Can CBD Help Manage MS Symptoms?

Disease modifying therapies (DMTs) have made a huge difference in helping to slow the progression of multiple sclerosis (MS) and ward off future relapses. But since there’s no cure for MS, it’s not uncommon for people to manage symptoms like pain and muscle spasticity with complementary and alternative therapies (CAM) therapies.

One popular CAM therapy that’s been shown to help manage MS symptoms is cannabidiol, which is more commonly known by its acronym, CBD. CBD, along with other compounds found in the cannabis plant called cannabinoids, “are among the most commonly studied alternative therapies for pain in chronic neurological diseases, including MS,” says Tiffany J. Braley, M.D., an associate professor of neurology at University of Michigan Health in Ann Arbor, MI.

Despite the growing interest in research, though, there’s still a lot that experts don’t know about CBD—including how it might work to relieve MS symptoms and just how effective it really is. Let’s take a look at what the research shows so far, including potential benefits and how it may help.

CBD is just one of the many chemicals found in the Cannabis sativa (i.e., cannabis) plant. But unlike its more famous, mind-altering counterpart, tetrahydrocannabinol (THC), CBD doesn’t cause a “high.” (Although you may feel a bit more “mellow” when you take it, notes Harvard Medical School.) CBD itself is harvested from a form of the cannabis plant called hemp, which only contains small (i.e., less than 0.3%) amounts of THC.

It’s not exactly known how CBD works to ease certain MS symptoms, says Dr. Braley, but research suggests that cannabinoids work on an area of the brain called, appropriately, the endocannabinoid system, which is partly responsible for regulating stress, anxiety, and pain.

It’s believed that CBD binds to certain receptors in the endocannabinoid system and raises the levels of a chemical that’s linked with lower pain sensitivity, per a report in the American Journal of Psychiatry.

While CBD has been growing in popularity for about two decades, the possible benefits of the cannabis plant have been known for thousands of years. According to research published in the journal Nature, cannabis first made an appearance in a Chinese book of herbal remedies as far back as 2,700 B.C.

Because of its ability to moderate pain signals, some studies suggest that CBD can be effective at easing the symptoms of MS, but it’s not clear whether the benefits are due to the compound or to a placebo effect, says neurologist Michelle Cameron, M.D., a professor in the department of neurology at Oregon Health & Science University in Portland, OR.

Moreover, she says, some of the highest-quality research investigating the potential of CBD in MS was done using an oral spray that has a combination of CBD and THC, meaning it’s not clear if some of the benefits were due to THC. (Since CBD and THC are found together in the plant, it’s not always easy, or cost-effective, to separate the two, says Dr. Cameron.)

“Many people would prefer to use CBD alone, for legal reasons or because they don’t want to be intoxicated, but we don’t have data to know how CBD alone works,” she says.

Still, ongoing research suggests CBD in combination with THC can play in managing MS symptoms, including pain, spasticity, and inflammation, among others. Let’s take a closer look at the specific ways CBD may help with multiple sclerosis.

CBD and Pain

About 50% to 70% of people with MS will experience chronic pain (both perceived and through physical markers of pain) at some point during their disease course, according to research in Frontiers in Neurology. One Italian study found that when people with secondary progressive MS used an oral cannabinoid spray that contained both CBD and THC, they experienced a reduction in perceived pain as well as its physical markers.

Other research has found that CBD may help people reduce their use of opioid medication, which is prescribed for pain but can be highly addictive. One study found that when people with chronic pain were given CBD soft gels, 53% of them reported taking less opioids after two months.

CBD and Muscle Spasticity

Some of the early symptoms of MS include muscle spasticity, or stiffness, accompanied by painful muscle spasms. One research review, published in the Cochrane Database of Systematic Reviews, found that people with MS who used nabiximols—i.e., sprays that contain cannabinoids including CBD and THC—were 2.5 times more likely to report a decrease in the severity of spasticity compared to those who took a placebo. This may be because CBD and THC both have muscle-relaxing effects.

CBD and Inflammation

MS is an inflammatory autoimmune disease of the central nervous system that occurs when immune cells mistakenly attack myelin, the fatty tissue that helps to insulate part of neurons. Research published in Frontiers in Immunology suggests that CBD and TCH together can help halt this inflammation, although the study authors noted that it wasn’t clear why the compounds had this effect. They also found that while the combination of CBD and THC had this attenuating effect, neither compound on its own had the same benefit.

