cbd thc oil for smooth muscle spasms

CBD Oil As a Muscle Relaxant [Try this All-Natural Treatment]

There’s a lot of misconception about the difference between muscle relaxers and painkillers. There’s also confusion regarding the role CBD oil plays as an alternative treatment option for both.

First, painkillers function via the central nervous system (CNS). They work to “deceive” the mind into thinking there is no pain, when in reality there is.

Consider a serious bone fracture. A skateboarder shatters his tibia into 19 different pieces and rushes to the nearest emergency room. Once doctors shoot him up with dilaudid (or morphine, or whatever), pain receptor function ceases and he becomes none the wiser regarding the searing pain that’s coursing through his body. In fact, he’s probably happy as a clam.

Do muscle relaxers work the same?

Muscle relaxers (known in the clinical world as ‘neuromuscular blocking agents’) work differently. Instead of functioning through the CNS by blocking pain transmission at the brain, they function at the actual site of the muscle(s). This cuts off nerve transmission at the acute musculoskeletal level. Think of painkillers as affecting the brain, and muscle relaxers as affecting actual muscles.

Understandably, this brings about some confusion as to what cannabis’ exact role is in terms of pain management. We all know that CBD is an excellent pain modulator within the central nervous system, but does it function at the actual site of muscles as well? In other words, is CBD oil as a muscle relaxer an actual thing, or are people just getting the terms ‘muscle relaxers’ and ‘painkillers’ mixed up?

As it turns out, cannabis does function well as both a neurological “painkiller” and an acute neuromuscular blocking agent.

In this article, we’ll go over exactly how CBD as a muscle relaxant functions at the physiological level. Many people are switching over from their prescription relaxant medications to CBD oils. This is for a number of different reasons, which we’ll talk about below.

As is always the case with health, however, it pays to know what’s going on at the physiological level before you jump headlong into a new treatment option.

Muscle Relaxers: What are they, and why are they dangerous?

Liked we explained briefly, muscle relaxers work by severing neurological communications between the CNS (the brain) and the actual muscles themselves. In that regard, relaxants and painkillers are indeed similar. The only real difference is the specific location where the nerve transmission interruption takes place

Now bear in mind that is a broad, relative explanation. If a neurologist were to read that, they’d probably feel inclined to elaborate on several dozen different things to provide a more exacting definition. But for our purposes, it will suffice.

In terms of the different kinds of muscle relaxers out there, several different types are commonly prescribed to treat localized spasticity. More often than not they’re used as acute (temporary) treatments, but sometimes they can be used along with opioid painkillers for effective treatment of chronic pain as well.

Common Muscle Relaxers

Xanax and Valium are probably the two most well-known muscle relaxers. These drugs are called benzodiazepines. Though they’re often used as anti-anxiety or sleep medications, they have good muscle-relaxing properties as well. Valium especially is a frequently prescribed relaxant for mild-to-moderate acute musculoskeletal pain wherein full-strength opioid painkillers are unnecessary.

Drugs like Zanaflex (tizanidine) are also common and work to reduce spasticity in cases of spinal cord injury or multiple sclerosis (of which CBD is another great treatment option, by the way).

Prescription medications like Soma (carisoprodol), Flexeril (cyclobenzaprine), and Robaxin represent the strongest class of muscle relaxants. These are Schedule IV Controlled Substances (as are Xanax and Valium). They produce meprobamate as a byproduct of their chemical breakdown. Meprobamate is a powerful tranquilizer that produces a sensation of whole-body euphoria. It is dangerous because it can galvanize dependence, abuse, and full-on addiction.

While not statistically as dangerous as opioid painkillers , prescription muscle relaxants still present a dangerous array of potential side effects (such as depression, low blood pressure, and liver problems), and can even be fatal when combined with alcohol or over the counter sleep medications. (Sadly, many combine muscle relaxants with heavy alcohol use as a potential means for suicide).

What are Muscle Relaxants Used for?

