Can CBD Help with Multiple Sclerosis?

  • Multiple sclerosis (MS) symptoms often include pain, inflammation, muscle spasticity, MS fatigue, and depression(1)
  • Sativex, which contains a 1:1 CBD-THC ratio, is the only cannabis-based prescription medicine approved as an additional treatment for nerve pain and spasticity in multiple sclerosis patients(2)
  • Researchers of a 2016 study in Therapeutic Advances in Neurological Disorders found evidence of the potential efficacy and effectiveness of THC-CBD oromucosal spray in symptom management for those experiencing spasticity due to MS(3).
  • In 2017, a pre-clinical study on CBD alone was conducted. Published in CNS and Neurological Disorders – Drug Targets, results showed that CBD may produce beneficial effects in individuals with MS(4).

Why People Are Using CBD for Multiple Sclerosis

According to The National Multiple Sclerosis Society, approximately 85% of people with MS are initially diagnosed with relapsing-remitting MS (RRMS)(5).

RRMS is a type of MS characterized by inflammatory attacks on the nerve fibers and myelin, the layers of insulating membranes surrounding nerve fibers in the central nervous system (CNS).

While RRMS is defined by attacks or relapses of new MS symptoms, progressive forms of MS involve fewer attacks.

The progressive types of MS are secondary-progressive MS (SPMS), primary-progressive MS (PPMS), and progressive-relapsing MS (PRMS).

The symptoms of MS vary, but they often include pain, inflammation, muscle spasticity, MS fatigue, and depression. 

Spasticity is a condition characterized by an abnormal increase in muscle tone or stiffness of muscle, which might interfere with movement.

MS symptoms can reduce physical activity, negatively impact functional mobility, and have a detrimental effect on a person’s quality of life(6)

Although there have been recent significant advances in disease-modifying therapy, none of the current treatments stops or cures MS-related symptoms(7)

Thus, many people with MS look for alternative and complementary therapies, such as cannabis plants and their derivatives.

CBD for Multiple Sclerosis: What The Research Says

Sativex is a cannabis-based prescription medicine that contains a 1:1 CBD (cannabidiol)-THC (delta-9-tetrahydrocannabinol) ratio. 

Approved as an additional treatment for nerve pain and spasticity in multiple sclerosis patients, Sativex is administered as a mouth spray (oromucosal)(8).  

In a 2005 study published in Issues in Emerging Health Technologies, 368 patients with various neurological conditions, including MS, were given the THC:CBD spray(9)

Results showed that the spray significantly reduced nerve pain, spasticity, muscle spasms, and sleep disturbances among the human subjects. 

However, the researchers observed adverse events, like dizziness, sleepiness, fatigue, feeling of intoxication, and experiencing an unpleasant taste.

A 2016 study in Therapeutic Advances in Neurological Disorders summarized the evidence for the efficacy and effectiveness of THC-CBD oromucosal spray in symptom management for those experiencing spasticity due to MS(10)

Researchers believe that for individuals with resistant moderate to severe MS-induced spasticity, THC-CBD spray can be a treatment option. 

It was only in 2017 when a pre-clinical study on CBD alone was conducted. The study, published in CNS and Neurological Disorders – Drug Targets, showed that CBD could produce beneficial effects in individuals with MS(11).

How CBD Oil Works to Help With Multiple Sclerosis

The two primary cannabinoid receptors are CB1 and CB2. CB1 receptors are found in the CNS (the brain and spinal cord), intestines, connective tissues, and other glands.

CB2 receptors are mostly located in the spleen, tonsils, and immune cells. Only a few are in the brain.

Data suggests that CBD does bind to the receptors but does not directly activate them. Instead, it appears to adjust how the receptors respond to stimulation from other compounds, such as THC(12).

The authors of a study, published in the British Journal of Pharmacology in 2010, noted there had been anecdotal and scientific evidence of cannabis providing symptomatic relief in neurodegenerative disorders, including MS(13). 

The study results implied that the endocannabinoid system (ECS) impairment might be responsible for some disease symptoms.

The ECS plays an active role in regulating a wide range of body functions, including pain sensation, immune response, anxiety, mood, appetite, sleep, metabolism, and memory. 

The CBD-THC spray, Sativex, acts via cannabinoid receptors distributed throughout the CNS and in immune cells(14).

