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Cannabis Extract Improves Spasticity Without Increasing Weakness in Patients With MS
A pooled analysis of three randomized trials of nabiximols helps lay the groundwork for an FDA submission in 2021. Approval would yield the first novel treatment for spasticity in multiple sclerosis in many years.
Cannabis Extract Improves Spasticity Without Increasing Weakness in Patients With MS
Cannabinoid oromucosal spray is poised for FDA submission in 2021
Nabiximols, a complex botanical medication formulated from extracts of the cannabis plant, improves spasticity in patients with multiple sclerosis (MS) without producing the accompanying muscle weakness sometimes observed with other antispasticity medications, according to an analysis of three European studies.
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“There also was no notable decrease in patients’ preferred walking speed,” reports Francois Bethoux, MD, of Cleveland Clinic’s Mellen Center for Multiple Sclerosis Treatment and Research. Although he did not participate in the studies analyzed, as an MS rehab expert and a consultant to GW Pharmaceuticals/Greenwich Biosciences, Dr. Bethoux was asked to present the European data at the virtual 2020 annual assembly of the American Academy of Physical Medicine & Rehabilitation in November.
An established spasticity therapy in many nations
Nabiximols is approved in over 25 countries outside the United States under the brand name Sativex ® and is self-administered as an oral spray. “It’s been many years since there has been a new treatment for spasticity in MS with a unique mechanism of action, so this drug would be a welcome addition to our armamentarium,” says Dr. Bethoux, who also serves as Chair of Cleveland Clinic’s Department of Physical Medicine & Rehabilitation. “In addition, nabiximols can be taken several times a day on an as-needed and as-tolerated basis, while currently available antispasticity agents are generally given on a schedule. This gives patients an opportunity to adjust the dosing schedule based on their needs.”
The cannabis extracts tetrahydrocannabinol (THC) and cannabidiol (CBD) are primary components of the medication, and work via the endocannabinoid system. For instance, THC has been observed to impact CB1 and CB2 receptors, which can be found in the nociceptive and spasticity pathways of the brain and spinal cord, as well as in the peripheral nervous system.
“Published reports suggest that a large number of persons with MS have used or currently use cannabis to help relieve symptoms related to spasticity,” observes Dr. Bethoux, “so it is not a surprise that a cannabis extract could be efficacious.” He notes that Cleveland Clinic, like many other health systems, has a policy that prohibits clinicians from condoning or making referrals to medical marijuana providers, so the availability of a regulated prescription option could be helpful to both patients and clinicians.
European trial results
Dr. Bethoux’s presentation focused on an analysis of three randomized controlled trials conducted at European hospitals involving more than 500 patients assigned to receive either nabiximols or placebo. All subjects had MS and spasticity that was not adequately controlled by current medications.
All three trials, which lasted from six to 16 weeks, evaluated spasticity using the Numeric Rating Scale (NRS). Two trials each evaluated muscle strength using the Motricity Index (MI) for legs, and two assessed mobility via the timed 10-Meter Walk Test. Two of the studies used an enriched trial design, in which patients were treated with single-blind nabiximols in phase A. Subjects who reported at least a 20% improvement in spasticity on the NRS were then randomized to nabiximols or placebo in phase B. The aim was to identify any correlation between spasticity and muscle strength or walking speed during the randomized portions of the studies.
Each of the trials demonstrated a statistically significantly greater improvement in spasticity from baseline with nabiximols compared with placebo, with treatment differences of 0.52 to 1.9 points on the NRS in favor of nabiximols.
Notably, the improvement in spasticity was not accompanied by an increase in muscle weakness or a change in walking speed. There was no meaningful association between change in spasticity on the NRS and change in MI score, according to Dr. Bethoux, and there was a weak-to-negligible correlation between change in spasticity on the NRS and change in preferred walking speed.
Imminent launch of US trials
The European trials were sponsored by GW Pharmaceuticals/Greenwich Biosciences, which owns the commercial rights to nabiximols in the United States. The company is in the process of launching five phase 3 clinical trials of the compound in the United States, with plans to use data from one of those trials and the three European studies from the current analysis to submit a New Drug Application to the FDA in mid-2021.