Muscle relaxers are used for uncontrollable muscle spasms that originate via neurological impulses sent from the central nervous system. These spasms (which can be extremely painful) originate from several different things:

  • Spinal cord injury or damage (the brain and spinal cord compose the CNS)
  • Diseases like multiple sclerosis , cerebral palsy, and fibromyalgia
  • Acute muscle strains and tears

Some use prescription pharmaceutical relaxants to treat these involuntary muscle contractions. The relaxants work by interrupting neurological communication at the site of the muscle. Spastic signals from the CNS come to a stop, and the muscles relax and shut down. (Surgical procedures also sometimes incorporate relaxants to provide temporary paralysis).

You can see then, the difference between the function of painkillers and muscle relaxants; in our aforementioned hypothetical situation of the skateboarder with the shattered tibia, a muscle relaxant would be an entirely insufficient treatment – he’s dealing with severe acute trauma, not spastic neurological signals between the CNS and various muscle groups.

CBD Oil as Muscle Relaxant: So how does it work?

With the fundamental understanding of muscle relaxants and what they do behind us, we can now look into the physiological roles of CBD (cannabidiol) oil, and how it functions as a neuromuscular blocker.

When muscle groups contract (whether voluntarily or involuntarily), it is in response to a nerve impulse that originates from within the central nervous system. Long neurons extend from the spinal cord and stretch outwards to various organs and muscle groups throughout the body. When these neurons reach the synapse of a particular group of muscle fibers, cell-to-cell communication takes place and the fibers contract. (That’s an elementary way to put it, but it will have to suffice in order to skip talking about action potentials, sarcomeres, and ion differentiation across cell membranes).

In any regard, in order for CBD to work as a muscle relaxant, cannabinoid receptors must be present at the site of muscular synapses. This is where the endocannabinoid system comes in.

If you haven’t heard of the endocannabinoid system (ECS) , you need to inform yourself now. In short, it is an innate network of cannabinoids and cannabinoid receptors that occur 100% naturally in the human body. Everyone has the receptors, whether they’ve smoked marijuana every day for 50 years or have never touched the drug in their life.

The ECS: A complex yet remarkable receptor network

Studies have shown the ECS to be present in virtually every single physiological system in the human body. In a nutshell, this explains the incredibly far-reaching medical potential of cannabis.

The National Organization for the Reform of Marijuana Laws (NORML) has called the endocannabinoid system “… the most important physiologic system involved in establishing and maintaining human health.”

In terms of the ECS acting as a muscle contraction regulatory device, studies have found cannabinoid receptors in the signaling machinery of skeletal muscle. In other words, it appears cannabinoids (such as CBD) may play a significant role in the communication between muscle groups and the neurons that control them.

Remember research is still a long way off in regards to pinpointing how this works. Also, it is unclear how exactly the ECS functions regarding the chemical pathways of cell-to-cell communication. One thing is for certain, though — cannabinoids absolutely play a part in the alleviation of muscle spasticity .

In fact, cannabis has for years shown excellent results in multiple sclerosis patients that deal with chronic spasticity. It’s only been somewhat recently, though, that individuals started using the oil to treat spasms stemming from other conditions.

Why CBD Oil?

If you’re wondering why we keep talking about CBD, or if you’re wondering what the heck it even is, it’s essentially a non-psychoactive cannabinoid that comes from the marijuana plant.

The two primary cannabinoids in marijuana are THC and CBD. THC is the psychoactive component that’s responsible for getting us high. When you smoke a joint, for example, you inhale both CBD and THC. CBD oil is an all-natural extraction of the non-psychoactive cannabinoid. That is, a way to receive all the medical and therapeutic benefits of cannabis without having to get high.

CBD as a Muscle Relaxant: The Bottom Line

Alleviating muscle spasms at the molecular level is just one of the many potential uses of CBD . Thousands of people have switched over to it from prescription medications (like carisoprodol or benzodiazepines) due to the high costs and dangerous side effects of the latter.

Keep in mind though that CBD oil for muscle spasms will not work for everyone. If you’re considering using it for your own condition, do your research and select a reputable tincture.

The oils we’ve selected below have been some of the most reputable and proven brands in recent years. They have shown good results for a variety of muscle and pain-related conditions, including spasticity.

