Introduction: The use of cannabis as medical therapy to treat chronic pain and spasticity in patients with multiple sclerosis (MS) is increasing. However, the evidence on safety when initiating treatment with medical cannabis oils is limited. The aim of this study was to investigate the safety of sublingual medical cannabis oils in patients with MS.
Methods: In this prospective observational safety study 28 patients with MS were treated with medical cannabis oils (THC-rich, CBD-rich and THC+CBD combined products) and were followed during a titration period of four weeks. Patients were evaluated at treatment start (Visit 1) and after four weeks treatment (Visit 2). At each visit neurological examination (Expanded Disability Status Scale – EDSS), ambulation (Timed 25-Foot Walk Test – T25FWT), routine blood tests, plasma cannabinoids, dexterity (9-Hole Peg Test – 9-HPT) and processing speed (Symbol Digit Modalities Test – SDMT) were tested. Adverse events (AEs) and tolerability were reported at Visit 2. Secondary, efficacy of medical cannabis on pain, spasticity and sleep disturbances were measured by numeric rating scale (NRS-11) each day during the 4-week treatment period.
Results: During treatment with cannabis preparations containing 10-25 mg/mL THC, the most common AEs were dry mouth, drowsiness, dizziness and nausea of mild to moderate degree. Two patients experienced pronounced symptoms with excessive dreaming and drowsiness, respectively, which led to treatment stop during the titration. Three serious adverse events (SAE) were reported but were not associated with the treatment. Mean doses of THC and CBD were 4.0 mg and 7.0 mg, respectively, and primarily administered as a once-daily evening dose. Furthermore, pain decreased from a median NRS score of 7 to 4, (p = 0.01), spasticity decreased from a median NRS score of 6 to 2.5 (p = 0.01) and sleep disturbances decreased from a median NRS score of 7 to 3 (p < 0.001). No impairment in disability, ambulation, dexterity or processing speed was observed.
Conclusion: Treatment with medical cannabis oils was safe and well tolerated, and resulted in a reduction in pain intensity, spasticity and sleep disturbances in MS patients. This suggests that medical cannabis oils can be used safely, especially at relatively low doses and with slow titration, as an alternative to treat MS-related symptoms when conventional therapy is inadequate.
CBD products are either made from hemp or marijuana, says Ben Thrower, M.D., medical director of the Andrew C. Carlos MS Institute at the Shepherd Center in Atlanta, GA, and senior medical adviser for the Multiple Sclerosis Foundation. Both are types of cannabis, but CBD products from hemp contains only trace amounts of THC, while CBD from marijuana—only legal in some states—can contain higher amounts of THC.
You’ve got the facts, and you’re interested in trying CBD for your MS symptoms. What now? Check with your doctor, says Dr. Thrower. “Patients should discuss all complementary therapies with their health care team,” he explains. That way, everyone is in the know. But keep in mind: “Health care providers have varying comfort levels and knowledge about the use of cannabis products in MS,” Dr. Thrower says. “Reputable stores selling CBD products may be able to help with product selection and dosing.”
Muscle tightness and involuntary spasms are other common symptoms caused, in part, by the pathways to the brain and spinal cord being compromised. “Spasticity in MS occurs because of issues in the CNS, not in the muscles,” says Costello. “So if you alter the pathways in the brain and spinal cord with CBD, then may you alter the pathways that control muscle as well.” Those changes in the CNS pathways may reduce spasticity—and in turn, help increase mobility.
Pain affects about two-thirds of people with MS. The most common type is known as central neuropathic pain, a.k.a. nerve pain. This type of pain is often felt as sharp stinging or burning sensation, and research suggests that some cannabinoid receptors in the CNS play a role in the processing of these sensations. For that reason, if you’re looking to relieve MS pain, “the interaction between CBD and those receptors may lead to a reduction in discomfort,” Costello says.
If you’re looking to treat MS symptoms, certain types of CBD may be more helpful for certain symptoms, says Dr. Thrower. “I have found oral hemp-based CBD oils to be helpful for sleep and anxiety in MS. Topical CBD may help with joint pain and muscle tightness,” he says. “If we want to manage more severe spasticity or burning pain in MS, I find that we need to use oil containing higher amounts of THC.” (Remember—THC products aren’t legal in every state.)