- Spasticity is one of the typical symptoms of multiple sclerosis (MS)(1). This condition also causes tightness or stiffness of the muscles, often affecting the legs (calf or thigh), groin, and buttocks.
- Cannabinoids may alleviate symptoms such as spasticity and chronic pain(2).
- The autoimmune encephalomyelitis model of multiple sclerosis assessed CBD’s anti-inflammatory capabilities(3). The findings of this research support the notion that CBD may aid in managing EAE (experimental allergic encephalitis) by generating immunosuppressive elements.
- In another clinical investigation, THC and CBD decreased neurophysiological symptoms in secondary progressive MS patients(4).
- Results show that combining delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in an oral spray alleviates neurophysiological symptoms in individuals with secondary progressive MS(5).
How Does CBD Work for MS?
Multiple sclerosis (MS) is an incurable autoimmune illness(6). Some nations have allowed the use of medical marijuana cannabinoids for MS. However, the mechanism of action to reduce neuroinflammation is unclear.
In MS, spasticity is a common symptom(8). Spasticity is a muscular tightness or stiffness commonly affecting the legs (calf or thigh), groin, and buttocks.
Cannabinoids help reduce symptoms such as spasticity and chronic pain(9).
Meanwhile, multiple sclerosis is a chronic and complex disease that affects the central nervous system(10). MS is characterized by lesions caused by an immunological response that involves the infliction of the myelin sheath and oligodendrocytes.
Oligodendrocytes care for nerve cells by creating myelin, which is the insulating, protective covering surrounding nerve fibers(11).
Myelin is an insulating layer or sheath that develops around neurons, including brain and spinal cord nerves(12). This myelin sheath enables the rapid and efficient transmission of electrical impulses and nerve cells. If myelin is weakened, these impulses are delayed, resulting in disorders like multiple sclerosis.
Clinical data supports that CBD has a range of positive pharmacological effects, such as antioxidative, anti-inflammatory, antiemetic, antipsychotic, and neuroprotective properties(13).
Only preclinical research has shown that these cannabinoid compounds and the endocannabinoids may also exert neuroprotective effects and slow disease progression(14).
Endocannabinoid System and How It Works
In recent years, researchers have emphasized the function of G protein-coupled receptors (GPCRs), notably cannabinoid receptors, in developing MS-specific therapies(15).
Clinical studies have shown that cannabinoids may have the ability to alleviate pain, tremors, and spasticity(16). Cannabinoids also seem to inhibit immunological responses in the CNS that are amplified due to a weakened blood-brain barrier.
Both modulators of the endocannabinoid system (ECS) and cannabinoid ligands actively increase oligodendrocyte survival by influencing nerve cell signaling, migration, and myelination(17).
In recent years, researchers have emphasized the function of G protein-coupled receptors (GPCRs), notably cannabinoid receptors, in the development of MS-specific therapies(18). Also, various CB1 and CB2 receptor agonists have anti-inflammatory effects and therapeutic promise for MS.
Research on CBD and Multiple Sclerosis
Recent societal acceptance of CBD may lead to more people with multiple sclerosis (PwMS) utilizing cannabis to alleviate symptoms of the condition(19). Anecdotal findings show that more PwMS use cannabis to enhance mobility.
Despite the prevalence and interest in cannabis among PwMS, there is a lack of scientific research about its effect on physical mobility(20). The advantages of cannabis usage in MS patients are currently being studied.
Meanwhile, other researchers used autoimmune encephalomyelitis, a murine model of MS, to test CBD‘s anti-inflammatory properties(21).
The effects of CBD on the development of EAE (experimental allergic encephalitis) disease paradigms were demonstrated by a reduction in the clinical scores of paralysis and a decrease in the infiltration of T cells in the central nervous system(22).
In another clinical study, THC and CBD reduced neurophysiological symptoms in secondary progressive MS patients(24).
Oral spray combining delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) helps neurophysiological symptoms in secondary progressive MS patients(25).
The small pilot study of 15 patients noted how the THC-CBD spray affected spasticity and pain scores(26). The spray improved spasticity and pain, which is one of the most disabling and undertreated MS symptoms.
However, THC–CBD also extended patients’ cutaneous silent periods (CSP)(27). CSP is the brief interruption in voluntary contraction that follows solid electrical stimulation of a cutaneous nerve.
What Is CBD?
The cannabis plant includes several biologically active compounds, including cannabinoids(28). Cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) are often the most concentrated chemical components of cannabis extract and predominantly drive therapeutic effects.