CB2 is involved in weakening inflammatory immune cell response to disease.

Meanwhile, the activation of CB1 receptors has been shown to block the release of glutamate, a chemical transmitter released by nerve cells in the brain(15)

Abnormal or excessive glutamate levels and signaling in the nervous system can contribute to MS(16).

The Pros and Cons of CBD Oil for Multiple Sclerosis

Pros

  • Evidence suggests that CBD may reduce MS symptoms, such as MS fatigue, pain, and spasticity, and ultimately improve mobility(17).
  • The 2018 Farm Bill has legalized CBD products derived from hemp. However, individual states in the United States have their legislation(18). 
  • The American Academy of Neurology has highlighted the safety profile and benefits of cannabis in a review of medical marijuana (medical cannabis). 

The review was conducted to address the treatment of symptoms of MS, epilepsy, and movement disorders(19). 

  • No studies have investigated the effects of cannabis oil on mobility in individuals with MS. However, some studies have suggested that CBD may exert positive effects on health by reducing inflammation and relieving pain(20).

Cons

  • Studies are too limited to determine if CBD is an effective treatment for conditions other than those approved by the US Food and Drug Administration (FDA).
  • There are risks in using CBD. Possible side effects include dry mouth, drowsiness, diarrhea, fatigue, and reduced appetite(21).
  • CBD can interact with other drugs and alter how the body metabolizes certain medications, as a 2017 research noted(22). 
  • A 2017 review revealed labeling inaccuracies in some CBD products. Some products had less CBD than stated in the label, while others had more(23).
  • How CBD Oil Compares to Alternative Treatments for Multiple Sclerosis

    Some of the alternative or complementary therapy options for MS include massage and a healthy, well-balanced diet with linoleic acid supplementation(24).

    Regular massage therapy can help MS patients relax and reduce stress and depression, which can exacerbate the disease. 

    CBD oil tinctures can be combined with massage oils. Like massage oils, CBD-infused bath bombs can help provide relaxation and relief from physical tension and emotional stress. 

    A study published in the journal CNS and Neurological Disorders – Drug Targets noted that CBD had therapeutic uses as an anti-anxiety-like and an antidepressant-like compound(25).

    There is also evidence that taking an oral supplement of linoleic acid (found in evening primrose oil) may improve MS symptoms. 

    Researchers of a 2019 study found that higher levels of α-linolenic acid (ALA) were associated with lower disease activity in MS patients(26).

    Meanwhile, cannabis extracts from Sativa cultivars (Cannabaceae) are rich in linoleic acid (57.1%), according to researchers of a 2012 study published in the European Journal of Lipid Science and Technology(27).

    How to Choose the Right CBD 

    Consider the following to ensure the reliability and safety of the CBD products purchased.

    1. Research on the legal stipulations applicable to CBD in the area where it would be bought and used.
    2. Read product reviews before buying from an online store. Check if the store is authorized by the government to sell CBD.
    3. Look for the certificate of analysis (COA) of the CBD product. A COA is a laboratory report that includes cannabinoid content and other tested compounds.
    4. Compare company claims with that of third-party lab testing reports. 

    CBD Dosage for Multiple Sclerosis

    The appropriate dose of cannabinoids for specific medical conditions is not known. However, there are suggested doses for some multiple sclerosis symptoms, like pain and spasticity.

    A 2011 systematic review that examined the effects of cannabinoids of any type (smoked cannabis, oral extracts, nabilone, synthetic THC, nabiximols) showed that cannabinoids provided pain relief(28). 

    When using Sativex for the first time for MS-related pain and spasticity, follow the number of sprays on the days and times in the table below as reference(29).

    Each 100 microlitre spray contains 2.7 mg THC and 2.5 mg CBD. 

    Number of Sprays
    Days Morning Sprays

    (Between waking up and noon)

    Evening Sprays

    (Between 4 pm and bedtime)

    Total Sprays/day 
    Day 1 0 1 1
    Day 2 0 1 1
    Day 3 0 2 2
    Day 4 0 2 2
    Day 5 1 2 3
    Day 6 1 3 4
    Day 7 1 4 5
    Day 8 2 4 6
    Day 9 2 5 7
    Day 10 3 5 8
    Day 11 3 6 9
    Day 12 4 6 10
    Day 13 4 7 11
    Day 14 5 7 12
    Do not use more than 12 sprays in one day.

