Cbd oil for transverse myelitis

Cannabidiol to Improve Mobility in People with Multiple Sclerosis

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Multiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS) that affects an estimated 2.3 million people worldwide (1). The symptoms of MS are highly varied but frequently include pain, muscle spasticity, fatigue, inflammation, and depression. These symptoms often lead to reduced physical activity, negatively impact functional mobility, and have a detrimental impact on patients’ quality of life. Although recent years have seen significant advances in disease modifying therapy, none of the current treatments halts or cures MS related symptoms (2). As a consequence, many people with MS (PwMS) look for alternative and complementary therapies such as cannabis.

The cannabis plant contains many biologically active chemicals, including ~60 cannabinoids (3). Cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) are typically the most concentrated chemical components of cannabis and believed to primarily drive therapeutic benefit. There is evidence that CBD has a number of beneficial pharmacological effects (4, 5). It is anti-inflammatory, antioxidative, antiemetic, antipsychotic, and neuroprotective. The review of 132 original studies by Bergamaschi et al. (6) describes the safety profile of CBD by highlighting that catalepsy is not induced and physiological parameters (heart rate, blood pressure, and body temperature) are not altered. Moreover, psychomotor and psychological functions are not negatively affected. High doses of up to 1,500 mg per day and chronic use have been repeatedly shown to be well tolerated by humans (6). Additionally, there is also evidence that CBD may reduce the negative psychotropic effects, memory impairment, and appetite stimulation, anxiety and psychotic-like states of THC while enhancing its positive therapeutic actions (7, 8).

Currently, many PwMS utilize cannabis to manage a variety of symptoms. Kindred et al. (9) showed in a web-based survey, which was hosted by the National Multiple Sclerosis Society that 66% of PwMS currently use cannabis for symptom treatment. Furthermore, a study from Canada found that approximately 50% of PwMS would consider the usage of cannabis if the legal status is clear and scientific evidence is available (10). Cannabis is legal in twenty-nine states for the use of specific medical conditions—including MS. Sixteen more states have passed laws that explicitly allow the medical use of CBD. It is suggested that recent increases in the social acceptance of CBD will lead to increases in the number of PwMS using cannabis to treat their symptoms. Anecdotal reports indicate that an increasing number of PwMS use cannabis (medical marijuana) as a supplement to improve their mobility.

Based on the following considerations, it is our opinion that CBD supplementation maybe advisable for PwMS to reduce fatigue, pain, spasticity, and ultimately improve mobility. An overview of the potential impacts of CBD on mobility of PWMS is show in Figure ​ Figure1 1 .

Impacts of CBD on mobility.

Cannabidiol Reduces Spasticity, Pain, Inflammation, Fatigue, and Depression in PwMS

Despite the common use of and interest in cannabis by people with MS (PwMS), there is very limited empirical data pertaining to its impact on physical mobility. The benefits related to cannabis use in PwMS are still under investigation. However, data indicates that cannabis, with 1:1 or greater CBD:THC ratio, reduces muscle spasticity (11) and pain in PwMS (12). The American Academy of Neurology (13) has highlighted cannabis’ safety profile as well as these benefits. However, there are currently no studies, which investigated the effects of cannabis on mobility in PwMS, some studies have suggested that cannabinoids may exert positive effects on health by decreasing inflammation and decreasing pain (6). Furthermore, inflammation plays an important role in the generation of MS related fatigue (14). Specifically, chronic peripheral inflammation and a resulting overactivity of the vagus nerve are related to fatigue in PwMS (14). There is indirect evidence that reductions in spasticity, pain, and fatigue may result in improvements in the mobility of PwMS (15–17). Furthermore, it is suggested that CBD showed a dose-dependent antidepressant-like effect in the animal model (18). The exact mechanism underlying such activity is still unknown. Depression is an important contributory factor to the observed impaired mobility in PwMS (15). Based on extant evidence we propose that the impact of cannabidiol (CBD) on mobility to be investigated.

Cannabis Reduces the Usage of Prescription Drugs, Particularly Pharmaceutical Opiods, Benzodiazepines, and Antidepressants

These medications continue to be widely prescribed in the majority of PwMS suffering from pain, spasticity, anxiety, and panic disorders. Common side effects of opioid administration include physical dependence, dizziness, sedation, nausea, vomiting, tolerance, constipation, and respiratory depression. Physical dependence and addiction are clinical concerns that may prevent accurate prescribing and in turn insufficient pain management. Traditional benzodiazepines are associated with sleep disturbances and anterograde amnesia. Another concern with long duration benzodiazepines such as diazepam or flurazepam, is drowsiness and “hangover effect.” Antidepressants can cause a wide range of unpleasant side effects, including nausea, fatigue and drowsiness, blurred vision, dizziness, and anxiety. It is obvious that those drugs delay or even prevent successful physical rehabilitation. A recent epidemiological study by Piper et al. (19) showed that among people that frequently used opioids, over three-quarters (77%) indicated that they reduced their use since they started cannabis. Approximately two-thirds of patients decreased their use of antianxiety (72%), migraine (67%), and sleep (65%) drugs following medical cannabis which significantly exceeded the reduction in antidepressants or alcohol use. Complete or part replacement of these drugs by specific cannabis products should definitely be the long-term goal.