CBD and Depression

Inflammation can increase the risk of depression among people with MS, which can then interfere with their quality of life—including their ability to move, according to some research. The research on CBD and depression and is limited, but some animal studies suggests that CBD can act similarly to an antidepressant.

CBD and Fatigue

Fatigue is a common symptom of MS, but it can also be a side effect of CBD—so this may be one instance where supplementing your MS treatment with CBD can do more harm than good. According to a review published in Therapeutics Advances in Neurological Disorders, fatigue, along with dizziness, were among the most common side effects of CBD use among people with MS-induced spasticity, although the rate was relatively low, at 2.5%. A study published in the Journal of Cannabis Research found that people who used CBD for stress, anxiety, and sleep problems reported similar rates of fatigue.

If taken correctly, CBD is generally safe, even for people with MS, according to research. The medication is usually taken in doses of up to 200 milligrams, according to MedlinePlus, although there is currently a prescription CBD medication called Epidiolex, which is approved in the U.S. to treat seizures, and is used at higher doses.

Keep in mind, though, that the Food and Drug Administration (FDA) doesn’t regulate over-the-counter (OTC) products in the same way it does prescription medication, so it’s possible that CBD products may be contaminated with other ingredients, including THC, which can cause intoxication at higher doses, according to the National Center for Complementary and Integrative Health (NCCIH).

CBD itself has been shown to have side effects that include:

• Diarrhea

• Drug interactions

• Dry mouth

• Light headedness

• Liver injury

• Low blood pressure

• Sleepiness or drowsiness

Since CBD can cause sleepiness, taking it along with other drowsiness-causing supplements, such as melatonin, can exacerbate the effects, according to the NCCIH.

Even though the side effects of CBD products, if there are any, may be fairly mild, it’s a good idea to start off using small amounts or doses of a product, says Dr. Cameron. Because CBD can also cause fatigue, you should avoid using CBD products if you’re going to be driving or operating machinery.

Always tell your doctor if you’re using a CBD product since the compound can interact with other medications, such as blood thinners, and cause serious side effects or decrease the medication’s effectiveness.

CBD is available in a few different forms, according to the Centers for Disease Control and Prevention (CDC), including:

• Capsules

• Cosmetics

• Creams

• Foods (or “edibles,” such as gummies)

• Lotions

• Oils

There’s no good research showing that one form of CBD is better than another at relieving MS symptoms, so if you want to use a CBD product, you may want to try the products in various formats to see which one works for you, says Dr. Cameron.

“Physicians are sometimes asked by patients whether cannabinoids should be used by people with MS, and if so, which formulation and dose should be used, and which symptoms are most likely to respond,” says Dr. Braley. But these questions are largely still being asked by experts themselves, who are still studying them, she notes.

Given the complex picture that surrounds cannabis use, it can be confusing as to where you can legally purchase CBD products. While CBD is not considered a controlled substance, per the Food and Drug Administration, since it contains only very low levels of THC, the legality of CBD products still differs across states, according to the CDC.

And it’s not always clear where to buy quality CBD products online. A study published in JAMA found that 26% of CBD products purchased online contained less CBD than which was on the label; about 20% of the products were also contaminated with higher levels of THC.

“If you live in a state where marijuana is legal, you may do better buying [CBD] at a dispensary, because in most states, all the products in a dispensary have to be tested,” says Dr. Cameron. If marijuana isn’t legal where you live, consider purchasing CBD in a grocery store or health food store, she says.

CBD products may be more readily available, but can medical marijuana (also known as cannabis) provide similar benefits? While some research shows that smoking cannabis can help ease pain among people with treatment-resistant MS spasticity, other research has found that inhaled or ingested cannabis can cause problems with cognitive functioning.

Still, it’s not uncommon for people with MS who are curious about marijuana’s benefits to give it a try: One study in the International Journal of MS Care found that nearly 10% of people with MS say they’ve used marijuana in the past three months. A Canadian study found that more than half of Canadians with MS reported using some form of medical cannabis to manage their symptoms, including smoking or vaping the drug, or using concentrates or edibles.

That said, it’s thought that the risks of inhaling cannabis outweigh the benefits, although less is known about using cannabis in other forms, like tinctures or gummies.

While some research shows that CBD products may help ease some of the symptoms of MS including pain, spasticity, inflammation, and depression, it’s not clear whether the benefits were due to placebo effect or the combination of CBD and THC. If you want to try CBD, consider purchasing it from a local dispensary or in a health food store rather than online. And before you take it, make sure to talk to your doctor first to avoid any potential interactions.