    A 2011 study noted that high doses of 1,500 mg CBD a day is well-tolerated by humans(30). Still, always consult with a doctor before taking any CBD products.

    How to Take CBD Oil for Multiple Sclerosis

    A topical CBD cream or patch is ideal to use for inflammation or pain in a specific area. The CBD can target localized clusters of cannabinoid receptors, rather than interacting with the entire endocannabinoid system (ECS).

    CBD oil capsules and edibles, such as gummies, brownies, and lozenges, are a convenient and straightforward way to take CBD oil, especially for beginners.

    Meanwhile, CBD oil tinctures and sprays may be practical options for those who seek fast results and maximum dosage control. 

    Conclusion

    CBD alone or its combination with another cannabinoid, like THC, may help alleviate many common MS symptoms.

    Unfortunately, studies on the use of CBD for specific medical conditions in humans are limited, and CBD’s long-term effects remain unknown. 

    More longitudinal research is required to gather more scientific evidence and validate results from previous studies.

    Consulting with a doctor experienced in CBD use is ideal before using CBD or any cannabis products.


    1. Rudroff, T., & Sosnoff, J. (2018). Cannabidiol to Improve Mobility in People with Multiple Sclerosis. Frontiers in neurology, 9, 183. https://doi.org/10.3389/fneur.2018.00183.
    2. Perras C (2005). Sativex for the management of multiple sclerosis symptoms. Issues in emerging health technologies, (72), 1–4.
    3. Zettl, U. K., Rommer, P., Hipp, P., & Patejdl, R. (2016). Evidence for the efficacy and effectiveness of THC-CBD oromucosal spray in symptom management of patients with spasticity due to multiple sclerosis. Therapeutic advances in neurological disorders, 9(1), 9–30. https://doi.org/10.1177/1756285615612659.
    4. Mannucci, C., Navarra, M., Calapai, F., Spagnolo, E. V., Busardò, F. P., Cas, R. D., Ippolito, F. M., & Calapai, G. (2017). Neurological Aspects of Medical Use of Cannabidiol. CNS & neurological disorders drug targets, 16(5), 541–553. https://doi.org/10.2174/1871527316666170413114210.
    5. The National Multiple Sclerosis Society. Relapsing-remitting MS (RRMS). Retrieved from https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Relapsing-remitting-MS.
    6. Rudroff, T., & Sosnoff, J. (2018). Cannabidiol to Improve Mobility in People with Multiple Sclerosis. Frontiers in neurology, 9, 183. https://doi.org/10.3389/fneur.2018.00183.
    7. Ziemssen T, Derfuss T, de Stefano N, Giovanonni G, Palavra F, Tomic D, et al. Optimizing treatment success in multiple sclerosis. J Neurol (2016) 263:1053–65.10.1007/s00415-015-7986-y.
    8. Perras C (2005). Sativex for the management of multiple sclerosis symptoms. Issues in emerging health technologies, (72), 1–4.
    9. Perras C (2005). Sativex for the management of multiple sclerosis symptoms. Issues in emerging health technologies, (72), 1–4.
    10. Zettl, U. K., Rommer, P., Hipp, P., & Patejdl, R. (2016). Evidence for the efficacy and effectiveness of THC-CBD oromucosal spray in symptom management of patients with spasticity due to multiple sclerosis. Therapeutic advances in neurological disorders, 9(1), 9–30. https://doi.org/10.1177/1756285615612659.
    11. Mannucci, C., Navarra, M., Calapai, F., Spagnolo, E. V., Busardò, F. P., Cas, R. D., Ippolito, F. M., & Calapai, G. (2017). Neurological Aspects of Medical Use of Cannabidiol. CNS & neurological disorders drug targets, 16(5), 541–553. https://doi.org/10.2174/1871527316666170413114210.
    12. Laprairie, R. B., Bagher, A. M., Kelly, M. E., & Denovan-Wright, E. M. (2015). Cannabidiol is a negative allosteric modulator of the cannabinoid CB1 receptor. British journal of pharmacology, 172(20), 4790–4805. https://doi.org/10.1111/bph.13250.
    13. Scotter, E. L., Abood, M. E., & Glass, M. (2010). The endocannabinoid system as a target for the treatment of neurodegenerative disease. British journal of pharmacology, 160(3), 480–498. https://doi.org/10.1111/j.1476-5381.2010.00735.x.
