Multiple sclerosis (MS) can create a wide number of debilitating symptoms from spasticity (muscle spasms, stiffness, and/or tremor), issues with cognition, mood, bladder and bowel problems, neuropathic pain, and insomnia. [1] The current evidence strongly supports the utilization of cannabis medicines in the treatment of many of the symptoms of MS, but not all.
Spasticity in MS is just one of the few diagnoses that meets the most rigorous standards of evidence-based medicine supporting the medical use of cannabis. Since endocannabinoids have the ability to regulate neurotransmission, cannabis-based medicines mimic endocannabinoids and help to balance and regulate the dysfunctional neurotransmission that underlies spasticity. The current state of evidence has not yet proven that cannabis medicines can slow advanced multiple sclerosis, [2] however, they could reduce the progression of early or less severe MS. [3]
Is CBD oil helpful for MS?
A 2011 paper by researchers from the University of London, examines the biological mechanisms underlying spasticity and how cannabinoids help to provide relief. [4] in 2003 and 2005, two large Cannabinoids in Multiple Sclerosis (CAMS) reports showed evidence of great improvements in the areas of spasticity, sleep, and pain, but the results were only noted on a subjective scale by the participants. [4] [5] The first was a placebo-controlled RCT of 630 patients comparing 2.5 mg of THC (dronabinol), cannabis extract containing 2.5 mg THC and 1 mg CBD, or placebo were dosed up to tolerance over five weeks, then continued over 15 weeks. The patients’ feedback revealed significant differences for either active treatment for spasticity, sleep, pain, and spasms. A one-year follow-up study included 80 percent of the initially enrolled patients. Patients reported statistically significant improvements in their symptoms of shaking, spasms, pain, sleep, tiredness, and energy in the active treatments. Interestingly, there was no difference between the THC alone, and the THC:CBD combination outcomes. A one-year follow-up to the CAMS study showed a tiny treatment effect on the Ashworth Scale and study participants revealed that they felt the cannabinoids were of value in treating their disease. [5]
A 2012 placebo-controlled study of 30 MS patients at the University of California Center for Medicinal Cannabis Research (CMCR) examined the effectiveness of smoked cannabis on MS spasticity and pain. [6] Study subjects were measured for pain, spasticity, ability to walk, and were given cognitive tests. The results revealed a large reduction in spasticity when cannabis was administered, as compared with the placebo. Pain was also significantly reduced by an average of 50 percent in the cannabis-treated group. Although, this study did not include enough cannabis-naive patients. If it had, the results may have proved even more significant.
The actions of endocannabinoids and administered cannabinoids on multiple pathways at a cellular level in the brain make a convincing argument that cannabinoids are neuroprotective. [7] cannabinoids reduce the inflammation that occurs when overstimulated macrophages and microglial cells (the brain’s own inflammatory cells) cause demyelination and cell death. Cannabinoids act as vasodilators resulting in increased blood flow to the injured cerebral areas. They also promote neuroprotection to potentially encourage healing in the injured areas. Cannabinoids are powerful antioxidants, which could reduce the oxidative damage that leads to the death of neurons. [8] [9]
Although both CBD and tetrahydrocannabinol have each shown neuroprotection in animal studies, it is still unclear whether combining CBD and THC leads to greater neuroprotection than THC alone, and there is even some concern that CBD could reduce the neuroprotective effect of THC. [10] 11] Though recent evidence has clearly demonstrated CBD’s neuroprotective effects alone. [12]
A 2012 study on the possibility of gaining neuroprotection with tetrahydrocannabinol was investigated via a double-blind randomized controlled trial of 498 people randomized 2:1 to THC (dronabinol) or placebo. [13] THC was able to stabilize disability in patients who were in the early stages of the disease, with a 50 percent reduced risk in progression. The dosing protocols began at 3.5 mg THC twice daily and titrated up to a tolerance or maximum of 28 mg. Average final doses were 14 to 21 mg daily and were well tolerated despite adverse effects often seen in this dose range.
However, a 2015 study warns of the possible impacts of smoking cannabis on brain volume in MS patients and corresponding deficits in cognition. [14]:
“To our knowledge, this is the first study in MS patients demonstrating a link between structural brain changes and cognitive deficits due to smoking cannabis... decreased regional brain volume was associated with poorer performance on all neuropsychological tests in MS patients who smoked cannabis, whereas only speeded tasks correlated with brain volumes in non cannabis patients… given there were no group differences in terms of overall brain volume or subcortical structures, non cannabis MS patients may be able to utilize other strategies to compensate to a degree for their memory, but not their processing speed deficits. Conversely, cannabis-smoking MS patients, who show significantly lower processing speed and visual memory scores, appear no longer able to compensate for either, and thus lower regional brain volumes in these patients was associated with poorer scores on all cognitive tests.”
Increased (and decreased) levels of endocannabinoids have been discovered in MS patients, but these changes do not correlate with clinical severity. [8]
Is CBD oil a miracle for multiple sclerosis?
Axons and neurons carry signals in the brain and spinal cord, so damage to them disrupts central nervous system signaling throughout the body. The ability of cannabinoids found inside the hemp cannabis plant to reduce inflammation and act as antioxidants within cellular structures of the brain has led to attempts to prove their value as neuroprotective agents in MS.
