Introduction 

Multiple sclerosis (MS) is an immune-mediated neurological disease. MS is the most common neurological disease and leads to long-term progressive physical, psychological, and cognitive disability in young adults. Amongst people with MS, a lot experience chronic pain that originates in the central nervous system (brain and spinal cord) due to nerve damage caused by MS. Additionally, most people experience spasticity which refers to muscle stiffness or involuntary muscle contractions, which can make movement difficult and/or painful. Over the past few decades, cannabis has been put forward as a treatment option to address these symptoms and improve the quality of life in MS patients.¹ 

Multiple sclerosis

Multiple Sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system, specifically the brain and spinal cord. In MS, the immune system mistakenly attacks the protective covering of nerve fibres, known as myelin, leading to inflammation and damage. This disruption in communication between the brain and the rest of the body can result in a variety of neurological symptoms. The exact cause of MS is still not fully understood, but it is believed to involve a combination of genetic predisposition and environmental factors, such as viral infections, which may trigger the immune response.

Symptoms

MS presents a diverse range of symptoms that can vary significantly from person to person. Some of the most common symptoms include:

• Fatigue: can be weakening and affect daily activities and productivity
• Pain: many individuals experience chronic pain, including neuropathic pain, which can significantly impact comfort and overall quality of life
• Spasticity: muscle stiffness and involuntary spasms can lead to mobility challenges, making physical activities difficult
• Cognitive impairment: difficulties with memory, attention, and problem-solving can hinder daily functioning and work performance
• Visual disturbances: problems such as blurred vision or double vision may occur, affecting a person's ability to perform tasks safely
• Emotional changes: MS can contribute to mood swings, anxiety, and depression, further complicating the overall experience of living with the disease

The cumulative effect of these symptoms can lead to a reduced quality of life, as individuals with MS may struggle with physical limitations, emotional challenges, and social isolation. Managing these symptoms effectively is crucial for improving the overall well-being of MS patients and enabling them to maintain their independence and engage in daily activities.²

Challenges in managing MS symptoms

Conventional treatments for MS primarily include disease-modifying therapies (DMTs), corticosteroids, and symptomatic medications. While these treatments can help manage the progression of the disease and alleviate certain symptoms, they also come with limitations and potential side effects.

• Disease-modifying therapies (DMTs): aim to reduce the frequency and severity of relapses and slow the progression of disability. However, DMTs often have a delayed onset of action, may not work for everyone, and can have significant side effects, including flu-like symptoms, liver issues, and an increased risk of infections
• Corticosteroids: frequently used to manage acute relapses, corticosteroids can provide rapid symptom relief. However, their long-term use can lead to adverse effects such as weight gain, mood swings, osteoporosis, and diabetes
• Symptomatic medications: medications for managing specific symptoms like spasticity, pain, and fatigue are often prescribed. Yet, many of these medications come with side effects that can impact a patient’s quality of life. For instance, muscle relaxants may cause drowsiness or dizziness, while pain medications, particularly opioids, carry risks of dependence and addiction

Due to these limitations, patients may find conventional treatments insufficient in managing their symptoms or experience unwanted side effects affecting their overall well-being.³

Alternative therapies

Given the challenges associated with conventional treatments, there is a growing need for alternative therapies to enhance patient outcomes. Many individuals with MS seek additional options to manage their symptoms more effectively and improve their quality of life.

Alternative therapies can include:

• Medical cannabis: it is increasingly recognised for its potential benefits in alleviating pain, spasticity, and other MS symptoms and may complement existing treatments
• Physical therapy and rehabilitation: tailored exercise programs can improve mobility, strength, and overall physical functioning
• Psychological support: mental health support, including counselling and support groups, can address the emotional challenges associated with MS and improve coping strategies
• Diet and lifestyle modifications: integrative approaches focusing on nutrition and lifestyle changes may also help

By exploring and integrating alternative therapies, MS patients may achieve better symptom control, reduced reliance on traditional medications, and ultimately an improved quality of life.⁴

Medical cannabis in history

Cannabis has been used therapeutically for nearly 5,000 years, with early records found in ancient Chinese medicine. It was introduced to Western medicine in 1841 by Irish physician William O’Shaughnessy. 

In recent years, medical cannabis has made a comeback, especially for pain management, with many patients reporting significant relief and reduced reliance on opioids. Studies show that most patients using cannabis for pain-related conditions medicate daily, with inhalation being the preferred method. While cannabis remains the most commonly used illicit drug globally, a lot of people consume it for medicinal purposes, highlighting its growing acceptance as a therapeutic agent.⁵

Cannabis components

Cannabis produces two predominant compounds.

Psychoactive tetrahydrocannabinol (THC)

‘Psychoactive’ refers to substances that affect a person’s mental state by influencing the brain and nervous system. THC’s psychotropic effects result from its interaction with the endocannabinoid system, particularly receptors in the brain which can influence mood, memory, perception, and cognitive function. This interaction leads to a range of psychotropic effects, including euphoria, altered sensory perception, impaired short-term memory, and changes in mood or cognition. 