“Quite a few studies of nabiximols have been conducted in addition to the three I presented,” says Dr. Bethoux, who adds that many have been completed in Europe. “Some have been sponsored by the company, and others have been initiated by investigators independently to look into side effects and patient perceptions of nabiximols.” He notes that these studies have found the medication to be well tolerated and have revealed no concerning safety signals.
“However, we will be looking to see if nabiximols affects cognitive function, since marijuana can impair memory and processing speed,” Dr. Bethoux observes. “Importantly, nabiximols has not been found to impact the ability to drive safely, which has been a concern with the use of cannabis.”
CBD Oil and MS: Is Cannabis Oil a Miracle for Multiple Sclerosis?
CBD — short for cannabidiol — has a long list of well-documented health benefits. People use CBD oil to improve general well-being and to alleviate a wide range of symptoms, from anxiety to pain, inflammation, and neurological problems.
However, some areas where CBD could potentially help, are yet to be thoroughly examined.
Such is the case of using CBD oil for multiple sclerosis (MS).
Many MS patients are successfully taking cannabidiol, claiming it helps with their symptoms and repairs damaged nerves.
Current research shows that extracts like CBD oil can be effective in reducing pain and spasms in MS patients.
But can CBD oil actually treat multiple sclerosis?
Unfortunately, the research is still inconclusive. In this article, we’ll cover the most important aspects of using CBD oil for MS — including the benefits, different consumption methods, and possible side effects.
What is Multiple Sclerosis?
Multiple Sclerosis is a self-aggressive disease where the body’s immune system attacks the central nervous system (CNS). Scientists are still trying to discover the exact cause of MS; however, the general consensus is that this disease may be triggered by a combination of genetic and environmental factors.
Currently, about 2.3 million people in the US suffer from MS. The majority of diagnosed patients are between their 20s and 50s — it’s unclear why some people have this condition while others don’t.
Multiple Sclerosis damages the protective layer around nerve fibers (myelin). When the CNS notices the patches of scars left behind by an aggressive immune system, it starts to send false signals to the brain — leading to an array of symptoms.
In some people, these symptoms are relatively mild like extensive fatigue, while other cases involve severe pain, involuntary muscle cramps, impaired memory and focus, and vision problems.
When left untreated, multiple sclerosis may result in partial or complete paralysis.
Types of Multiple Sclerosis
There are 4 main forms of multiple sclerosis based on the type and severity of symptoms:
This is the most prevalent type of MS and affects about 85% of patients diagnosed with MS.
People with RRMS suffer from periodical fare-ups that exacerbate their symptoms, followed by silent periods where the patient remains symptom-free until the next flare-up.
For SPMS sufferers, symptoms deteriorate over time but without flare-ups. In most cases, RRMS transforms into SPMS.
A less common form of MS, primary-progressive multiple sclerosis affects about 10% of all MS patients.
This form of the disease is marked by worsening symptoms from the beginning, without flare-ups or remissions typical to other types of MS.
This is the rarest form of MS and occurs in about 5% of MS sufferers. The symptoms of PRMS worsen steadily over time, with flare-ups and acute relapses but without remission periods.
What is CBD Oil?
CBD oil is a concentrated CBD extract made from cannabis plants — both hemp and marijuana.
CBD is a cannabinoid — a naturally occurring phytochemical — and the second-most recognized active ingredient of cannabis.
Unlike the most popular cannabinoid, delta-9-tetrahydrocannabinol (THC), CBD is non-psychoactive and thus won’t get you high. This makes CBD legal in most countries across the world.
The lack of psychoactive effects doesn’t make it an inferior cannabinoid. On the contrary, CBD has a long list of well-documented health benefits with only a few mild side effects. Cannabis advocates argue that CBD can help with virtually any condition deriving from a compromised endocannabinoid system (ECS) — the prime neurochemical network in our bodies.
Most CBD stuff sold online and in local dispensaries comes from hemp plants, which takes us to the next question.
How is CBD Hemp Oil Different from Medical Marijuana?
The main difference between CBD from hemp and medical marijuana is the aforementioned THC content.
