Evidence based

CBD and Multiple Sclerosis: Current Research & Understanding

Multiple sclerosis is a debilitating neurodegenerative disorder. CBD can help to relieve inflammation, pain, fatigue, and other common symptoms.

Article By
Justin Cooke , posted 2 months ago

Multiple sclerosis (MS) is a debilitating neurodegenerative disorder affecting two and a half million people around the world.

This condition is still poorly understood, and as of yet, there’s no cure for the disease.

Cannabis extracts have recently been investigated for their potential role in treating the disease and its symptoms — and the results are promising.

In 2018, a cannabis-derived pharmaceutical medication called Sativex® was approved for the treatment of muscle contractions, bladder dysfunction, and nerve pain associated with MS.

In this article, you’ll learn how CBD and THC are used as a treatment for MS and its symptoms, and the limits of this all-natural approach.

  • Table of Contents

Summary: Using CBD for MS

A pharmaceutical preparation of CBD (cannabidiol) and THC (delta-9-tetrahydrocannabinol) — Sativex® — was approved by the FDA in 2018 as a treatment for MS.

Sativex® was shown to improve muscle spasms [7, 8, 9], bladder dysfunction [10], and nerve pain [11] — all of which are common symptoms of MS.

Sativex® comes as a spray containing a 1:1 ratio of THC to CBD and a trace amount of other select cannabinoids.

MS begins with low-grade inflammation in the brain. Specialized cells known as T-cells pass through the blood-brain barrier and congregate around the nerve fibers. These T-cells are one of the main components of our immune system. Think of them as our immune soldiers, deployed to fight infection.

In the case of MS, these T-cells decide to attack the myelin sheath around the nerve fibers — destroying and scaring them in the process. One of the primary aims of treatment is stopping these T-cells from going rogue and attacking the body, and preventing them from being passing the blood-brain barrier.

CBD has been shown to slow the movement of T-cells across the blood-brain barrier and limit the inflammatory reaction involved with the disease [4, 5, 6].

It’s important to remember that there is still no cure for MS — CBD and other medications can only slow the progression of the disease and treat individual symptoms.

Benefits of Using CBD for MS

  • Resists the development of autoimmunity
  • Reduces neuroinflammation
  • Keeps T-cells from congregating around the nerves
  • Reduces muscle spasms
  • Supports bladder control
  • Reduces nerve pain

Tips for Getting the Most from CBD for MS

  1. Make sure to check the quality of CBD products before buying — poor-quality products often contain contaminants that can make the condition worse. Look for certificates of analysis and companies that use organic hemp.
  2. Avoid relying on CBD gummies for your daily dose of CBD — gummies are high in sugar, which has been linked with MS. Oils, tinctures, or capsules are better options.
  3. Combine CBD supplementation with other diet and lifestyle modifications conducive to alleviating MS symptoms.
  4. Always speak with your doctor before taking CBD or other cannabis products — especially if taking other medications.

What is MS?

MS is an autoimmune condition affecting the myelin insulation around nerve cells. Without myelin, the nerves can’t transmit messages to the rest of the body or the brain.

The cause of MS is hard to determine in most cases but usually involves underlying autoimmune conditions. Autoimmunity happens when the body’s immune system begins attacking and destroying myelin on the nerve cells in the brain.

There is no cure for MS — most of the treatment options are aimed at slowing progression and easing symptoms.

MS can have different levels of severity from one person to the next — symptoms can be anywhere from mild to severe. However, the lifespan of those affected is generally the same as those without the disease. Some reports suggest a six-year difference between people with MS and those without.

What’s Happening in the Brain as a Result of MS?

Each of our neurons is coated with a fatty substance known as myelin. Its purpose is to speed up the electrical transmission as it moves down the neuron. MS causes a breakdown of this myelin and a buildup of scar tissue in its place (sclerosis).

When the myelin sheath is destroyed, electrical impulses can’t move through the nerve effectively and get lost before getting to the intended destination in the brain or elsewhere in the body. This means the message won’t reach its destination. Thoughts feel slowed, concentration is difficult, and body movements become clumsy as only some of these messages make it through. 

The myelin also prevents nerve impulses from affecting other nearby neurons — so without it, our neurons begin to “short-out” — sending electrical signals unintentionally. This accounts for a lot of the muscle spasms involved with MS.

