Multiple Sclerosis (MS)

Medical Cannabis and Multiple Sclerosis

Multiple Sclerosis (MS) is a neurodegenerative condition that impacts the brain and spinal cord, and the resultant damage to the myelin sheath disrupts the signals to and from the brain. This can cause spasms, numbness, mood changes, fatigue, pain, memory problems, loss of sensation (sight, sound, taste, smell, touch), and paralysis. Medical cannabis can be helpful for those who suffer from spasms, fatigue, and chronic pain due to MS and several other neurological disorders.

What is Multiple Sclerosis?

MS is a demyelinating disease where the myelin sheath that protects nerve cells is damaged. This impairs the conduction of signals across nerve cells and, over time, can cause persistent muscle spasms and consistent nerve pain (neuropathy). Approximately 2.5 million people worldwide suffer from MS, while the U.S. makes up around 400,000. Rates of MS are higher farther from the equator. The onset of MS is usually between 20 and 40 years of age but can arise at any age from 10 to 80 years old, with a mean of 32 years old.

Symptoms of MS include vision problems and possibly blindness over time. Other symptoms include fatigue, numbness, tingling, muscle spasms, mobility problems, confusion and problems with thinking and planning, depression and anxiety, bladder dysfunction, and nerve and muscle pain. Symptoms can progressively build over time in those with MS. In some cases, MS occurs in recurring, isolated attacks. Chronic inflammation and immune system dysregulation are common characteristics of MS.

Several factors could cause multiple sclerosis, although the precise cause or causes are not known. Genetics is a factor, and there are approximately 200 genes that have been identified where abnormalities could contribute to the development of MS. Environmental factors and having suffered a previous major condition may also be factors in the development of MS.

In some forms of MS, the body’s immune system attacks the body’s nervous system, and T-regulatory cells do not function properly. T-cells become activated in the lymph system and enter the central nervous system, causing inflammation and damage. T-cells activate helper B-cells, which activate antibodies and cause further damage to the CNS and myelin sheath surrounding nerves.

This form of MS is thought to be an autoimmune or autoimmune-like disorder, but not all forms of MS follow this diagnostic pattern. Some propose that MS is not an autoimmune disease at all. It may be more accurate to call MS an “immune-mediated” condition instead of an autoimmune disease or disorder, but this is still debated.

Brief Summary of Current Treatments

Current treatments for MS include:

• Physiotherapy
• Various modes of psychological and occupational therapy (OT)
• Improving sleep and diet
• Exercise
• Steroid tablets and/or injections
• Antispasmodics like baclofen, gabapentin and carbamazepine
• Antidepressants, including SSRIs and tricyclic ones like amitriptyline
• Benzodiazepines
• Immunosuppressive treatments like chemotherapy

How Might Medical Cannabis Help?

Sativex is a medication in the United Kingdom that uses a mixture of THC and CBD to treat MS. Sativex may also be of use for any neuropathic pain associated with MS. Sativex is produced by GW Pharmaceuticals and has an approximate THC:CBD ratio of 1:1. This means that there is already a significant amount of evidence showing that medical cannabis and marijuana extracts can be effective for MS.

THC may help reduce the number of spasms and help reduce pain due to its analgesic effects. CBD may help relieve some of the psychoactive effects of THC when present in equal ratios and thus help reduce some of the more confusing and fatiguing effects of THC. CBD and THC can also work alongside each other and increase the anti-inflammatory properties via the entourage effect. THC’s and CBN’s sedative effects may also help treat sleep issues like insomnia, while CBD can help lift mood and relieve anxiety.

Phytocannabinoids could help promote neurogenesis for older people and could be of use for those with MS. Cannabinoids’ wide range of receptor targets and mode of pharmacological action (i.e., as an analgesic, mood booster, immunomodulator, and anti-inflammatory agent) could make medical cannabis an ideal medication for various symptoms associated with MS. Cannabinoids

• Tetrahydrocannabinol (THC) = has antispasmodic properties, helping calm down muscle spasms
• Cannabidiol (CBD) = has anti-inflammatory properties and effectively slows the chemical signals that are causing the spasms
• Cannabinol (CBN) = has sedative properties that can aid sleep
• Cannabichromene (CBC) = has neuroprotective properties that can help prevent or reduce brain inflammation and damage
• Cannabigerol (CBG) = has neuroprotective and antioxidant properties, which are exerted by CBG’s influence on serotonin receptors
• Cannabidiolic acid (CBDA/CBDa) = has antispasmodic and antiseizure properties, and may enhance the therapeutic potential of CBDA and THCA via the entourage effect  
• Tetrahydrocannabinolic acid (THCA/THCa) = has anti-inflammatory and analgesic properties

Cannabinoid Ratios

• THC:CBD 1:1
• THC:CBD 1:3 (note that some products may label the CBD first, so CBD:THC 3:1)

Terpenes and Terpenoids

• Myrcene

• Linalool
• Humulene
• Beta-caryophyllene
• Pinene
• Limonene
• Camphene
• Farnesene

Many terpenes in cannabis have anti-inflammatory and relaxing effects that can help reduce pain, stiffness and inflammation associated with MS.

Flavonoids

There are an increasing number of studies looking at the potential of flavonoids in managing pain and inflammation, which are characteristics of almost all health problems. There are several flavonoids in cannabis that have potent anti-inflammatory effects. These include:

• Cannflavins A, B and C
• Quercetin
• Kaempferol
• Catechin
• Apigenin

Effective Ways of Taking Medical Cannabis for Multiple Sclerosis

Routes of Administration

• Inhalation
• Sublingual
• Ingestion

Special Formulations

Finding a product or strain (more accurately “cultivar” or “chemovar”) with a mixture of THC, CBD, myrcene, humulene, beta-caryophyllene, pinene, limonene, and linalool may be ideal. 1:1 THC:CBD ratios may be ideal, although some may opt for more CBD-rich formulations (e.g., THC:CBD 1:2, 1:3, or higher) if they find the effects of THC overwhelming.