Difference Between THC and CBD
The psychoactive substances found in marijuana (cannabis) contain over 500 components(29). Two of these are known to have pharmacological properties that are currently under scientific investigation. These include tetrahydrocannabinol and cannabidiol.
The potency of cannabis is evaluated by the concentration of THC in a sample. Among the cannabis plant‘s components, THC is the primary compound that has a psychoactive effect(30). The adverse effects of regular or acute use of marijuana are often related to the concentrations of THC in the product.
Meanwhile,
CBD Usage and Dosage
There is no exact CBD dosage intended for multiple sclerosis.
CBD oil offered at unregulated dispensaries comes in a sublingual CBD tincture formulation. These products are often distributed in 30ml vials with dropper lids(32). The tincture‘s strength varies between 1,500 and 3,000 milligrams per bottle. If a drop is equivalent to 0.05ml, one bottle contains around 600 CBD oil drops.
Typically, drops are put under the tongue. The patient should wait 30 to 60 seconds for the oil to seep into the mouth lining without swallowing it(33). Additionally, capsules and gummies are also available.
CBD oil may assist patients with early-onset epilepsy who are resistant to traditional treatment(34). CBD 10 mg/kg/day or 20 mg/kg/day, when combined with standard therapy for Lennox-Gastaut syndrome, it resulted in a higher decrease in drop seizures than placebo.
Disclaimer: Patients with MS may need a healthcare expert’s advice before using CBD products.
Effectiveness of CBD Usage in MS
There are no specific CBD products for MS.
Cannabis is used to relieve MS patients‘ chronic pain and spasms(35). The data on medical cannabis oil safety is minimal. Clinical trials examined the safety of sublingual cannabis oils in MS patients.
THC and CBD were given as once-daily evening dosages of 4mg and 7mg, respectively(36). Pain dropped from a median NRS score of 7 to 4, (p = 0.01), spasticity from 6 to 2.5 (p = 0.01), and sleep disruptions from 7 to 3 (p 0.001). No disability, ambulation, dexterity, or processing speed impairments were detected.
Meanwhile, there is an approved oral spray intended for symptoms of MS.
Sativex is a medication derived from cannabis and used for spasticity to address the frequent MS symptom of stiffness and muscle spasms(37). Sativex is nabiximols’ brand name. This drug is the only UK-licensed medicine for treating MS-related muscular symptoms.
Sativex is an orally administered spray. It includes two cannabinoids from the cannabis plant, equal amounts of tetrahydrocannabinol and cannabidiol(38).
On the other hand, many individuals, especially those with multiple sclerosis, are becoming more interested in using CBD and medical marijuana(39).
An online survey conducted in 2017 by the National Multiple Sclerosis Society noted that as many as 66% of MS patients were using cannabis to alleviate their symptoms(40).
A study from Canada about MS patients showed that 50% would consider using cannabis if the legal status were clear and the scientific proof was accessible(41).
Safeness of CBD Usage
In a study, MS patients receiving cannabis products such as medical cannabis oils had less pain, spasticity, and sleep difficulties(42).
This research implies that medical cannabis oils may be used safely to alleviate MS symptoms when conventional medication is ineffective.
Risks and Side Effects
A study indicated that dry mouth, drowsiness, dizziness, and nausea were common with cannabis formulations containing 10 to 25 mg/ml THC(43). Meanwhile, two patients had severe symptoms during titration, excessive dreaming, and sleepiness. Three serious adverse effects (SAEs) were documented but not related to therapy.
Moreover, CBD may be harmful to some individuals(44). Before the FDA authorized Epidiolex (purified CBD), its effectiveness and safety were studied.
Some study participants suffered adverse symptoms (mainly diarrhea or sleepiness) and liver function abnormalities(45). Epidiolex was discontinued due to liver issues since the substance reacted with other medicines these individuals took.
Epidiolex users taking CBD under medical supervision may address these issues. CBD users without a prescription may not know how much CBD to take(46).
A 2017 study of 84 online CBD products indicated that 26% had less CBD than the label suggested, while 43% included substantially more(47).
Legality of CBD
The loosening of legal prohibitions on cannabis and its chemical ingredients led to fast growth and the broad availability of CBD products(48). Pure CBD does not cause THC-like intoxication, but using the compound is still risky.
Researchers explore CBD from scientific, commercial, and regulatory viewpoints. The clinical studies review the data used to support CBD‘s genuine and claimed medicinal benefits and marketing misinformation.
