintain health and prevent disease8,13. Modulating the endocannabinoid system has shown to be therapeutically beneficial by slowing the progression of neural disorders14.

Mayo Clinic psychiatrist Dr. J. Michael Bostwick published a lengthy report in 2012 that details the endocannabinoid system’s impact on several of the body’s systems, including the autonomic nervous system. In the report, Dr. Bostwick explains that endocannabinoid system “functions in parallel and in conjunction with adrenergic, cholinergic, and dopaminergic systems in both the central and autonomic nervous systems,” and influences various autonomic processes like blood pressure5.

Studies also show that cannabis causes blood vessels to vasodilate, improving blood flow and reducing blood pressure9,15,16. The vasodilator effect has been shown to help normalize blood pressure, indicating that cannabis may reduce the risk of a person with ANS from fainting due to a lack of blood flow to the brain4.

States That Have Approved Medical Marijuana for Autonomic Dysfunction

So far, no states have approved medical marijuana for the treatment of autonomic dysfunction. However, Arkansas, Montana, New Mexico, New York and Pennsylvania have approved medical marijuana for the treatment of neuropathy.

However, in Washington D.C., any condition recommended by DC-licensed physician can be approved for medical marijuana. California allows medical marijuana for “any debilitating illness where the medical use of marijuana has been deemed appropriate and has been recommended by a physician.’” In Nevada, other conditions are subject to approval, and in Connecticut, the Department of Consumer Protection may approve other medical conditions. Patients in Massachusetts may be able to get legal access, as the state approves “other conditions as determined in writing by a qualifying patient’s physician.” In Oregon and Rhode Island, “other conditions are subject to approval.”

Recent Studies on Cannabis’ Effect on Autonomic Dysfunction
    • Cannabidiol (CBD) exerts neuroprotective, anti-oxidative and anti-apoptotic effects.
      Neuroprotective effect of cannabidiol, a non-psychoactive component from Cannabis sativa, on beta-amyloid-induced toxicity in PC12 cells.
      (https://www.ncbi.nlm.nih.gov/pubmed/15030397)
    • Modulating endocannabinoid system with cannabinoids reduces neuronal degeneration and is a promising pharmacological target for neurodegenerative diseases.
      Cannabinoid receptor 2 signaling in neurodegenerative disorders: From pathogenesis to a promising therapeutic target.
      (https://www.ncbi.nlm.nih.gov/pubmed/28210207)

References:

    1. Autonomic Dysfunction. (2016, May 13). Healthline. Retrieved from http://www.healthline.com/health/autonomic-dysfunction – Overview1.
    2. Autonomic Nervous System Disorders. (2016, February 2). Medline Plus. Retrieved from https://medlineplus.gov/autonomicnervoussystemdisorders.html.
    3. Autonomic Neuropathy or Autonomic Dysfunction (Syncope): Information and Instructions. (2016, November 30). Cleveland Clinic. Retrieved from http://my.clevelandclinic.org/health/articles/autonomic-neuropathy-autonomic-dysfunction-syncope-information-instructions.
    4. Bátkai, S., Pacher, P., Osei-Hyiaman, D., Radaeva, S., Liu, J., Harvey-White, J., Offertaler, L., Mackie, K., Rudd, M.A., Bukoski, R.D., and Kunos, G. (2004). Endocannabinoids Acting at Cannabinoid-1 Receptors Regulate Cardiovascular Function in Hypertension. Circulation, 110(14), 1996–2002.
    5. Bostwick, J.M. (2012, February). Blurred Boundaries: The Therapeutics and Politics of Medical Marijuana. Mayo Clinic Proceedings, 87(2), 172-186. Retrieved from http://www.mayoclinicproceedings.org/article/S0025-6196%2811%2900021-8/fulltext.
    6. Cassano, T., Calcagnini, S., Pace, L., De Marco, F., Romano, A., & Gaetani, S. (2017). Cannabinoid Receptor 2 Signaling in Neurodegenerative Disorders: From Pathogenesis to a Promising Therapeutic Target. Frontiers in Neuroscience, 11, 30.
    7. Croxford, J.L., Pryce, G., Jackson, S.J., Ledent, C., Giovannoni, G., Pertwee, R.G., Yamamura, T., and Baker, D. (2008, January). Cannabinoid-mediated neuroprotection, not immunosuppression, may be more relevant to multiple sclerosis. Journal of Neuroimmunology, 193(1-2), 120-9.
    8. Di Marzo, V., Bifulco, M., and De Petrocellis, L. (2004, September). The endocannabinoid system and its therapeutic exploitation. Nature Reviews, 3(9), 771-84.
    9. Herradon, E., Martin, M.I., and Lopez-Miranda, V. (2007, November). Characterization of the vasorelaxant mechanisms of the endocannabinoid anandamide in rat aorta. British Journal of Pharmacology, 152(5), 699-708.
    10. Kubajewska, I., and Constantinescu, C.S. (2010, August). Cannabinoids and experimental models of multiple sclerosis. Immunobiology, 215(8), 647-57.
    11. Iuvone, T., Esposito, G., Esposito, R., Santamaria, R., Di Rosa, M., and Izzo, A.A. (2004, April). Neuroprotective effect of cannabidiol, a non-psychoactive component from Cannabis sativa, on beta-amyloid-induced toxicity in PC12 cells. Journal of Neurochemistry, 89(1), 134-41.
    12. Lafuente, H., Alvarez, F.J., Pazos, M.R., Alvarez, A., Rey-Santano, M.C., Mielgo, V., Murgia-Esteve, X., Hilario, E., and Martinez-Orgado, J. (2011, September). Cannabidiol reduces brain damage and improves functional recovery after acute hypoxia-ischemia in newborn pigs. Pediatric Research, 70(3), 272-7.
    13. Pacher, P., Batkai, S., and Kunos, G. (2006, September). The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacological Reviews, 58(3), 389-462.
    14. Pertwee, R.G. (2006, January). Cannabinoid pharmacology: the first 66 years. British Journal of Pharmacology, 147(Suppl 1), S163-S171.
    15. Stanley, C.P., and O’Sullivan, S.E. (2014, March). Cyclooxygenase metabolism mediates vasorelaxation to 2-arachidonoylglycerol (2-AG) in human mesenteric arteries. Pharmacological Research, 81, 74-82.
    16. Stanley, C.P., and O’Sullivan S.E. (2014, March). Vascular targets for cannabinoids: animal and human studies. British Journal of Pharmacology, 171(6), 1361-78.
    17. Szabo, B., Nordheim, U., and Niederhoffer, N. (2001, May). Effects of cannabinoids on sympathetic and parasympathetic neuroeffector transmission in the rabbit heart. The Journal of Pharmacology and Experimental Therapeutics, 297(2), 819-826.

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