Some cultivars to look out for include:

• Cannatonic
• Canna-Tsu
• ACDC
• Pennywise
• Ringo’s Gift
• Amnesia Haze
• Critical Mass
• Blue Dream
• Cinderella ‘99
• Skywalker OG
• Forbidden Fruit
• Purple Kush
• Granddaddy Purple (GDP)

Dosing Methods

• Vaporizer or inhaler
• Tincture
• Edibles or drinkables

What are the Pros and Cons of Taking Medical Cannabis for Multiple Sclerosis (MS)?

Potential Pros

• THC could help manage muscle spasms and stiffness.
• Prevents swelling of the brain and optic nerve–many cannabinoids, including THC and CBD, may contribute to this effect.
• CBD may be neuroprotective and may even counteract MS development. This could be due to its ability to prevent inflammation in the brain.
• Help manage the pain of MS and the side effects of other medications, often causing nausea, fatigue, and weight problems.
• Compounds in cannabis (e.g., CBD, CBG) may promote neurogenesis (the growth of new brain cells).

Potential Cons

• THC may cause confusion and other harmful effects. This is why 1:1 THC:CBD ratios are considered most therapeutic for MS.
• Age of user also matters: Younger MS sufferers may need to be careful with THC.
• Side effects of psychoactive cannabinoids like THC may be overwhelming for some.

Useful Anecdotal Information

Multiple Sclerosis Patient Calls Medical Cannabis Trial a Miracle | Montreal Gazette

Medical Marijuana Effectively Treats MS Review Finds | CBS News

Scientific Data Overview and Studies

• Total Studies = 131
• Positive Studies = 120
• Inconclusive Studies = 9
• Negative Studies = 2
• 77 Meta-Analyses (70 positive, 6 inconclusive, 1 negative); 21 Animal Studies (20 positive, 1 inconclusive); 11 Double-Blind Human Trials (10 positive, 1 inconclusive); 16 Human Trials (14 positive, 1 inconclusive, 1 negative); 6 Lab Studies (all positive)
• 54 studies include CBD (51 positive, 3 inconclusive); 53 studies include THC (49 positive, 4 inconclusive); 4 studies include CBG (all positive); 1 study includes CBN (positive); 1 study includes CBDA (positive); 1 study includes THCA (positive); 37 studies include a THC:CBD 1:1 ratio (all positive)
• No. of Leafwell Patients (2022) = 243 (multiple sclerosis); 3,700 (muscle spasms and spasticity, which may or may not be MS-related)
• Possible Overall Efficacy: High

Quotes from Studies

“A large proportion of patients with multiple sclerosis (MS) have spasticity, which has a marked impact on their quality of life. Anecdotal evidence suggests a beneficial effect of cannabis on spasticity as well as pain. Recently, randomized, double-blind, placebo-controlled studies have confirmed the clinical efficacy of cannabinoids for the treatment of spasticity in patients with MS. Based on these data, nabiximols (Sativex), a 1:1 mix of Δ-9-tetrahydrocannabinol and cannabidiol extracted from cloned Cannabis sativa chemovars, received approval for treating MS-related spasticity in various countries around the globe.” Source: Leussink, Verena Isabell et al. ‘Symptomatic therapy in multiple sclerosis: the role of cannabinoids in treating spasticity‘ Therapeutic advances in neurological disorders vol. 5,5 (2012): 255-66. doi:10.1177/1756285612453972

“The THC-CBD spray improved spasticity and pain in secondary progressive MS patients. The spray prolonged CSP duration, which appears a promising tool for assessing and monitoring the analgesic effects of THC-CBD in MS.”

Vecchio D, Varrasi C, Virgilio E, Spagarino A, Naldi P, Cantello R. ‘Cannabinoids in multiple sclerosis: A neurophysiological analysis’. Acta Neurol Scand. 2020 Oct;142(4):333-338. doi: 10.1111/ane.13313. Epub 2020 Jul 21. PMID: 32632918.

“The majority of patients with multiple sclerosis (MS) develop troublesome lower urinary tract symptoms (LUTS). Anecdotal reports suggest that cannabis may alleviate LUTS, and cannabinoid receptors in the bladder and nervous system are potential pharmacological targets. In an open trial we evaluated the safety, tolerability, dose range, and efficacy of two whole-plant extracts of Cannabis sativa in patients with advanced MS and refractory LUTS…

Patient self-assessment of pain, spasticity and quality of sleep improved significantly (P <0.05, Wilcoxon’s signed rank test) with pain improvement continuing up to median of 35 weeks. There were few troublesome side effects, suggesting that cannabis-based medicinal extracts are a safe and effective treatment for urinary and other problems in patients with advanced MS.”

Brady CM, DasGupta R, Dalton C, Wiseman OJ, Berkley KJ, Fowler CJ. ‘An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis’. Mult Scler. 2004 Aug;10(4):425-33. doi: 10.1191/1352458504ms1063oa. PMID: 15327041.

Conclusion

Many clinical trials and systematic reviews show that medical cannabis can help manage symptoms associated with MS, improving a range of quality of life (QOL) scores. The scientific evidence is overwhelmingly positive.

Related Articles

• Using Cannabis for FNDs (Functional Neurological DIsorders)
• Medical Cannabis for Neuropathy (Nerve Pain)
• Medical Cannabis for Muscle Spasms
• CBD and the Brain: The Impact of Cannabidiol on Brain Health
• Can Cannabis Boost Brain Cell Growth?

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