CBD and Spasticity in Patients with Multiple Sclerosis
Multiple sclerosis is a serious and chronic autoimmune disease. Multiple sclerosis is when the immune system attacks nerves that are located between the brain and the body. Specifically, it attacks protective nerve coverings causing issues between the connection of brain and body. Over time, the brain and spinal cord become disabled. Currently, there is no cure for multiple sclerosis. However, there are treatment options for managing symptoms and slowing down the progression of the disease.1
What is multiple sclerosis?
As previously mentioned, multiple sclerosis is an autoimmune disease. The severity of the disease depends on the amount of nerve damage that has occurred. The most common disease course is known as relapsing-remitting MS. This disease course describes a person that has periods of time where symptoms occur, known as relapses. In this disease course, relapses are followed by temporary periods of recovery, or remissions. During remission, a person will not have any new symptoms. Events such as increases in body temperature can temporarily worsen symptoms of multiple sclerosis, but this is usually not considered a true relapse.1
- Numbness or weakness in limbs
- Electric shock sensations
- Lack of coordination
- Vision problems
- Slurred speech
- Problems with sexual, bowel, or bladder function
Multiple sclerosis is a serious disease. Many complications may develop due to multiple sclerosis such as paralysis, mental changes, epilepsy, and spasticity.1
What is spasticity?
Spasticity is present in about 80% of multiple sclerosis patients. Spasticity presents as an unusual muscle tightness. Muscle tightness is generated from a muscle contraction that is held for a long period of time. In other words, the muscle is flexed for a long time and it cannot move. In multiple sclerosis patients, spasticity tends to occur more frequently in the leg and hip muscles.
Treating spasticity can decrease pain associated with it, decrease the risk of joint deformities, and decrease the amount of muscle stiffness. Fortunately, there are multiple treatment options to reduce symptoms of spasticity.2
Is CBD oil a treatment option for multiple sclerosis?
There are a wide range of medications and therapy options for treating symptoms of multiple sclerosis. A natural treatment option to consider for symptom relief is CBD. CBD is used as add-on therapy for those with multiple sclerosis. CBD helps improve symptoms of muscle spasticity and reduces pain associated with multiple sclerosis.1 The physiology is of how CBD works to improve symptoms is not well understood. However, CBD has been shown to have pain relieving and anti-inflammatory properties.3
What is an oromucosal spray?
An oromucosal spray is a spray that is absorbed in the mouth through the cellular lining in the cheeks. A different section of the cheek must be used after each spray. A CBD oromucosal spray exists that contains both tetrahydrocannabinol (THC) and cannabidiol (CBD), which are both components of cannabis, as an add-on treatment for spasticity related to multiple sclerosis. THC has psychoactive properties while CBD helps muscle relaxation.3
The oromucosal formulation of CBD is currently the form of CBD that has the most evidence for benefiting multiple sclerosis symptoms. In other words, the oromucosal spray has some evidence that it is effective for spasticity and pain relief.1
Are there any studies for CBD use in multiple sclerosis?
Several studies have examined the use of CBD for multiple sclerosis patients. These studies observed CBD as an add-on therapy to pharmacotherapy to help with MS symptom relief and muscle spasticity. The main goal of these studies was to use the results to help improve overall quality of life in people with multiple sclerosis.
Muscle spasticity can weaken mental and physical abilities which impairs daily activities, such as driving. One study looked at the ability to drive for people with multiple sclerosis and symptomatic muscle spasticity. The objective of the study was to evaluate the use of THC:CBD products for people with multiple sclerosis and the impact it has on their driving ability. The study showed that driving performance did not worsen when people with multiple sclerosis used CBD to help with symptom relief, but it also did not improve. It is recommended to occasionally assess driving ability of patients with multiple sclerosis, especially after changes in therapy have been made and after relapses.5
A small study for a drug branded as Sativex® was also conducted for people with multiple sclerosis. Sativex® is a THC:CBD drug that is used in countries outside of the United States. Similarly, this study looked at driving ability of people with multiple sclerosis. Symptoms of muscle spasticity improved and driving ability was not negatively affected by the drug. Notably, common side effects included dizziness and vertigo.4
Another small study for people with multiple sclerosis was conducted to determine efficacy, safety, and tolerability of THC:CBD drugs for spasticity. Based off of the measured spasticity scoring rubric, patients showed improvements in symptoms of muscle spasticity.6
Have perspectives changed for CBD use in multiple sclerosis patients?
