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Can Cannabis Benefit People with Multiple Sclerosis?

Can Cannabis Benefit People with Multiple Sclerosis?

Despite numerous anecdotal testimonials from MS patients in favour of using cannabis for treating pain and providing spasticity relief, very little conclusive, evidence-based information is currently available. The MS Society of Canada states that while cannabis is generally used to manage MS pain and spasticity, it is not an approved medicine or treatment in Canada but that large well-controlled studies have been ongoing since 2019, to determine if cannabis or its chemical derivatives might play a role in the treatment of MS-related symptoms.  

Furthermore, the MS Society states the following: “Disease-modifying therapies for multiple sclerosis (MS) aim to either slow disease progression or manage symptoms of MS. Many individuals diagnosed with MS are using or considering using cannabis as part of their symptom management care plan. A recently published survey of people with MS showed that over 90 percent of the respondents have either considered using cannabis to manage their MS, have used it for MS, or have spoken to their healthcare provider about its use.”

What is Multiple Sclerosis?

Your brain, spinal cord and central nervous system are a jumble of wires and nerves that transmit messages all over your body. To transport messages from one part to another, the body uses special high-speed cables—bundles of axons coated by a fatty substance called myelin. To prevents short circuits, all nerves are covered with an insulation called myelin sheath. The coating insulates the bundles and speeds the transmission of electrical signals along this communication expressway, allowing for faster processing.

When you develop multiple sclerosis (MS) your immune system attacks the myelin. Scientists speculate that possibly it’s because the body mistakes it for a virus. Nerves then get injured, and your symptoms will depend on where the damage occurs. Problems range from vision abnormalities and fatigue to poor coordination and tingling sensations.

MS is defined as “a chronic, often disabling disease of the central nervous system comprising the brain, spinal cord and optic nerve” by the MS Society of Canada. The condition typically appears in people between the ages of 20 to 40. 

While the course of MS can be unpredictable, an acute flare-up is usually followed by a remission, which can last for some time, even years before another episode occurs. After an acute attack, your nerves begin to heal, forming scars, or plaques, over areas of myelin damage. (This process gives MS its name: Sclerosis is from the Greek skleros, which means hard, and multiple sclerosis connotes hard, patchy scarring along the nerves.) If this acute damage is too great, residual symptoms can persist. These may include weakness, fatigue, sensory loss, visual changes, dizziness, tremors, speech difficulties, trouble swallowing, urinary and bowel problems and mood swings. Eventually, if MS continues unchecked, you can lose the ability to walk as your muscles become increasingly difficult to control.

Some 50,000 Canadians have MS, which affects twice as many women as men. About 20% of cases are called benign MS: You have a single attack, which is never repeated. However, most people (up to 75%) have relapsing-remitting MS: You may be symptom-free between attacks, and months (even years) can go by before another flare-up, or relapse. Then there are the more various forms of the disease: secondary progressive, in which years of relapsing-remitting MS changes to continuous deterioration; primary progressive, in which deterioration is slow but constant, with no remission; and (very rarely) progressive-relapsing, in which continuous deterioration is interspersed with sudden episodes of new symptoms or worsened old ones.

Traditional Treatments and Medications

The goal of MS treatment is to stave off acute attacks (when nerve damage is likely to occur) as long as possible and then to manage all your symptoms effectively. Your success will depend on the type of MS you have. 

There are many pharmaceutical options for treating both the cause of MS and its symptoms. These medications are available only through prescription, so you’ll have to keep in close contact with your doctor, detailing what’s working and what isn’t. And if a drug doesn’t work, don’t despair. There’s usually something else to try.

For treating the disease itself, evidence suggests that interferon medications, if used early enough, can limit irreversible nerve damage and may slow the disease’s progression. So if you’ve had an initial attack, and are not on interferon, ask your doctor if it makes sense to start. Drugs often prescribed include interferon beta-1a (Avonex, Rebif) and beta-1b (Betaseron). Studies have found that all three reduce flare-ups for relapsing-remitting MS by 30%, and make attacks less severe if they do occur. Interferone works by suppressing inflammatory mechanisms in the immune system and blocking molecules that target myelin for attack. These drugs also have antiviral properties, which could be potentially beneficial because many experts believe that a virus may be one cause of MS.

Another helpful drug is glatiramer acetate (Copaxone), a synthetic molecule similar to a protein found in myelin. It works by tricking your immune system into attaching the drug instead of the myelin sheath. It’s most beneficial if started early in the disease, and its effectiveness increases the longer you take it.

For severe flare-ups, you may be put on corticosteroids, such as oral prednisone or intravenous methylprednisolone (Medrol). They reduce inflammation in the central nervous system and inhibit your immune system from attacking myelin. Unfortunately, steroids don’t change the progression of the disease and are not prescribed for milder flare-ups because they lose effectiveness if overused.

For the more serious forms of MS, your options are more limited. A drug called mitoxantrone (Novantrone) is the first one approved for treating secondary progressive MS. It’s shown some effectiveness at slowing relapses and the progression of the disease. Side effects however can be serious, including heart complications.

