Cbd oil dosage for multiple sclerosis

CBD for MS (Multiple Sclerosis): What The Research Says

MS is a disorder involving the loss of insulation around the nerve fibers.

Learn how CBD can support symptoms & may be able to slow the progression of the disease.

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

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

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

MEDICALLY REVIEWED BY

Carlos G. Aguirre, M.D., Pediatric Neurologist

Updated on November 14, 2021

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Can CBD Oil Help With MS? What Are The Benefits?

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

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

CBD has also been shown to inhibit the ability for immune cells to attack the myelin sheathing on our nerve cells — which is the primary cause for MS.

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

Benefits of Using CBD for MS
  • Reduces neuroinflammation
  • Reduces muscle spasms
  • Prevents T-cell infiltration & slow disease progression
  • Alleviates nerve pain
  • Resists the development of autoimmunity
  • Supports bladder control

1. Inhibits Brain Inflammation

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. 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. May Prevent T-Cell Infiltration & Slow Disease Progression

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].

4. Alleviates 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 Multiple Sclerosis

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.

Tips for Getting the Most from CBD for Multiple Sclerosis
  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.

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.

What Type of CBD Products Are Best For MS?

The best option is to source a CBD product made with a full-spectrum extract.

These products include an array of cannabinoids, terpenes, and other phytochemicals from the cannabis plant. Each of these compounds work together to produce the overall effects of CBD oil.

With MS, it’s especially important to find oils that have third-party testing to prove they’re contaminant-free. Contaminants like arsenic, mercury, or cadmium can worsen the condition by causing further damage to the neurons.

There are a few products people with MS are using to support symptoms:

  • CBD Oils — this is the most common form of CBD supplement for MS
  • CBD Capsules — offer the same benefits of CBD oil without the need to do any measuring
  • CBD Gummies — similar to CBD capsules, but rarely available in full-spectrum forms
  • CBD Concentrates — shatters, waxes, and dabs deliver heavy doses of CBD in a small volume
  • CBD Vape Pens — these offer the fastest onset of effects, but have the shortest duration

What’s The Dose of CBD For Multiple Sclerosis?

The dose of CBD can vary from one person to another, so it’s important you take some time to see what works best for you.

With that said, most MS patients, and MS research, used a heavier dose than usual (around 2 mg per kg or more).

Use our CBD oil dosage calculator to help find the optimal dose based on your weight and desired strength of effects.

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What is Multiple Sclerosis (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 Are The Symptoms of MS?

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

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.

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.

There’s a chance CBD can interact with certain medications, so always check with your doctor before using it.

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

Final Verdict: Can CBD Help With Multiple Sclerosis?

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.

Safety and efficacy of low-dose medical cannabis oils in multiple sclerosis

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.

Copyright © 2020 Elsevier B.V. All rights reserved.

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