The information contained in this article is for informational purposes only and does not constitute medical advice. Prior to making changes to your lifestyle or treatment plan always consult with your doctor. Medical professionals approved and experienced using cannabidiol (CBD) and other legal cannabis products to treat chronic pain conditions and other related multiple sclerosis symptoms is ideal. Drug interactions must be considered along with any potential health benefits.
Dosage Protocols for MS
Partial relief of muscle pain and cramps, nerve pain, anxiety, dysphoria, and insomnia are reasonable expectations from using tetrahydrocannabinol, whether inhaled, oral mucosal, or edible preparations are used. Trials with multiple preparations and dosing are needed to achieve optimal results. MS patients should not be discouraged if the initial regimens are ineffective or hard to tolerate. For the management of spasticity and pain take 2 to 6 mg each of THC and CBD every three to four hours, sublingually or inhaled using a vaporization device.
An 18:1 CBD to THC tincture is recommended for anxiety, in 5 mg doses, as needed until 5 pm. Take 5 to 7 mg of THC orally for insomnia. If disease modification is an important goal, the most pragmatic regimen would be that employed in the CUPID study [2] [3]: which is 3.5 mg of THC twice daily orally, with doses increasing by 3.5 mg weekly to a maximum of 28 mg, in twice daily dosing or until side effects become intolerable.
Consumption Methods
Orally administered cannabinoids tend to reduce multiple sclerosis pain less effectively than smoked or sublingual cannabis medicines. [15] [16] There is strong evidence that cannabis medicines that contain both THC and CBD, when taken orally, reduce patient-reported spasticity and spasms. [17]
Previous studies on spasticity with orally administered cannabinoid medicines, like the CAMS study above, produced mixed results, where significant reductions in spasticity were noted only on subjective scales. [18] [19] In 2016, a study using the oral spray nabiximols (Sativex), now including more than 1,600 patients, added to the data showing efficacy for oral-mucosal administration of cannabinoids to relieve pain and spasms. [20] The oral spray Sativex (derived from cannabis) is now approved in over 30 countries worldwide for the treatment of multiple sclerosis.
For insomnia and potential disease modification, oral administration is best. Tetrahydrocannabinol taken orally is ideal for sleep: 5 mg THC, swallowed one hour before bed or when bed rest is needed. Swallowing THC increases its soporific and analgesic effects and extends the period of time it is active for The terpene beta-caryophyllene has significant neuroprotective, antioxidant, anti-inflammatory, and immune-modulator action, all aspects that could be extremely helpful in treating neurodegenerative diseases like MS. It can be swallowed, if found in enteric-coated form (to enable it to survive stomach passage intact); 25 to 30 mg is thought to be an effective dose. Otherwise, like all other terpenes, it must be absorbed under the tongue, sublingually.
Inhaled forms are felt nearly immediately; 2.5 to 7.5 mg of vaporized or inhaled tetrahydrocannabinol is recommended for faster onset than with oral administration. As always, use the lowest effective dose to avoid the development of a tolerance whenever possible. Cannabis-naive patients should start with no more than 2.5 mg of THC and wait 10 to 15 minutes before adding more. Cannabis dosage has a “sweet spot” for pain relief, so caution must be observed to avoid overmedication to avoid exceeding the optimal dose for relief. Inhaled or sublingual medicines tend to reduce MS pain more effectively than swallowed forms. As with all cannabis medicines, start low and slow, and gradually increase the dosage until symptoms subside.
Best Strains for MS
Blending different THC-dominant strains yields the best relief from spasticity and pain, suggesting that a beneficial entourage effect of terpenoids and minor cannabinoids is created. This blending may be extended to include CBD-rich cannabis as well. Blue Dream, Bubba Kush, Cookies, Pincher Creek, Trainwreck, and OG Kush are the most common varieties used for blending. Beta-caryophyllene is also a powerful anti-inflammatory, and is found in Cookies and Kryptonite. ACDC/Cannatonic is an excellent cultivar for its rich CBD content.
For more information read our other articles on MS:
If you found this article of value, please share it.
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3084507/
2. https://pubmed.ncbi.nlm.nih.gov/25676540/
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3744749/
4. https://pubmed.ncbi.nlm.nih.gov/25876933/
5. https://pubmed.ncbi.nlm.nih.gov/16291891/
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394820/
7. https://pubmed.ncbi.nlm.nih.gov/24424194/
8. https://pubmed.ncbi.nlm.nih.gov/26408162/
9. https://bibliography.maps.org/bibliography/default/citation/14580
10. https://link.springer.com/article/10.1007/s11481-014-9575-8
11. https://pubmed.ncbi.nlm.nih.gov/25857324/
12. https://pubmed.ncbi.nlm.nih.gov/26845349/
13. https://pubmed.ncbi.nlm.nih.gov/23856559/
14. https://www.sciencedirect.com/science/article/pii/S221315821500073X
15. https://pubmed.ncbi.nlm.nih.gov/19768368/
16. https://pubmed.ncbi.nlm.nih.gov/16186518/
17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011465/
18. https://pubmed.ncbi.nlm.nih.gov/14615106/
19. https://pubmed.ncbi.nlm.nih.gov/15327042/
20. https://pubmed.ncbi.nlm.nih.gov/26788128/