However, objections to the notion that cannabinoids should be used to improve the mobility in PwMS include the following: (1) limited scientific evidence for the effectiveness of cannabis on mobility in PwMS; (2) uncertainty of legal status; (3) social stigmatization from friends, family, and authorities such as employers, landlords, and law enforcement; (4) incidence of dependency; and (5) negative psychoactive effects of cannabis. These objections have some merit and should be taken into consideration. It is important to note that the psychoactive effects of cannabis, such as cognitive impairments, psychosis, and anxiety are due to tetrahydrocannabinol (THC). However, CBD has antipsychotic properties and can also counter several negative side effects of THC. Most PwMS prefer to avoid feeling high. Therefore, individuals should seek out strains of cannabis containing equal or higher levels of CBD, compared to THC. Another concern is the risk of addiction. It is estimated that ~9% of individuals utilizing cannabis will become dependent on the drug (20). Although a significant risk, this incidence of dependency is significantly lower than that of approved chronic pain management pharmaceuticals (21). Observing for cannabis dependency is suggested for all patients.

Things to Consider

CBD-Drug Interactions

Serious drug interactions have not been seen with CBD in combination with any other drugs.

However, CBD and other plant cannabinoids can potentially interact with many pharmaceuticals. For example, the activity of liver enzymes such as cytochrome P450 is impacted. More than 60 percent of marketed pharmaceuticals are metabolized by this group of enzymes. At high enough dosages, CBD will temporarily deactivate these liver enzymes, thereby altering how a wide range of compounds is metabolized. The exact mechanisms are unknown and more human studies, which monitor CBD-drug interactions are needed (22). PwMS who are taking any prescription medications are strongly advised to consult with a medical professional.

Labeling Accuracy of CBD Extracts

A major concern is the often labeling accuracy of CBD extracts. Bonn-Miller et al. (23) found a wide range of CBD concentrations among CBD products purchased online. The tested products contain 26% less CBD than labeled, which could negate any potential clinical benefit. The over labeling of CBD products and that THC was detected (up to 6.43 mg/mL) in 18 of the 84 samples tested suggest that there is a need for federal and state regulatory agencies to take steps to ensure label accuracy of CBD products sold online and in dispensaries.

Can a Cannabidiol User Test Positive for Marijuana?

In the CBD products without THC, then a urine test would not yield a positive result for THC metabolites. However, most CBD products contain minimal amounts of THC in CBD. An important aspect in cannabinoid compounds is the entourage effect. The entourage effect means that the compounds in cannabis work more sufficient together than if the compounds are isolated. Therefore, CBD products may contain more cannabis compounds, including THC, to increase the effectiveness of the product (7). Furthermore, often a study by Merrick et al. (24) is cited which showed that CBD could be converted into THC after prolonged exposure to “simulated” gastric acid. However, there is no scientific evidence that this reaction occurs in vivo in humans (25). If someone is using a CBD product and needs to undergo urine drug tests, lab reports should be requested and examined to ensure that the CBD product contain exactly what is expecting and on the label.

It is clear that more research is needed. However, because of the safety of CBD and if the concerns listed above are accounted, we are in the opinion that we already have some good reasons to believe that CBD enriched cannabis is useful to improve the mobility of PwMS.

Author Contributions

TR and JS contributed to drafting the article and revising it critically for important intellectual content. All the authors approved the final version of the manuscript.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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CBD Oil and MS: Is Cannabis Oil a Miracle for Multiple Sclerosis?

CBD — short for cannabidiol — has a long list of well-documented health benefits. People use CBD oil to improve general well-being and to alleviate a wide range of symptoms, from anxiety to pain, inflammation, and neurological problems.

However, some areas where CBD could potentially help, are yet to be thoroughly examined.

Such is the case of using CBD oil for multiple sclerosis (MS).

Many MS patients are successfully taking cannabidiol, claiming it helps with their symptoms and repairs damaged nerves.

Current research shows that extracts like CBD oil can be effective in reducing pain and spasms in MS patients.