THC can also cause relaxation and pain relief, but at higher doses, it may result in anxiety, paranoia, or hallucinations. The extent of these effects depends on the dosage, method of consumption, and individual sensitivity to THC.

Non-psychoactive Cannabidiol (CBD) 

CBD is non-psychoactive but contains mild psychotropic properties, which can influence mental states and brain function. Its effects involve multiple pathways and interactions with various receptors, including serotonin, amma-aminobutyric acid (GABA), and TRPV1 receptors, as well as the endocannabinoid system.

These interactions have anti-anxiety, elevated mood, and neuroprotection effects without resulting intoxication. By enhancing serotonin, anandamide levels, and GABA activity, CBD promotes relaxation, mood stabilisation, and stress relief. Its anti-inflammatory and neuroprotective properties also contribute to overall mental well-being.

Reducing inflammation in nerve cells for their protection

One of the key therapeutic properties of cannabis is its ability to reduce neuroinflammation and protect nerve cells from damage. In conditions like Multiple Sclerosis (MS), where inflammation in the central nervous system plays a major role in disease progression, cannabis's anti-inflammatory effects can be highly beneficial. 

Cannabinoids interact with CB1 and CB2 receptors in the endocannabinoid system, helping to modulate immune responses and reduce the production of pro-inflammatory molecules. Cannabis can prevent further damage to the myelin sheath which is attacked in MS.

Potential to slow disease progression and reduce symptom severity

Cannabis's neuroprotective properties extend beyond reducing inflammation. Studies suggest that cannabinoids can also promote the survival and regeneration of nerve cells. This protective effect can help preserve the integrity of neural pathways, potentially slowing down the progression of neurodegenerative diseases like MS. By protecting against the loss of neurons and maintaining neural communication, cannabis may also reduce the severity of symptoms such as pain, spasticity, and cognitive impairment.^5,6

While further research is needed to fully understand the long-term effects of cannabis on MS progression, its neuroprotective and anti-inflammatory benefits offer a promising avenue for improving both symptom management and overall disease outcomes.⁷

Symptom relief in MS patients using medical cannabis

Pain management

Medical cannabis has shown promise in reducing chronic neuropathic pain associated with MS, a symptom that is often resistant to conventional pain medications. Cannabinoids such as THC and CBD provide relief by targeting pain pathways in the central nervous system.

Reduction of spasticity

Cannabis has demonstrated efficacy in reducing muscle stiffness and involuntary spasms, which are common in MS patients. By interacting with the CB1 receptors in the brain and spinal cord, cannabinoids can relax muscles and reduce the frequency of spasms.

This improves mobility and overall comfort, enabling MS patients to perform daily activities better and maintain independence.

Fatigue and sleep issues management

Fatigue and sleep disturbances are common amongst people with MS, often worsening other symptoms. Cannabis, particularly strains rich in CBD, can help promote relaxation and improve sleep quality.

Improved sleep contributes to better daily functioning and increased energy levels, enhancing the ability to cope with the disease.⁸

Benefits of medical cannabis over traditional medications

Reduced dependence on pharmaceuticals

One of the significant advantages of medical cannabis is its potential to reduce reliance on conventional medications such as opioids, muscle relaxants, and anti-spasticity drugs.

Many report a decrease in their use of these medications, which often come with serious side effects and the risk of dependence. Cannabis offers a natural alternative with fewer long-term risks.

Fewer side effects

Traditional medications used to manage MS symptoms can cause side effects like drowsiness, digestive issues, and dependency. In contrast, medical cannabis is generally well-tolerated by most patients, with fewer and more manageable side effects.

Improvement in mood and mental health

MS is often accompanied by emotional challenges such as anxiety, depression, and stress. CBD, known for its anxiolytic properties, can help alleviate these mental health issues, providing a calming effect without the intoxicating effects of THC.

This leads to enhanced emotional well-being and an improved ability to cope with the chronic condition, supporting better overall mental health for MS patients.^5,6

Summary

Multiple sclerosis (MS) is a common neurological disease that affects young adults, causing long-term physical, psychological, and cognitive disabilities. Many people with MS experience chronic pain and spasticity, making movement difficult. Cannabis has been proposed as a treatment to relieve these symptoms and improve quality of life. MS occurs when the immune system attacks the myelin-covering nerve fibres, leading to various symptoms such as fatigue, pain, spasticity, and cognitive impairment amongst other symptoms. Managing MS symptoms can be challenging with conventional treatments like disease-modifying therapies (DMTs) and corticosteroids, which may have side effects. Alternative therapies are being explored, including medical cannabis, physical therapy, mental health support, and lifestyle changes. Medical cannabis, with compounds like THC and CBD, may help relieve pain, reduce spasticity, and improve sleep and mood. It can reduce reliance on traditional medications and comes with fewer side effects, potentially enhancing the overall well-being of MS patients.