Eventually, when there’s no myelin left, the affected neurons can no longer send messages at all. As this begins to happen, there are several negative symptoms depending on where the demyelination occurs. People with MS often experience bouts of dizziness, loss of bladder control, changes in the way they walk or move, hearing loss, vision loss, headaches, and fatigue.

Four Different Types of MS

1. Clinically Isolated Syndrome

This is the first episode of MS symptoms. Usually, the first sign of the disease is a sudden onset of symptoms that last more than 24 hours. When this happens only once, it’s referred to as clinically isolated. When these symptoms return, we can begin classifying them as a specific form of MS listed below.

2. Relapse-Remitting MS

This form of MS is characterized by bursts of intense symptoms followed by periods of remission. The condition gets gradually worse over time — often, over many years.

Roughly 85% of people with MS experience this form of the disease.

3. Primary-Progressive MS

This form of MS involves a steady progression of symptoms without remissions. It affects about 15% of MS cases on average.

Primary progressive MS involves a steady attack on myelin, producing a predictable worsening of symptoms over time.

Plateaus may occur from time to time, during which symptoms appear to remain the same for long periods. However, it’s unclear why some cases plateau for a while before continuing their progression. Good MS management will promote plateaus more often, but this isn’t always possible.

4. Secondary-Progressive MS

This is a hybrid of relapse-remitting and primary progressive MS. Symptoms generally start with initial episodes of relapse or remission before transitioning into something with a more steady progression of symptoms.

Symptoms of MS

  • Difficulty speaking (dysarthria)
  • Involuntary eye movements (nystagmus)
  • Tremors
  • Constipation
  • Sexual dysfunction
  • Visual abnormalities
  • Weakness
  • Spasticity
  • Urinary dysfunction
  • Cognitive impairment
  • Pins and needles
  • Seizures
  • Difficulty swallowing
  • Breathing disorders
  • Itchiness
  • Headaches

What Causes MS?

Roughly 1 in 700 people in the United States will be diagnosed with MS at some point in their lives. These figures are similar in other developed regions of the world. Twin studies on the condition have shown that although there are genetic components to the disease, it goes much deeper than that. With identical twins, if one has MS, the other only has a 30% chance of developing the condition — this is much lower than with other genetic disorders.

It’s hard to determine the individual causes of MS — it’s more than likely the condition is a combination of many different factors.

There are some factors that medical researchers have determined to be related to those affected. We call these risk factors for the condition. The more risk factors are present, the higher the chances of developing MS.

Risk Factors for MS

  • Age (most common between the ages of 20 and 50)
  • Gender (women are more than twice as likely to develop MS than men)
  • Ethnicity (European descent has the highest rate of MS)
  • Genetics (HLA-DR2 gene mutations may develop MS)
  • Vitamin D deficiency
  • Viral infection (EBV, cytomegalovirus, varicella zoster)
  • Other autoimmune conditions or atopy
  • Exposure to heavy metals

How Is MS Treated?

The most debilitating symptoms of MS are fatigue, muscle spasms/weakness, and nerve pain. Therefore, the primary treatment aim, aside from slowing the progression of the disease, is to address these symptoms as necessary.

Opiate and corticosteroid analgesics are often used to treat severe cases of pain. Otherwise, other analgesics such as acetaminophen are preferred because they produce fewer side-effects and less potential for addiction.

Cannabis extracts — including CBD and THC — are also popular treatments for the pain associated with MS.

Emotional changes are common with the condition, so antidepressants and mood stabilizers are often prescribed.

Common Medications for MS May Include:

  • Antidepressants — to treat depression as a symptom of the condition.
  • Anti-inflammatories — TNF-a, NF-kB, eicosanoid synthesis modulators, and glucocorticoids.
  • Aubagio (Teriflunomide) — used for relapse-remitting MS.
  • Cannabis extract (CBD) — helps relieve symptoms of MS and may slow the progression of the disease.
  • Copaxone (Glatiramer) — stops the immune system from attacking myelin.
  • Corticosteroids — used for acute flare-ups of symptoms.
  • Interferon beta 1a or 1b — slow the progression of the condition but may cause liver damage.
  • Mitoxantrone (Novantrone) — suppresses the immune system to stop attacks but can damage the heart.
  • Tysabri (Natalizumab) — last-resort medication as it can lead to infection in the brain.
  • Vitamin D — often given because vitamin D deficiency is considered a risk factor.