But can CBD oil actually treat multiple sclerosis?

Unfortunately, the research is still inconclusive. In this article, we’ll cover the most important aspects of using CBD oil for MS — including the benefits, different consumption methods, and possible side effects.

What is Multiple Sclerosis?

Multiple Sclerosis is a self-aggressive disease where the body’s immune system attacks the central nervous system (CNS). Scientists are still trying to discover the exact cause of MS; however, the general consensus is that this disease may be triggered by a combination of genetic and environmental factors.

Currently, about 2.3 million people in the US suffer from MS. The majority of diagnosed patients are between their 20s and 50s — it’s unclear why some people have this condition while others don’t.

Multiple Sclerosis damages the protective layer around nerve fibers (myelin). When the CNS notices the patches of scars left behind by an aggressive immune system, it starts to send false signals to the brain — leading to an array of symptoms.

In some people, these symptoms are relatively mild like extensive fatigue, while other cases involve severe pain, involuntary muscle cramps, impaired memory and focus, and vision problems.

When left untreated, multiple sclerosis may result in partial or complete paralysis.

Types of Multiple Sclerosis

There are 4 main forms of multiple sclerosis based on the type and severity of symptoms:

Relapsing-Remitting (RRMS)

This is the most prevalent type of MS and affects about 85% of patients diagnosed with MS.

People with RRMS suffer from periodical fare-ups that exacerbate their symptoms, followed by silent periods where the patient remains symptom-free until the next flare-up.

Secondary-Progressive (SPMS)

For SPMS sufferers, symptoms deteriorate over time but without flare-ups. In most cases, RRMS transforms into SPMS.

Primary-Progressive (PPMS)

A less common form of MS, primary-progressive multiple sclerosis affects about 10% of all MS patients.

This form of the disease is marked by worsening symptoms from the beginning, without flare-ups or remissions typical to other types of MS.

Progressive-Relapsing (PRMS)

This is the rarest form of MS and occurs in about 5% of MS sufferers. The symptoms of PRMS worsen steadily over time, with flare-ups and acute relapses but without remission periods.

What is CBD Oil?

CBD oil is a concentrated CBD extract made from cannabis plants — both hemp and marijuana.

CBD is a cannabinoid — a naturally occurring phytochemical — and the second-most recognized active ingredient of cannabis.

Unlike the most popular cannabinoid, delta-9-tetrahydrocannabinol (THC), CBD is non-psychoactive and thus won’t get you high. This makes CBD legal in most countries across the world.

The lack of psychoactive effects doesn’t make it an inferior cannabinoid. On the contrary, CBD has a long list of well-documented health benefits with only a few mild side effects. Cannabis advocates argue that CBD can help with virtually any condition deriving from a compromised endocannabinoid system (ECS) — the prime neurochemical network in our bodies.

Most CBD stuff sold online and in local dispensaries comes from hemp plants, which takes us to the next question.

How is CBD Hemp Oil Different from Medical Marijuana?

The main difference between CBD from hemp and medical marijuana is the aforementioned THC content.

Hemp plants are high in CBD and very low in THC. The THC content of hemp plants is usually below 0.3%, which isn’t enough to produce any psychoactive effects.

On the other hand, marijuana has high THC levels and doesn’t offer much CBD. However, some strains are specifically bred to achieve higher CBD levels at the cost of some THC.

Still, you won’t buy marijuana products in your local head shop or health store as marijuana remains a controlled substance according to federal law. You can buy medical marijuana if you live in a state that runs a medical marijuana program.

CBD oil from hemp is legal in all 50 states. You can find it in cannabis dispensaries, head shops, and online stores. You don’t need a doctor’s prescription to try CBD oil for multiple sclerosis.

Different Ways to Take CBD Oil for Multiple Sclerosis

If you’re considering trying CBD oil for your MS symptoms, it is available in the form of oil drops, tinctures, sprays, capsules, and edibles, which can be ingested, as well as vape products and creams for topical use.

Can CBD Oil Help With Multiple Sclerosis?

Dr. Ben Thrower, a physician at the Shepherd Center in Atlanta, GA, is very optimistic about using CBD oil for multiple sclerosis, but at the same time, he underlines the importance of THC in the treatment.

“Many of our MS patients have used hemp-based CBD products with 0.3 percent THC or less (…) For the management of spasticity/spasms or burning pain (central neuropathic pain), I have found that most patients need higher THC concentrations.”

THC is a well-known pain reliever — this may explain the need for higher levels of THC in CBD products for treating MS symptoms.