Hemp plants are high in CBD and very low in THC. The THC content of hemp plants is usually below 0.3%, which isn’t enough to produce any psychoactive effects.
On the other hand, marijuana has high THC levels and doesn’t offer much CBD. However, some strains are specifically bred to achieve higher CBD levels at the cost of some THC.
Still, you won’t buy marijuana products in your local head shop or health store as marijuana remains a controlled substance according to federal law. You can buy medical marijuana if you live in a state that runs a medical marijuana program.
CBD oil from hemp is legal in all 50 states. You can find it in cannabis dispensaries, head shops, and online stores. You don’t need a doctor’s prescription to try CBD oil for multiple sclerosis.
Different Ways to Take CBD Oil for Multiple Sclerosis
If you’re considering trying CBD oil for your MS symptoms, it is available in the form of oil drops, tinctures, sprays, capsules, and edibles, which can be ingested, as well as vape products and creams for topical use.
Can CBD Oil Help With Multiple Sclerosis?
Dr. Ben Thrower, a physician at the Shepherd Center in Atlanta, GA, is very optimistic about using CBD oil for multiple sclerosis, but at the same time, he underlines the importance of THC in the treatment.
“Many of our MS patients have used hemp-based CBD products with 0.3 percent THC or less (…) For the management of spasticity/spasms or burning pain (central neuropathic pain), I have found that most patients need higher THC concentrations.”
THC is a well-known pain reliever — this may explain the need for higher levels of THC in CBD products for treating MS symptoms.
However, Thrower points to CBD topicals as a potential solution for fighting localized pain in MS patients
“Some patients do find relief with Low-THC, CBD lotions applied topically,” said Thrower.
What Does the Research Say About Using CBD Oil for Multiple Sclerosis
In a 2009 study, researchers investigated previous reports from MS patients who used cannabis for their symptoms to find out whether a mix of CBD and THC may reduce spasticity associated with MS.
Each of the analyzed papers focused on testing THC and CBD in capsules and oral sprays. These products generally involved more THC than CBD, which resulted in a trend of reduced spasticity.
Researchers also concluded that THC/CBD solutions are well tolerated by patients and that the experienced side effects didn’t always stem from using cannabis alone.
In 2016, researchers were looking at how a pharmaceutical spray Sativex might reduce muscle spasms in MS sufferers.
Sativex is an oral solution made from CBD and THC in a 1:1 ratio. The spray was developed to reduce neuropathic pain, overactive bladder, spasticity, and other common symptoms of multiple sclerosis.
Researchers examined self-reported data from several hundred MS patients who were using the drug for one year. Results showed a 20% improvement in muscle spasticity for 70% of subjects and a 30% improvement in 28% of patients.
For about 39% of patients, the treatment was ineffective. Although those patients dropped out of the study, the results do provide evidence to support further research on cannabinoids for multiple sclerosis.
Finally, there’s a 2018 research review that analyzed existing studies to find indirect that CBD, along with other cannabinoids, can improve the mobility of MS patients.
The paper focused mostly on a high CBD to THC ratio as the potential reliever of muscle spasms and pain in MS patients. It also discussed how cannabis reduces inflammation, contributing to less fatigue in subjects.
Because CBD oil may be able to alleviate so many symptoms of multiple sclerosis — pain, spasticity, inflammation, and fatigue — it’s reasonable to assume that CBD can have a positive impact on mobility in MS patients.
What Are the Side Effects of Using CBD Oil for Multiple Sclerosis?
When it comes to unwanted reactions to CBD, Thrower said there are very few. They’re also uncommon and generally considered mild.
“I have found the side effect profile of these products to be less than some of the prescription medications,” he added. “CBD/THC products tend to be far less sedating than Baclofen or Tizanidine, which are [muscle relaxants] traditionally used for spasticity,” he added.
Most often, taking too much CBD oil results in a dry mouth, lowered blood pressure, and dizziness. In very rare cases, high doses of CBD oil can trigger diarrhea.
Key Takeaways: What You Need to Know About Using CBD Oil for MS
So, there you have it — everything we know about using CBD oil for MS so far.