Research Involving CBD for MS

1. CBD Inhibits Neuroinflammation

MS, like many other medical conditions, is characterized by underlying inflammation in the brain and spinal cord. Inflammation itself is extremely complex, often involving dozens of inflammatory messengers each interacting differently with each other.

Researchers have highlighted key inflammatory messengers involved with MS — this is used to drive the development of new treatment options.

In the case of MS, the primary inflammatory markers involved include TNFα, IL-1β, IL-2, IL-6, IL-12, and IFN-γ. CBD has been shown to reduce the activity of all of these inflammatory markers and activate other inflammatory processes in the microglial cells that are found abundantly in the human brain [4, 5, 6].

The overall effect is a reduction in neuroinflammation driving the destruction of the myelin — the primary cause for disease progression.

2. CBD Reduces Muscle Spasticity

A 2012 meta-analysis analyzed a series of clinical trials from 1980 to 2012 to review the effects of CBD and THC on muscle spasticity associated with MS [13]. They found that, overall, CBD and THC extracts were well tolerated and offered improvement in symptoms even in patients who were unable to find relief with conventional anticonvulsant medications.

3. CBD Reduces Nerve Pain

Sativex® was involved in a series of clinical studies to determine its effects on the various symptoms of MS, including nerve pain [12]. This study found that those taking Sativex® had significantly reduced pain scores in the final week of treatment.

In other studies, CBD was demonstrated to be beneficial for various types of pain, including neuropathic pain [14], cancer pain [15], and arthritic pain [16].

Guide to Using CBD for MS

CBD is a useful supplement for alleviating symptoms of MS and may even be able to slow the progression of the disease.

Most of the research involving CBD for MS used a combination of CBD and THC at a 1:1 ratio. It appears these two cannabinoids work synergistically together to provide relief from symptoms.

In many countries, products containing THC are illegal. However, MS is one of the few conditions that medical cannabis is generally prescribed for — but this can vary according to your country.

Even if you can’t find products containing both THC and CBD, or don’t want the psychoactive effects from the THC, you can still use most CBD products. CBD will provide relief from several key symptoms of MS.

Step 1: Find the Best CBD Products for MS

As previously mentioned, products containing an even ratio of CBD:THC are likely going to have the most to offer. These products are not widely available, however, because they are illegal in most countries.

The second best option is to source a product made with a full-spectrum extract. This will include the whole array of cannabinoids, terpenes, and other phytochemicals from the cannabis plant.

There are plenty of high-quality full-spectrum CBD products on the market. Separating the good products from bad ones is as easy as skimming through reviews written by knowledgeable CBD users. This is an essential step because the CBD industry is poorly regulated and there is a lot of low-quality, contaminated products on the market.

With MS, contaminants can worsen the condition, so it’s crucial that you go with a product that’s been made from organic hemp and undergone third-party lab tests to confirm the absence of contaminants such as heavy metals or pesticides.

CBD comes in many different forms. Although all are going to be beneficial, there are positives and negatives to each.

For More Information on Finding the Best CBD Products, Check Out Some of Our Guides:

Step 2: Assess Optimal Starting Dosage

The next step is to outline the rough dosage you’re likely to need.

This can vary from one person to the next but can be estimated using your weight and the desired strength (low, medium, or high).

Recommended strength for MS: high strength

Here’s a convenient dosing chart to make calculating your dose as simple as possible.

Daily Doses of CBD by Weight and Strength (in mg)

Weight (lbs)Low StrengthMedium StrengthHigh Strength

100 lbs

10 mg

30 mg

60 mg

125 lbs

13 mg

38 mg

75 mg

150 lbs

15 mg

45 mg

90 mg

175 lbs

17 mg

52 mg

105 mg

200 lbs

20 mg

60 mg

120 mg

225 lbs

22 mg

67 mg

135 mg

250 lbs

25 mg

75 mg

150 mg

Final Verdict: Using CBD for MS

MS is a slow-progressing neurodegenerative disorder affecting the myelin sheath on the neuron cells. As the myelin breaks down, the neurons lose their ability to transmit electrical signals to other areas of the brain and body.

CBD and THC have both been extensively tested to establish their role in alleviating symptoms of this condition. It appears that an even ratio of the two compounds is going to offer the most benefit, but products containing a high CBD content still have positive effects.

We recommend using a full-spectrum product at the higher end of the dosage scale for this condition. It’s also critically important that your doctor monitors your CBD use to avoid negative interactions with other medications and to ensure the best possible outcome.