    14. Government of Canada. (2005, April 13). Fact Sheet – SATIVEX. Retrieved from https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/notice-compliance/conditions/fact-sheet-sativex.html.
    15. Shen M, Piser TM, Seybold US, et al: Cannabinoid receptor agonists inhibit glutamatergic synaptic transmission in rat hippocampal cultures. J Neurosci 1996; 16:4322–4334. 
    16. Levite M. (2017). Glutamate, T cells and multiple sclerosis. Journal of neural transmission (Vienna, Austria : 1996), 124(7), 775–798. https://doi.org/10.1007/s00702-016-1661-z
    17. Rudroff, T., & Sosnoff, J. (2018). Cannabidiol to Improve Mobility in People with Multiple Sclerosis. Frontiers in neurology, 9, 183. https://doi.org/10.3389/fneur.2018.00183.
    18. US FDA. (2020, March 11). FDA Regulation of Cannabis and Cannabis-Derived Products, Including Cannabidiol (CBD). Retrieved from https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd.
    19. Koppel, B. S., Brust, J. C., Fife, T., Bronstein, J., Youssof, S., Gronseth, G., & Gloss, D. (2014). Systematic review: efficacy and safety of medical marijuana in selected neurologic disorders: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology, 82(17), 1556–1563. https://doi.org/10.1212/WNL.0000000000000363.
    20. Bergamaschi, M. M., Queiroz, R. H., Zuardi, A. W., & Crippa, J. A. (2011). Safety and side effects of cannabidiol, a Cannabis sativa constituent. Current drug safety, 6(4), 237–249. https://doi.org/10.2174/157488611798280924.
    21. Bauer, B. (2018, Dec 20). What are the benefits of CBD — and is it safe to use? Retrieved from https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/is-cbd-safe-and-effective/faq-20446700.
    22. Iffland, K., & Grotenhermen, F. (2017). An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. Cannabis and cannabinoid research, 2(1), 139–154. https://doi.org/10.1089/can.2016.0034.
    23. Bonn-Miller, M. O., Loflin, M., Thomas, B. F., Marcu, J. P., Hyke, T., & Vandrey, R. (2017). Labeling Accuracy of Cannabidiol Extracts Sold Online. JAMA, 318(17), 1708–1709. https://doi.org/10.1001/jama.2017.11909.
    24. Cleveland Clinic. (2014, Aug 22). Multiple Sclerosis: Alternative & Complementary Therapies. Retrieved from https://my.clevelandclinic.org/health/treatments/11666-multiple-sclerosis-alternative–complementary-therapies.
    25. De Mello A et al. “Antidepressant-Like and Anxiolytic-Like Effects of Cannabidiol: A Chemical Compound of Cannabis sativa”, CNS & Neurological Disorders – Drug Targets (2014) 13: 953. https://doi.org/10.2174/1871527313666140612114838.
    26. Bjornevik, K., Myhr, K. M., Beiske, A., Bjerve, K. S., Holmøy, T., Hovdal, H., Midgard, R., Riise, T., Wergeland, S., & Torkildsen, Ø. (2019). α-Linolenic acid is associated with MRI activity in a prospective cohort of multiple sclerosis patients. Multiple sclerosis (Houndmills, Basingstoke, England), 25(7), 987–993. https://doi.org/10.1177/1352458518779925.
    27. Kuhnt, K., Degen, C., Jaudszus, A., & Jahreis, G. (2012). Searching for health beneficial n-3 and n-6 fatty acids in plant seeds. European journal of lipid science and technology: EJLST, 114(2), 153–160. https://doi.org/10.1002/ejlt.201100008.
    28. Lynch, M. E., & Campbell, F. (2011). Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials. British journal of clinical pharmacology, 72(5), 735–744. https://doi.org/10.1111/j.1365-2125.2011.03970.x.
    29. NPS MedicineWise. (2019, Dec 9). Sativex. Retrieved from https://www.nps.org.au/medicine-finder/sativex-oromucosal-spray#how-to-use-sativex.
    30. Bergamaschi, M. M., Queiroz, R. H., Zuardi, A. W., & Crippa, J. A. (2011). Safety and side effects of cannabidiol, a Cannabis sativa constituent. Current drug safety, 6(4), 237–249. https://doi.org/10.2174/157488611798280924.
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