Thus, further study is needed to determine CBD‘s medicinal benefits. CBD products need federal regulation for quality, safety, and effectiveness. Until new laws assure purity and label accuracy, consumers should weigh the advantages of CBD usage against the risks of purchasing unknown-quality CBD goods.
DUI Law and CBD Use
All states in the US have laws prohibiting controlled substances, such as drugs and alcohol(49).
In most states, a drug-related driving offense can be based on the presence of certain substances in one’s system.
In 2018, FDA created an exemption for FDA-approved “finished dosage formulations” of CBD containing less than 0.1% THC(50).
Since CBD is no longer an illegal controlled substance, it should not be considered a threat to anyone’s driving ability. However, it is essential to remember that DUI (driving under the influence) laws could still apply to CBD use.
In some states, it is considered illegal to drive with a blood-test result showing a THC concentration of five nanograms or more(51). Since CBD products can contain traces of THC, investigators may test the samples during a DUI investigation.
Although federal law requires that CBD oil‘s THC concentrations be below 0.3%, studies have shown that several products labeled as such have had higher concentrations. Suppose the CBD product has a higher concentration than expected. In that case, the amount of THC found in the driver’s system might be higher.
What Is Multiple Sclerosis?
Multiple sclerosis (MS) is a medical condition that may damage the brain and spinal cord. The condition may result in many potential symptoms, such as arm or leg mobility, vision, sensation, and balance issues(52).
Multiple sclerosis is a type of disease that attacks the protective sheath (myelin) that is made up of nerve fibers(53).
Myelin sheath is the layer that protects and facilitates the transmission of electrical impulses from the brain to the rest of the body(54).
MS can cause communication problems between the brain and the rest of the body, which eventually cause deterioration of the nerves.
Causes of Multiple Sclerosis
It is unclear what causes the immune system to target the myelin sheath(55). The illness can be triggered by genes inherited from the parents and, in part, by environmental factors.
The following things have been cited as probable causes of multiple sclerosis:
- Genes
Although multiple sclerosis is not an inherited disease, there is a genetic risk that can be passed on(56). The general population has a 1 in 750 to 1,000 chance of getting the condition. In people with MS, the genetic risk is increased. For instance, if one of the twins has the disease, the other has a 1 in 4 chance of developing MS.
Around 200 genes have been identified as contributing factors to the development of multiple sclerosis. There is still a lot of research that needs to be conducted to understand the genetic factors contributing to this condition.
- Viral infections
The link between the Epstein-Barr virus and multiple sclerosis has been studied for several years(57). A study conducted by Harvard Chan School researchers found that the virus can cause the disease.
This study is a big step toward developing a treatment that could prevent MS from developing. According to researchers, the study’s findings suggest that the most effective way to prevent the disease is to stop the virus from spreading.
Although there is currently no effective treatment for people with Epstein-Barr virus infection, a vaccine or targeted therapy could help prevent or cure the disease.
- Childhood Obesity and Female Gender
Over the past decade, various studies have shown that adolescent and early childhood obesity increases the risk of developing multiple sclerosis(58). However, evidence supporting the link between obesity and the development of this condition has been mixed and confirmed in the female gender.
The substantial evidence supporting the link between childhood and obesity and the development of MS supports the idea that the relationship may be causal. However, it also raises concerns about the possible confounding effects of these findings.
- Smoking
Smoking is a common practice among multiple sclerosis patients(59). It has adverse effects on one’s health, but it can also have direct links to the disease.
In addition to damaging the neurons and oligodendroglia, cigarette smoke also contains thousands of compounds that can affect the immune system. Being exposed to smoke at any point in one’s life increases the risk of developing multiple sclerosis than those who are not smoking.
However, there is currently not enough evidence supporting the effects of vapor cigarettes on MS.
- Lack of Sunlight and Vitamin D
Studies have shown that people exposed to sun and vitamin D are less prone to developing multiple sclerosis(60). Some studies also suggest that those with MS may benefit from having vitamin D.
These benefits include improving the quality of life, reducing the severity of their symptoms, and delaying the time it takes to recover from the disease.
Although evidence is still not clear on the effects of vitamin D on multiple sclerosis, it is believed that it can help lower the risk of the disease. However, high vitamin D levels can alter the body’s calcium levels.
Common Symptoms of Multiple Sclerosis
Multiple sclerosis is a type of disease that affects different parts of the body. Each individual with the MS condition is different(61).
Some individuals have a persistent MS that may keep on worsening over time, while others have no symptoms. When the symptoms get worse, these are referred to as relapses(62). Meanwhile, when MS symptoms improve or disappear, they are referred to as remissions or remitting MS.