In one study, participants with multiple sclerosis were asked about their cannabis use for symptom relief. Of the participants, 26% had previously used it for their symptom relief and about 47% were considering using it for symptoms associated with multiple sclerosis. This research shows that a high interest exists for using cannabis as a therapy for symptoms related to multiple sclerosis. However, patients must have a discussion with their primary care provider to see if it is an appropriate option.7
Alternative therapies for multiple sclerosis
Non-pharmacotherapy options for multiple sclerosis symptom relief include:
- Yoga and meditation
- Healthy diet
- Physical therapy
- Occupational therapy1,2
These alternatives are important for improving comfort, improving body and muscle relaxation, and improving overall quality of life. Exercising and healthy dieting are both proven to increase mental and physical well-being. As previously mentioned, multiple sclerosis affects both mental and physical aspects of the body so being mindful of mental and physical health is imperative.1
Furthermore, physical therapy and occupational therapy are appropriate options for improving performance in daily activities. These therapies help to increase muscle function and strength. Having healthy muscle strength and coordination are good markers for success in performing daily tasks. This is important for developing a more independent lifestyle.2
Multiple sclerosis is a disease often worsens with time. There are periods of remission and relapse, which makes it a difficult disease to predict and manage. It is a serious disease that affects the body’s nerves and can cause negative consequences, such as muscle spasticity and pain. These symptoms lead to both mental and physical difficulties. However, there are some natural treatment options that are used as add-on therapy to medications for multiple sclerosis. A few options for natural treatment include a healthy diet, exercise, physical and occupational therapy, and some variations of CBD. CBD and THC combination drugs have been observed in multiple studies for the treatment of symptoms associated with multiple sclerosis. Some research shows that CBD improves symptoms of muscle spasticity and does not have a negative effect on driving ability in patients with multiple sclerosis. This is a promising add-on option for improving overall quality of life in patients with multiple sclerosis because patients may have more autonomy to complete daily activities and experience less pain associated with the disease. 1,2,3,4
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- “Multiple Sclerosis.” Mayo Clinic. 12 June 2020. https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269
- “Spasticity.” Health. Johns Hopkins Medicine. Sept. 2020. https://www.hopkinsmedicine.org/health/conditions-and-diseases/spasticity#:~:text=Spasticity%20is%20abnormal%20muscle%20tightness,Stroke
- Williamson, E M, and F J Evans. “Cannabinoids in clinical practice.” Drugs 60,6 (2000): 1303-14. doi:10.2165/00003495-200060060-00005
- Freidel, M et al. “Drug-resistant MS spasticity treatment with Sativex(®) add-on and driving ability.” Acta neurologica Scandinavica 131,1 (2015): 9-16. doi:10.1111/ane.12287
- Celius, Elisabeth G, and Carlos Vila. “The influence of THC:CBD oromucosal spray on driving ability in patients with multiple sclerosis-related spasticity.” Brain and behavior 8,5 e00962. 6 Apr. 2018, doi:10.1002/brb3.962
- Collin, C et al. “Randomized controlled trial of cannabis-based medicine in spasticity caused by multiple sclerosis.” European Journal of Neurology. 23 Feb. 2007, doi: 10.1111/j.1468-1331.2006.01639.x
- Stacey S. Cofield, et al. Perspectives on marijuana use and effectiveness. A survey of NARCOMS participants. Neurol Clin Pract Aug 2017, 7 (4) 333-343; DOI: 10.1212/CPJ.0000000000000383