This is a repository copy of Treatments for spasticity and pain in multiple sclerosis: a systematic review . White Rose Research Online URL for this paper: http://eprints.whiterose.ac.uk/1776/ Monograph: Beard, S.M., Hunn, A. and Wight, J. (2003) Treatments for spasticity and pain in multiple sclerosis: a systematic review. Technical Report. Gray Publishing , Tunbridge Wells. ISSN 1366-5278 Reuse Unless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version - refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher’s website. Takedown If you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing [email protected] including the URL of the record and the reason for the withdrawal request. [email protected] https://eprints.whiterose.ac.uk/ Health Technology Assessment 2003; Vol. 7: No. 40 Treatments for spasticity and pain in multiple sclerosis: a systematic review S Beard A Hunn J Wight Health Technology Assessment NHS R&D HTA Programme HTA HTA How to obtain copies of this and other HTA Programme reports. An electronic version of this publication, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (http://www.ncchta.org). A fully searchable CD-ROM is also available (see below). Printed copies of HTA monographs cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our Despatch Agents, York Publishing Services. Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph. You can order HTA monographs from our Despatch Agents, York Publishing Services by: – fax (with credit card or official purchase order) – post (with credit card or official purchase order or cheque) – phone during office hours (credit card only). Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. Contact details are as follows: York Publishing Services Email: [email protected] PO Box 642 Tel: 0870 1616662 YORK YO31 7WX Fax: 0870 1616663 UK Fax from outside the UK: +44 1904 430868 NHS and public libraries can subscribe at a very reduced cost of £100 for each volume (normally comprising 30–40 titles). The commercial subscription rate is £300 per volume. Please contact York Publishing Services at the address above. Subscriptions can only be purchased for the current or forthcoming volume. Payment methods Paying by cheque If you pay by cheque, the cheque must be in pounds sterling, made payable to York Publishing Distribution and drawn on a bank with a UK address. Paying by credit card The following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase order You can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD? Please use the form on the HTA website (www.ncchta.org/htacd.htm). Or contact York Publishing Services (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide. The website also provides information about the HTA Programme and lists the membership of the various committees. Treatments for spasticity and pain in multiple sclerosis: a systematic review S Beard A Hunn J Wight School of Health and Related Research (ScHARR), University of Sheffield, UK Declared competing interests of authors: none Published December 2003 This report should be referenced as follows: Beard S, Hunn A, Wight J. Treatments for spasticity and pain in multiple sclerosis: a systematic review. Health Technol Assess 2003;7(40). Health Technology Assessment is indexed in Index Medicus/MEDLINE and Excerpta Medica/ EMBASE. NHS R&D HTA Programme he NHS R&D Health Technology Assessment (HTA) Programme was set up in 1993 to ensure Tthat high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS. The research reported in this monograph was commissioned by the HTA Programme and funded as project number 99/05/03. Technology assessment reports are completed in a limited time to inform decisions in key areas by bringing together evidence on the use of the technology concerned. The views expressed in this publication are those of the authors and not necessarily those of the HTA Programme or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for any recommendations made by the authors. Criteria for inclusion in the HTA monograph series Reports are published in the HTA monograph series if (1) they have resulted from work commissioned for the HTA Programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors. Reviews in Health Technology Assessment are termed ‘systematic’ when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA Programme Director: Professor Kent Woods Series Editors: Professor Andrew Stevens, Dr Ken Stein, Professor John Gabbay, Dr Ruairidh Milne, Dr Chris Hyde and Dr Rob Riemsma Managing Editors: Sally Bailey and Sarah Llewellyn Lloyd The editors and publisher have tried to ensure the accuracy of this report but do not accept liability for damages or losses arising from material published in this report. ISSN 1366-5278 © Queen’s Printer and Controller of HMSO 2003 This monograph may be freely reproduced for the purposes of private research and study and may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to HMSO,The Copyright Unit, St Clements House, 2–16 Colegate, Norwich, NR3 1BQ. Published by Gray Publishing, Tunbridge Wells, Kent, on behalf of NCCHTA. Printed on acid-free paper in the UK by St Edmundsbury Press Ltd, Bury St Edmunds, Suffolk. O2 Health Technology Assessment 2003; Vol. 7: No. 40 Abstract Treatments for spasticity and pain in multiple sclerosis: a systematic review S Beard, A Hunn and J Wight School of Health and Related Research (ScHARR), University of Sheffield, UK Objectives: To identify the drug treatments currently designed specifically to evaluate the alleviation of pain available for the management of spasticity and pain in in patients with MS and there was no consistency multiple sclerosis (MS), and to evaluate their clinical and regarding the use of validated outcome measures. It cost-effectiveness. was suggested that, although expensive, the use of Data sources: Electronic bibliographic databases, intrathecal baclofen may be associated with significant National Research Register, MRC Clinical Trials Register savings in hospitalisation costs in relation to bed-bound and the US National Institutes of Health Clinical Trials patients who are at risk of developing pressure sores, Register. thus enhancing its cost-effectiveness. No studies of Review methods: Systematic searches identified 15 cost-effectiveness were identified in the review interventions for the treatment of spasticity and 15 of pain. There is evidence, albeit limited, of the interventions for treatment of pain. The quality and clinical effectiveness of baclofen, dantrolene, outcomes of the studies were evaluated. Reviews of diazepam, tizanidine, intrathecal baclofen and BT the treatment of spasticity and pain when due to other and of the potential cost-effectiveness of intrathecal aetiologies were also sought. baclofen in the treatment of spasticity Results: There is limited evidence of the effectiveness in MS. of four oral drugs for spasticity: baclofen, dantrolene, Conclusions: Many of the interventions identified are diazepam and tizanidine. Tizanidine appears to be no not licensed for the alleviation of pain or spasticity in more effective than comparator drugs such as baclofen MS and the lack of evidence relating to their and has a slightly different side-effects profile. Despite effectiveness may also limit their widespread use. claims that it causes less muscle weakness, there was Indeed, forthcoming information relating to the use of very little evidence that tizanidine performed any cannabinoids in MS may result in there being better better in this respect than other drugs, although it is evidence of the effectiveness of new treatments than of more expensive. The findings of this review are any of the currently used drugs. It may therefore be of consistent with reviews of the same treatments for value to carry out double-blind randomised controlled spasticity derived from other aetiologies. There is good trials of interventions used in current practice, where evidence that both botulinum toxin (BT) and intrathecal outcomes could include functional benefit and impact baclofen are effective in reducing spasticity, and both on quality of life. Further research into the are associated with functional benefit.