MS can cause various symptoms such as(63):.
- Muscle spasticity, weakness, and stiffness
- Fatigue
- Bladder problems
- Bowel problems
- Vision issues
- Numbness and tingling
- Mobility problems
- Pain
- Depression and anxiety
- Sexual problems
- Speech and swallowing difficulties
Meanwhile, although MS can lead to severe disability, the condition can also be mild(64). It is possible to treat symptoms of multiple sclerosis. The average life expectancy of people with this condition is shorter than those without it.
It is most common in individuals in their 20s, 30s, and 40s(65). Women are 2 to 3 times more likely to develop MS than men.
Conventional (Non-cannabis) MS Treatment Methods
There are no particular MS diagnostic tests(66). Instead, differential diagnosis is used as a treatment option to rule out other illnesses that may elicit similar signs and symptoms.
The doctor will likely begin with a comprehensive review of an individual’s medical history and physical exam(67).
Various blood tests can help identify other conditions that can trigger the symptoms of MS(68). These tests are being developed to analyze the various biomarkers associated with the disease.
Moreover, magnetic resonance imaging (MRI) is another treatment method(69). MRI is a type of imaging that can reveal the presence of multiple sclerosis lesions on the spinal cord and brain. A contrast material is injected into the area to highlight the lesions during this procedure.
Likewise, a spinal tap is another procedure that involves taking a small sample of the cerebrospinal fluid from the patient’s spinal canal(70). This sample can be used to identify abnormalities in the antibodies produced by the disease.
Meanwhile, MS treatment varies depending on the illness’s stage and the patient’s symptoms(71). It may consist of treating MS symptom relapses with steroids. Another treatment is to reduce the number of relapses via the therapy of particular MS symptoms (disease-modifying therapies).
In addition, vitamin D has been one of the most well-researched MS supplements(72). Low vitamin D levels and an increased risk of MS episodes or exacerbations have been the subject of increasing study for some years.
The current study reveals a possible connection. However, further research is required to establish a definitive correlation(73). The relationship between vitamin D and MS is reinforced by the link between sun exposure and MS risk. Countries located farther from the equator have a greater MS prevalence and risk.
- Cannabidiol Attenuates Experimental Autoimmune Encephalomyelitis Model of Multiple Sclerosis Through Induction of Myeloid-Derived Suppressor Cells
https://www.frontiersin.org/articles/10.3389/fimmu.2018.01782/full - The endocannabinoid system and its therapeutic exploitation in multiple sclerosis: Clues for other neuroinflammatory diseases
https://www.sciencedirect.com/science/article/pii/S0301008217300709 - Cannabidiol Attenuates Experimental Autoimmune Encephalomyelitis Model of Multiple Sclerosis Through Induction of Myeloid-Derived Suppressor Cells
https://www.frontiersin.org/articles/10.3389/fimmu.2018.01782/full - THC, CBD Combo Eases MS Symptoms, Extends Cutaneous Silent Period
https://www.ajmc.com/view/thc-cbd-combo-eases-ms-symptoms-extends-cutaneous-silent-period - Ibid.
- Cannabidiol Attenuates Experimental Autoimmune Encephalomyelitis Model of Multiple Sclerosis Through Induction of Myeloid-Derived Suppressor Cells
https://www.frontiersin.org/articles/10.3389/fimmu.2018.01782/full - Cannabis (Marijuana) and Cannabinoids: What You Need To Know
https://www.nccih.nih.gov/health/cannabis-marijuana-and-cannabinoids-what-you-need-to-know - Spasticity (stiffness)
https://mymsaa.org/ms-information/symptoms/spasticity/#:~:text=Spasticity%20is%20a%20common%20symptom,balance%20in%20an%20upright%20position. - The endocannabinoid system and its therapeutic exploitation in multiple sclerosis: Clues for other neuroinflammatory diseases
https://www.sciencedirect.com/science/article/pii/S0301008217300709 - Cannabinoid and endocannabinoid system: a promising therapeutic intervention for multiple sclerosis
https://pubmed.ncbi.nlm.nih.gov/35182322/ Under the Microscope: Oligodendrocytes
https://www.mssociety.org.uk/research/latest-research/latest-research-news-and-blogs/under-the-microscope-oligodendrocytes- Myelin
https://medlineplus.gov/ency/article/002261.htm#:~:text=Myelin%20is%20an%20insulating%20layer,damaged%2C%20these%20impulses%20slow%20down. - Cannabidiol to Improve Mobility in People with Multiple Sclerosis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5874292/ - The endocannabinoid system and its therapeutic exploitation in multiple sclerosis: Clues for other neuroinflammatory diseases
https://www.sciencedirect.com/science/article/pii/S0301008217300709 - Cannabinoid and endocannabinoid system: a promising therapeutic intervention for multiple sclerosis
https://pubmed.ncbi.nlm.nih.gov/35182322/ - Ibid.