References

  1. Mecha, M., Feliú, A., Iñigo, P. M., Mestre, L., Carrillo-Salinas, F. J., & Guaza, C. (2013). Cannabidiol provides long-lasting protection against the deleterious effects of inflammation in a viral model of multiple sclerosis: a role for A2A receptors. Neurobiology of disease, 59, 141-150.
  2. Mechoulam, R., Peters, M., Murillo‐Rodriguez, E., & Hanuš, L. O. (2007). Cannabidiol–recent advances. Chemistry & biodiversity, 4(8), 1678-1692.
  3. Kozela, E., Pietr, M., Juknat, A., Rimmerman, N., Levy, R., & Vogel, Z. (2010). Cannabinoids Δ9-tetrahydrocannabinol and cannabidiol differentially inhibit the lipopolysaccharide-activated NF-κB and interferon-β/STAT proinflammatory pathways in BV-2 microglial cells. Journal of biological chemistry, 285(3), 1616-1626.
  4. Kozela, E., Lev, N., Kaushansky, N., Eilam, R., Rimmerman, N., Levy, R., … & Vogel, Z. (2011). Cannabidiol inhibits pathogenic T cells, decreases spinal microglial activation and ameliorates multiple sclerosis‐like disease in C57BL/6 mice. British journal of pharmacology, 163(7), 1507-1519.
  5. Croxford, J. L., Olson, J. K., Anger, H. A., & Miller, S. D. (2005). Initiation and exacerbation of autoimmune demyelination of the central nervous system via virus-induced molecular mimicry: implications for the pathogenesis of multiple sclerosis. Journal of virology, 79(13), 8581-8590.
  6. Notcutt, W., Langford, R., Davies, P., Ratcliffe, S., & Potts, R. (2012). A placebo-controlled, parallel-group, randomized withdrawal study of subjects with symptoms of spasticity due to multiple sclerosis who are receiving long-term Sativex®(nabiximols). Multiple Sclerosis Journal, 18(2), 219-228.
  7. Woerly, S., Marchand, R., & Lavallée, G. (1991). Interactions of copolymeric poly (glyceryl methacrylate)-collagen hydrogels with neural tissue: effects of structure and polar groups. Biomaterials, 12(2), 197-203.
  8. Wade, D. T., Collin, C., Stott, C., & Duncombe, P. (2010). Meta-analysis of the efficacy and safety of Sativex (nabiximols), on spasticity in people with multiple sclerosis. Multiple Sclerosis Journal, 16(6), 707-714.
  9. Brady, C. M., DasGupta, R., Dalton, C., Wiseman, O. J., Berkley, K. J., & Fowler, C. J. (2004). An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis. Multiple Sclerosis Journal, 10(4), 425-433.
  10. Barnes, M. P. (2006). Sativex®: clinical efficacy and tolerability in the treatment of symptoms of multiple sclerosis and neuropathic pain. Expert opinion on pharmacotherapy, 7(5), 607-615.
  11. Rog, D. J., Nurmikko, T. J., & Young, C. A. (2007). Oromucosal Δ9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: an uncontrolled, open-label, 2-year extension trial. Clinical therapeutics, 29(9), 2068-2079.
  12. Leussink, V. I., Husseini, L., Warnke, C., Broussalis, E., Hartung, H. P., & Kieseier, B. C. (2012). Symptomatic therapy in multiple sclerosis: the role of cannabinoids in treating spasticity. Therapeutic advances in neurological disorders, 5(5), 255-266.
  13. Costa, B., Trovato, A. E., Comelli, F., Giagnoni, G., & Colleoni, M. (2007). The non-psychoactive cannabis constituent cannabidiol is an orally effective therapeutic agent in rat chronic inflammatory and neuropathic pain. European journal of pharmacology, 556(1-3), 75-83.
  14. Johnson, J. R., Lossignol, D., Burnell-Nugent, M., & Fallon, M. T. (2013). An open-label extension study to investigate the long-term safety and tolerability of THC/CBD oromucosal spray and oromucosal THC spray in patients with terminal cancer-related pain refractory to strong opioid analgesics. Journal of pain and symptom management, 46(2), 207-218.
  15. Hammell, D. C., Zhang, L. P., Ma, F., Abshire, S. M., McIlwrath, S. L., Stinchcomb, A. L., & Westlund, K. N. (2016). Transdermal cannabidiol reduces inflammation and pain‐related behaviours in a rat model of arthritis. European Journal of Pain, 20(6), 936-948.

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