Let’s summarize the article in a nutshell:
- CBD can be effective in reducing pain and spasms in multiple sclerosis patients
- However, CBD alone has limited potential for relieving MS.
- It appears that adding THC significantly improves the therapeutic properties of CBD
- Some people can have negative reactions to the psychoactive effects of THC, especially if their symptoms call for higher doses of medical cannabis oil.
- Moreover, equal ratios of CBD to THC may not work for certain people, as studies have shown.
- Full-spectrum cannabis extracts with higher ratios of CBD to THC may be able to relieve a wider range of symptoms and improve mobility in MS patients.
- Hemp-derived CBD topicals may be effective in reducing localized pain and inflammation during flare-ups.
I hope this article has helped you understand how cannabinoids work for specific MS symptoms. As always, make sure to contact your GP before taking any CBD product, especially if you’re already taking prescribed medications cannabidiol can interact with.
Nina created CFAH.org following the birth of her second child. She was a science and math teacher for 6 years prior to becoming a parent — teaching in schools in White Plains, New York and later in Paterson, New Jersey.
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What Are the Benefits of CBD for Multiple Sclerosis?
Research on CBD for MS is limited, but shows it might reduce pain and spasticity
Kelly Burch is a freelance journalist who has covered health topics for more than 10 years. Her writing has appeared in The Washington Post, The Chicago Tribune, and more.
Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more.
Emily Dashiell, ND, is a licensed naturopathic doctor who has worked in group and private practice settings over the last 15 years. She is in private practice in Santa Monica, California.
Multiple sclerosis (MS) is an autoimmune disease that causes a range of symptoms, including fatigue, cognitive impairment, and muscle weakness. MS can manifest in many ways, but patients have one thing in common: the symptoms of MS have a big impact on their quality of life.
To manage symptoms, some MS patients turn to cannabidiol, or CBD, a non-psychoactive compound found in the cannabis plant. Scientists are still researching the benefits of CBD for people with MS, but early indications show that CBD might help control some MS symptoms, such as pain and muscle stiffness.
This article will review what you should know about CBD and multiple sclerosis, including the potential benefits, safety concerns, and optimal dosage.
Verywell / Michela Buttignol
Immune System and Multiple Sclerosis
Multiple sclerosis is an autoimmune disease. That means that the symptoms of the disease occur because the immune system is attacking healthy cells in the way that it’s supposed to attack viruses and other pathogens.
In MS, the immune system targets the myelin sheath, a protective coating that wraps around nerve cells in the spinal cord and brain. When the immune system attacks this barrier, it causes inflammation and damage, which can impair the nerve signaling that facilitates movement, breathing, thinking, and more.
The severity of MS symptoms varies, depending on the location of the attack and the extent of the damage to the myelin sheath, but they most often include fatigue, muscle weakness or stiffness, and cognitive dysfunction.
Cannabinoids and the Immune System
Cannabinoids are a group of compounds found in the cannabis plant. The two main cannabinoids are THC (the psychoactive ingredients in marijuana) and CBD (which does not have a psychoactive component).
The body processes cannabinoids via cannabinoid receptors, which are found in the brain and in immune cells. This is all part of the endocannabinoid system, which regulates inflammation, immune function, motor control, pain, and other bodily functions commonly affected by MS.
This connection helps explain why CBD can be beneficial for MS. Cannabinoids have been shown to reduce inflammation and regulate immune response. CBD does this without mind-altering properties, making it appealing to people looking for relief from MS symptoms without the “high” of marijuana.
Benefits of CBD for MS
In a recent meta-analysis, researchers concluded that cannabinoids, including CBD, are “probably effective” at alleviating certain symptoms of MS, including pain and abnormal muscle tightness (spasticity), but “probably not effective” for treating muscle tremors or incontinence.
Additional research supported using CBD for MS. Here are some key findings:
- A 2018 scientific review found that CBD supplementation reduced pain, fatigue, inflammation, depression, and spasticity in people with MS, while improving mobility. The authors concluded that recommending CBD supplementation for people with MS would be advisable.
- A 2014 scientific review found that Sativex (nabiximols), a CBD nasal spray, can help reduce pain, spasticity, and frequent urination in patients with MS.