However, Thrower points to CBD topicals as a potential solution for fighting localized pain in MS patients

“Some patients do find relief with Low-THC, CBD lotions applied topically,” said Thrower.

What Does the Research Say About Using CBD Oil for Multiple Sclerosis

In a 2009 study, researchers investigated previous reports from MS patients who used cannabis for their symptoms to find out whether a mix of CBD and THC may reduce spasticity associated with MS.

Each of the analyzed papers focused on testing THC and CBD in capsules and oral sprays. These products generally involved more THC than CBD, which resulted in a trend of reduced spasticity.

Researchers also concluded that THC/CBD solutions are well tolerated by patients and that the experienced side effects didn’t always stem from using cannabis alone.

In 2016, researchers were looking at how a pharmaceutical spray Sativex might reduce muscle spasms in MS sufferers.

Sativex is an oral solution made from CBD and THC in a 1:1 ratio. The spray was developed to reduce neuropathic pain, overactive bladder, spasticity, and other common symptoms of multiple sclerosis.

Researchers examined self-reported data from several hundred MS patients who were using the drug for one year. Results showed a 20% improvement in muscle spasticity for 70% of subjects and a 30% improvement in 28% of patients.

For about 39% of patients, the treatment was ineffective. Although those patients dropped out of the study, the results do provide evidence to support further research on cannabinoids for multiple sclerosis.

Finally, there’s a 2018 research review that analyzed existing studies to find indirect that CBD, along with other cannabinoids, can improve the mobility of MS patients.

The paper focused mostly on a high CBD to THC ratio as the potential reliever of muscle spasms and pain in MS patients. It also discussed how cannabis reduces inflammation, contributing to less fatigue in subjects.

Because CBD oil may be able to alleviate so many symptoms of multiple sclerosis — pain, spasticity, inflammation, and fatigue — it’s reasonable to assume that CBD can have a positive impact on mobility in MS patients.

What Are the Side Effects of Using CBD Oil for Multiple Sclerosis?

When it comes to unwanted reactions to CBD, Thrower said there are very few. They’re also uncommon and generally considered mild.

“I have found the side effect profile of these products to be less than some of the prescription medications,” he added. “CBD/THC products tend to be far less sedating than Baclofen or Tizanidine, which are [muscle relaxants] traditionally used for spasticity,” he added.

Most often, taking too much CBD oil results in a dry mouth, lowered blood pressure, and dizziness. In very rare cases, high doses of CBD oil can trigger diarrhea.

Key Takeaways: What You Need to Know About Using CBD Oil for MS

So, there you have it — everything we know about using CBD oil for MS so far.

Let’s summarize the article in a nutshell:

  • CBD can be effective in reducing pain and spasms in multiple sclerosis patients
  • However, CBD alone has limited potential for relieving MS.
  • It appears that adding THC significantly improves the therapeutic properties of CBD
  • Some people can have negative reactions to the psychoactive effects of THC, especially if their symptoms call for higher doses of medical cannabis oil.
  • Moreover, equal ratios of CBD to THC may not work for certain people, as studies have shown.
  • Full-spectrum cannabis extracts with higher ratios of CBD to THC may be able to relieve a wider range of symptoms and improve mobility in MS patients.
  • Hemp-derived CBD topicals may be effective in reducing localized pain and inflammation during flare-ups.

I hope this article has helped you understand how cannabinoids work for specific MS symptoms. As always, make sure to contact your GP before taking any CBD product, especially if you’re already taking prescribed medications cannabidiol can interact with.

Nina Julia

Nina created CFAH.org following the birth of her second child. She was a science and math teacher for 6 years prior to becoming a parent — teaching in schools in White Plains, New York and later in Paterson, New Jersey.

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Cannabis extract for the treatment of painful tonic spasms in a patient with neuromyelitis optica spectrum disorder: A case report

Painful tonic spasm (PTS) is a common yet debilitating symptom in patients with neuromyelitis optica spectrum disorder (NMOSD), especially those with longitudinally extensive transverse myelitis. Although carbamazepine is an effective treatment, it poses the risk of severe adverse reactions, such as Steven-Johnson syndrome (SJS). In this case report, we describe an NMOSD patient with severe PTS suffering from carbamazepine-induced SJS who responded well to cannabis extract. Since cannabinoids can ameliorate spasticity in an experimental autoimmune encephalomyelitis model through cannabinoid 1 (CB1) receptor activation, cannabis extract which includes delta-9-tetrahydrocannabinol (THC) is a potential treatment option for PTS in NMOSD patients.

Keywords: Cannabis; Carbamazepine; Longitudinally extensive transverse myelitis; Neuromyelitis optica (NMO); Painful tonic spasm; THC.

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

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