For relieving MS symptoms, there is a wide array of drugs that can be extremely helpful, especially in milder cases. Antispasmodics ease the muscle spasms that can accompany MS. These include botulinum toxin injections (Botox) and izandidine (Zanaflex). Tremors can be controlled with drugs like clonazepam (Rivotril) and primidone (Mysoline). Some people with MS develop urinary complications. For urge incontinence, in which the need to urinate comes on very suddenly, anticholinergic drugs, such as oxybutynin (Ditropan), are useful. If urinating is a problem drugs like maprotiline (Ludiomil) are a good choice. There are medications for sexual disfunction : sildenafil (Viagra) for men, low-dose corticosteroids for women.

Depression is common if you suffer from MS, due both to the effects of the disease on the brain and the impact of living with a degenerative condition. It’s important to talk to your doctor about the emotional side of this disease. Too many people try to conduct their lives in a “business as usual” fashion when they could be getting effective professional help.

Can MS Patients Benefit from Cannabis?

Despite the numerous anecdotal testimonials from MS patients in favour of using cannabis for treating pain and providing spasticity relief, very little conclusive, evidence-based information is available. 

There are two UK studies, one published in the Lancet (known as the Cannabinoids in Multiple Sclerosis (CAMS) study) and a more recent follow-up published in the Journal of Neurology, Neurosurgery & Psychiatry, one of the British Medical Journals, that focused on the effectiveness and long-term safety of cannabinoids in multiple sclerosis. Both studies were conducted under the same scientific research leadership.

The studies included 630 patients, aged 18 to 64 years, with stable MS with muscle spasticity. Overall, patients felt that these drugs were helpful in treating their disease. Patients were given oral tetrahydrocannabinol and there were no major safety concerns. The researchers concluded that a long-term placebo-controlled study is needed to establish whether cannabinoids may have a role beyond symptom amelioration in MS.

However, the researchers observed that “Cannabis and its component cannabinoids (particularly tetrahydrocannabinol, believed to be the major active cannabinoid) have been claimed anecdotally to improve symptoms related to multiple sclerosis (MS), although until recently there has been little scientific evidence of effect. There is also experimental evidence that cannabinoids may have a neuroprotective action. . . .However, there was evidence of improvement in walking time for ambulatory patients and in patient perceptions of spasticity, muscle spasms, pain, and sleep.”

Some MS patients are not waiting on further medical results to use cannabis to help manage their MS symptoms. They believe strongly that cannabis does help.

CBD and THC comes in many formulations at Medicanna and some patients suggest that a dosage of roughly 1:1 CBD to THC ratio may reduce pain and muscle spasm. Talk to your doctor about adding cannabis as an additional treatment. 

Cannabis may calm muscle stiffness and involuntary muscle movements. Medical cannabis may help to soothe spasms and allow you to move your arms and legs more easily.

Cannabis may help to ease an overactive bladder. One of the unpleasant symptoms of MS is the feeling of needing to go to the bathroom and medical cannabis is said to help ease the spasms that cause the frequent urge to pee.

Cannabis might reduce nerve pain. Medical cannabis has been widely reported to help ease the discomfort and pain of MS. It may also help you sleep better as well.

In a survey conducted by the National Multiple Sclerosis Society in the U.S., 66% of people with MS said they currently use cannabis for symptom treatment and that slightly more than half of the respondents believe cannabis has some benefit on their MS symptoms. Cannabis was mostly used for pain, spasticity/muscle tightness, and muscle spasms. The most common side effect mentioned by the cannabis users was slower cognitive processes. 

Sources:

The MS Society of Canada (head office is located in Toronto, but division offices are located in Dartmouth, Montreal, Toronto, Winnipeg, Regina, Edmonton, and Burnaby).

https://mssociety.ca/hot-topics/cannabis

“Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial” by JP Zajicek, HP Sanders, DE Wright, PJ Vickery, WM Ingram, SM Reilly, AJ Nunn, LJ Teare, PJ Fox, AJ Thompson. The Lancet, November 08, 2003. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)14738-1/fulltext

“Cannabinoids in multiple sclerosis (CAMS) study: safety and efficacy data for 12 months follow up” by JP Zajicek, HP Sanders, DE Wright, PJ Vickery, WM Ingram, SM Reilly, AJ Nunn, LJ Teare, PJ Fox, AJ Thompson. Journal of Neurology, Neurosurgery & Psychiatry, British Medical Journals, Volume 76, Issue 12. 2005.

https://jnnp.bmj.com/content/76/12/1664

“Multiple sclerosis” Wikipedia, https://en.wikipedia.org/wiki/Multiple_sclerosis

“Understanding Multiple Sclerosis (MS),” Healthline, https://www.healthline.com/health/multiple-sclerosis#takeaway

“Almost Half of US MS Patients Surveyed Report Using Cannabis for Nerve Pain, Sleep,” by Steve Bryson, October 9, 2020. Multiple Sclerosis News Today.com https://multiplesclerosisnewstoday.com/news-posts/2020/10/09/almost-half-us-multiple-sclerosis-ms-patients-report-cannabis-use-for-nerve-pain-sleep-nationwide-survey/

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