- Ibid.
- Ibid.
- Ibid.
- Ibid.
- Cannabidiol Attenuates Experimental Autoimmune Encephalomyelitis Model of Multiple Sclerosis Through Induction of Myeloid-Derived Suppressor Cells
https://www.frontiersin.org/articles/10.3389/fimmu.2018.01782/full - Ibid.
- Ibid.
- THC, CBD Combo Eases MS Symptoms, Extends Cutaneous Silent Period
https://www.ajmc.com/view/thc-cbd-combo-eases-ms-symptoms-extends-cutaneous-silent-period - Ibid.
- Ibid.
- Ibid.
- Cannabidiol to Improve Mobility in People with Multiple Sclerosis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5874292/ - Cannabis, cannabinoids, and health
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741114/ - Ibid.
- Ibid.
- Pharmacist’s Guide to CBD Oil
https://www.uspharmacist.com/article/pharmacists-guide-to-cbd-oil - Ibid.
- Ibid.
- Safety and efficacy of low-dose medical cannabis oils in multiple sclerosis
https://pubmed.ncbi.nlm.nih.gov/33387864/ - Ibid.
- Sativex (nabiximols)
https://www.mssociety.org.uk/about-ms/treatments-and-therapies/cannabis/sativex - Ibid.
- CBD and Multiple Sclerosis: What You Need to Know
https://multiplesclerosisnewstoday.com/news-posts/2019/09/20/cbd-oil-and-multiple-sclerosis/ - Ibid.
- Cannabidiol to Improve Mobility in People with Multiple Sclerosis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5874292/ - Safety and efficacy of low-dose medical cannabis oils in multiple sclerosis
https://pubmed.ncbi.nlm.nih.gov/33387864/ - Ibid.
- Cannabis (Marijuana) and Cannabinoids: What You Need To Know
https://www.nccih.nih.gov/health/cannabis-marijuana-and-cannabinoids-what-you-need-to-know - Ibid.
- Ibid.
- Ibid.
- Cannabidiol: Science, Marketing, and Legal Perspectives
https://www.ncbi.nlm.nih.gov/books/NBK565434/ - State and Federal Laws and Sanctions Concerning Drugs and Alcohol
https://www.bu.edu/safety/alcohol-drugs/laws/ - Access to cannabidiol without a prescription: A cross-country comparison and analysis
https://www.sciencedirect.com/science/article/pii/S0955395920302747 - Drug Impaired Driving Law
https://www.cga.ct.gov/2019/rpt/pdf/2019-R-0056.pdf - Overview-Multiple sclerosis
https://www.nhs.uk/conditions/multiple-sclerosis/#:~:text=Multiple%20sclerosis%20(MS)%20is%20a,it%20can%20occasionally%20be%20mild. - Multiple sclerosis
https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269 - Causes-Multiple sclerosis
https://www.nhs.uk/conditions/multiple-sclerosis/causes/ - Ibid.
- What Causes MS?
https://www.nationalmssociety.org/What-is-MS/What-Causes-MS - Epstein-Barr virus may be leading cause of multiple sclerosis
https://www.hsph.harvard.edu/news/press-releases/epstein-barr-virus-may-be-leading-cause-of-multiple-sclerosis/ - Obesity and Multiple Sclerosis Susceptibility: A Review
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5156319/ - Multiple Sclerosis & Smoking
https://my.clevelandclinic.org/departments/neurological/depts/multiple-sclerosis/ms-approaches/ms-and-smoking - Vitamin D and MS: Is there any connection?
https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/expert-answers/vitamin-d-and-ms/faq-20058258 - Symptoms-Multiple sclerosis
https://www.nhs.uk/conditions/multiple-sclerosis/symptoms/ - Ibid.
- Ibid.
- Ibid.
- Ibid.
- Diagnosis- Multiple sclerosis FAQs
https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274 - Ibid.
- Ibid.
- Ibid.
- Ibid.
- Treatment-Multiple sclerosis
https://www.nhs.uk/conditions/multiple-sclerosis/treatment/ - Vitamins for MS: Do supplements make a difference?
https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/expert-answers/vitamins-for-ms-do-supplements-make-a-difference/faq-20112502 - Ibid.