- Two different 2021 medical reviews found that in animal models, CBD helps regulate the immune system, reducing the autoimmune response that causes MS symptoms. More research is needed, but in the future this may mean that cannabis-derived medications and CBD could be used to treat the progression of MS, not just the symptoms.
Are There Any Side Effects?
CBD is generally considered safe, and it does not have mind-altering properties. A dose of up to 300 mg daily of CBD is safe for up to six months. Higher doses are safe for a shorter amount of time.
However, like any other supplements or medication, CBD may have side effects in some individuals. These may include:
- Low blood pressure
- Damage to the liver
In addition, CBD may interact with many other prescription drugs. It’s best to speak with your healthcare provider before supplementing with CBD, especially if you are pregnant or breastfeeding. Most doctors who treat MS are familiar with CBD, since at least 20% of MS patients are currently using CBD.
CBD is legal for consumption in the United States, but cannabis products that contain THC are illegal at the federal level. Be sure to understand the legal and professional implications of using CBD, especially if you are regularly screened for drug use.
Keep in mind that the Food and Drug Administration does not oversee or regulate any CBD supplements, so it’s important to purchase CBD products from a reputable source.
How to Use CBD for MS
CBD is available in many different forms, including topicals, tinctures, edibles, and nasal sprays.
You’ll also have to decide whether you want to take a full or broad-spectrum CBD, which contains other cannabinoids, or a CBD isolate, which contains just cannabidiol. Limited research suggests there may be a benefit to the “entourage effect”: It’s believed that having other cannabinoids present may make CBD more effective.
Consulting your healthcare provider can help you decide where to start with CBD supplementation. They can offer insight as to what has worked for other patients and guide you toward an appropriate dose of CBD.
How to Buy CBD for MS
It’s important to deal with reputable dispensaries when purchasing CBD for MS. Here’s what you should consider when buying CBD to treat MS:
- The legal status of CBD in your state, including whether you need a medical cannabis card
- The possible impact of taking CBD on your professional licenses or other areas in your life
- Your goals in taking CBD, and the symptoms you would most like to address
- Whether you would like a CBD isolate or a full-spectrum product that contains other cannabinoids
- Whether the retailer is licensed in your state
- Where the product was sourced (grown)
- Whether the product has a COA, or certificate of analysis, which shows the chemical composition of a substance
A Word from Verywell
MS can have a huge impact on your quality of life, which is why so many people look for relief from MS symptoms. The research around CBD and MS is very promising: It shows that some people experience reduced pain and spasticity when they use CBD supplements.
In the future, CBD-derived medication may even be used to control the progression of the disease by reducing inflammation.
Unfortunately, use of CBD for MS is still in its infancy, and there’s a clear need for more research. For now, it’s best to talk with your doctor and trusted peers when deciding whether CBD is right for you. Don’t be shy about speaking up: Research has shown that up to 60% of MS patients are currently using cannabis and 90% would consider it.
You shouldn’t feel any shame or hesitation about investigating this treatment option. However, it’s important to understand any legal and professional implications for where you live, especially if you use a product containing THC.
Although there is a lot of promise for CBD to treat MS, there is no FDA-approved treatment. Using it in combination with more traditional medically sanctioned treatment is likely a good course of action.
Frequently Asked Questions
Research indicates that CBD likely helps with muscle spasticity in people with MS. A UK-based study found that physicians did not measure a large improvement in spasticity in people taking CBD versus a supplement. However, the people taking CBD reported a reduction in spasticity compared with those taking a placebo. Because of that, the Multiple Sclerosis Society says that CBD is likely effective for spasticity.
CBD is generally considered safe, and some research shows that it likely helps treat pain and spasticity caused by MS. However, CBD is not FDA approved for treating MS or its symptoms. You should speak with your healthcare provider about using CBD to treat MS.
Much of the research on using CBD for MS pain has been done using oral supplements and nasal sprays. Some people also report benefits from smoking CBD flowers or cannabis. It’s best to speak with your healthcare provider and consider the legal standing of CBD and cannabis in your state as you decide how best to use CBD to treat MS pain.