According to the Multiple Sclerosis (MS) Journal, nearly 1 million Americans are affected by MS, a number that continues to grow daily, with the majority of those affected being women. MS is an autoimmune disease which affects your body’s nervous system, specifically damaging the insulation that surrounds nerve fibers. The three most common types of MS are:
- Relapsing-remitting MS (RRMS)
- Secondary-progressive MS (SPMS)
- Primary-Progressive MS (PPMS)
Once diagnosed, slowing the progression of the disease may require several lifestyle changes such as nutrition, exercise, mental well-being, and therapies. Multidisciplinary approaches are often suggested to help diagnosed individuals live a full life.
Cannabis has been looked to for its healing properties for millennia. To date, a plethora of diseases such as anorexia, emesis, pain, inflammation, neurodegenerative disorders, epilepsy, glaucoma, osteoporosis, schizophrenia, cardiovascular disorders, cancer, obesity, metabolic syndrome, and MS are either being treated with or have the potential to be treated by cannabinoid antagonists, agonists, and related compounds.
The efficacy of Cannabis sativa has been assessed for the management of MS at a cellular level but also for symptoms, including spasticity, pain, tremors, ataxia, bladder functions, sleep, and quality of life. Cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC), derived from the Cannabis sativa plant, have shown through research to have anti-inflammatory and antioxidant benefits.
Immune Cell Modulation
Toll-like receptors (TLRs) have been demonstrated through human and animal studies to be key players in MS pathogenesis. Data indicate that THC and CBD can act as TLRs modulating drugs in primary immune cells, offering insight to the cellular targets the phytocannabinoids may have in eliminating inflammation for MS. In one 2022 published study, the anti-inflammatory potential of THC and CBD were compared when delivered alone versus a 1:1 combination. The results highlight that the combination of the phytocannabinoids was more effective in modulating TLR signaling
Spasticity
A main psychoactive compound of the Cannabis sativa plant, THC, was discovered in the 1960s and was shown to have activity on the cannabinoid receptor 1 (CB1) in the brain. This has a big impact on the development of cannabinoid therapeutic drugs and their potential to alleviate MS-related spasticity.
Nabiximols (Sativex) is a cannabinoid based medication available in the United Kingdom. It comes in the form of a mouth spray in a 1:1 ratio of THC:CBD. It has been approved for treatment of symptoms of spasticity in adults with MS. A randomized controlled trial published in 2023 reported that nabiximols led to improvement in spasticity that was sustained over the 12-week treatment period. Another study in 2022 evaluated real-world data from the Italian Medicines Agency e-Registry on 1,138 patients with MS. Results showed favorable impacts of nabiximols, resolving a range of MS spasticity-associated symptoms at week 4 and after 18 months for those who continued treatment.
Pain
Pain associated with MS includes central neuropathic pain, musculoskeletal pain, and non-neuropathic pain. Cannabis use for pain can be traced back thousands of years. Observationally in research, the response to pain in individuals has been favorable when compared to baselines or controls.
A review of literature published through June 2017 examined trials regarding cannabinoid use for pain in patients with neuropathy and malignant diseases. Out of 18 trials, 15 demonstrated a significant analgesic effect of cannabinoids as compared to placebo, the reduction in pain intensity was considered clinically significant. The most commonly reported adverse effects were well tolerated.
Tremors and Ataxia
MS may cause tremors and ataxia in more than 80% of patients due to how it affects the cerebellum. Despite how common these symptoms may be, the pharmacotherapies are often ineffective, therefore there is a need for new treatments with limited side effects. Although one study in 1982 showed the ability of THC to suppress tremors in two of eight MS patients, another showed acute improvements in 1989 and benefits have been seen in mouse models, current human trials to understand cannabis as an effective therapy for tremors and ataxia are insufficient and still needed.
Bladder Function
A prevalent symptom in MS patients is lower urinary tract dysfunction, typically appearing in the later stages of the disease. The primary issues are urinary urgency and urge incontinence.
The diverse effects of CB1 and CB2 receptor systems in the lower urinary tract may be novel targets for cannabinoid therapy. Anecdotal reports suggest cannabis may alleviate lower urinary tract symptoms. An open trial published in 2004 evaluated whole-plant Cannabis sativa extracts for patients with advanced MS and refractory lower urinary tract symptoms. Patients began with a 1:1, THC:CBD ratio for eight weeks and then transitioned to THC only for an additional eight weeks. The 15 who were evaluated showed a significant decrease in incontinence with significant improvements in self-reported pain, spasticity, and quality of sleep. Given the few adverse effects, this study suggested cannabis-based medicinal extracts to be a safe and effective treatment.
Sleep
Cannabis Sativa is often used for improved sleep and relaxation, attributed to Indian hemp in the nineteenth century.
Hemp seeds contain a vitamin B6 content that can trigger the conversion of our body’s tryptophan into serotonin, which can then be converted to melatonin.
CBD has been researched for its therapeutic potential for sleep disorders through limiting symptoms that may keep us awake at night but also may contribute to an increase in sleep duration and depth, as well as decrease in the anxiety responses induced by sleep disturbance.
In comparison to CBD, THC has shown in studies as having an effect on mental and physical sedation, even in low amounts. THC also has positive therapeutic benefits that may lead to better sleep.
Cannabinoids CBD, THC, and CBN have been lightly studied for their effects in balancing melatonin production. Cannabinoids are also being studied to better understand the complementary relationship they have with melatonin. Data published in 2022 suggest that a CBD-melatonin formula could be competitive with synthetic-hypnotic drugs (i.e. Ambien, Unisom). The antioxidant activity of melatonin that benefits the brain network coupled with the pain reduction and anti-anxiety effects of CBD promoted a balanced sensation of wellbeing during sleep.
Quality of Life
MS patients have been found to have a lower health-related quality of life than the general population.
A qualitative analysis published in 2022 paid close attention to the notable quality of life improvements attributed to medicinal cannabis use. The two overarching categories were “enhanced well-being” and “improved daily functioning”. Enhanced well-being includes feelings such as regaining a sense of hope, enjoying family life, and laughing more often.
A review of published studies from 2007 to 2021 on cannabinoid therapy for MS concluded with a moderate certainty of evidence that 1:1 CBD:THC oromucosal spray mixtures as an add-on therapy improved measures of spasticity, pain, and bladder and sleep related quality of life in responders within weeks of starting treatment.
Conclusion
Cannabis sativa extracts show promise in alleviating associated symptoms of MS for individuals, so much so that countries have approved botanical or synthetic forms as treatment options. Further studies are warranted to investigate long-term outcomes, dosing, and understanding the mechanisms responsible for inhibiting neuroinflammation and enhancing neuroprotection.
If you or a loved one have questions on how cannabinoid therapy such as how to find a quality product or how to talk with your doctor, the Realm of Caring Care Team is here to help. Reach out, we are here to help.
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