CBD Oil for Muscle Spasms: Is Cannabidiol an Effective Treatment?

CBD is a great way to relieve the symptoms of muscle spasms.

In this article, we will be looking at the best CBD for muscle spasms.

We’ll cover how it works, what dose to use, what forms work best, and what side-effects to watch out for.

What Are Muscle Spasms?

Muscle spasms, also known as muscle cramps, are the result of involuntary contractions. Muscle spasms can become an issue if they cannot be relaxed naturally.

Anyone can suffer from muscle spasms with the most common muscle groups being the thighs, claws, arms, hands, and feet.

Pain levels range from mild annoyance to severe pain.

When you suffer from muscle spasms, the affected muscle may feel harder and look distorted. This is due to the involuntary contractions. These spasms can last a few seconds to 10 minutes or more.

Muscle spasms can happen at any time to people of all ages. When you’re exercising, sitting still, sleeping, or even walking to the shop you can experience these cramps.

Some people suffer more than others. People with diabetes, anemia, MS, spinal injuries, or kidney disease can suffer more from this issue than people in good health.

What Causes Muscle Spasms?

Whether you suffer from the above ailments or not, there are a few common issues that can cause muscle spasms. See the list below.

  • Over-exercising
  • Insufficient stretching before physical activity
  • Dehydration
  • Stress
  • Muscle fatigue
  • Physical activity in hot climates
  • Electrolyte imbalances
  • Too much caffeine
  • Exhaustion and lack of sleep
  • Certain prescription medications

Methods to Reduce or Prevent Muscle Spasms

As well as using CBD for muscle spasms there are some ways you can reduce or prevent the spasms entirely. Of course, if you suffer from a disease, illness, or take medication that causes muscle spasms, these pointers may not help.

If you regularly suffer from muscle spasms, then implementing a few of the points below may help you:

  • Stay hydrated
  • Make sure to stretch before strenuous activity
  • Try and lower your stress levels (CBD is great for this)
  • Get a full 8 hours rest at night
  • Take mineral supplements that include magnesium, potassium, and sodium
  • If prescription meds are causing issues, speak with your doctor about alternatives
  • Cut down on the caffeine
  • Avoid over-exercising

Muscle Spasms & the Endocannabinoid System

The endocannabinoid system is made up of cannabinoid receptors CB1 and CB2. It’s a complex cell-signaling system that was first identified in the 1990s.

Regardless of whether you use CBD or other cannabis products, this system is part of everyone’s biology.

Endocannabinoids are cannabinoids made inside the body. They help regulate a range of functions and processes. See the list below for a few of these.

  • Mood and emotion
  • Sleep
  • Memory
  • Appetite
  • Fertility
  • Immune response
  • metabolism

In the same way that endocannabinoids interact with the body, cannabinoids from the hemp plant do as well — including CBD. They do this by interacting with CB1 and CB2 receptors.

CB1 receptors have been identified predominantly in the central nervous system (brain and spinal cord). They’ve also been found in connective tissues, the intestines, gonads, and other peripheral organs.

CB2 receptors have been identified in white blood cells, the spleen, tonsils, thymus, and lymphatic system.

CBD and other cannabinoids interact with these receptors. Studies have shown that CBD impacts receptor activity. They can interact with neurotransmitters, reduce inflammation, and aid in pain relief.

When a muscle contracts, causing cramps and spasms, it’s because of a chemical message from the central nervous system. The body’s endocannabinoid system can take care of this and reduce contractions and pain.

If the body struggles to produce enough endocannabinoids to stop these chemical signals, then muscle spasms will continue to cause discomfort.

This is where CBD comes in.

CBD interacts with the CB1 receptors in the central nervous system and effectively slows the chemical signals that are causing the spasms [1].

This results in muscle relaxation and fewer muscle contractions. Pain relief coincides with these effects.

Can CBD Relieve Muscle Spasms?

As mentioned in the last section, CBD interacts with the body’s endocannabinoid system to relieve muscle spasms and the pain associated with it.

CBD Relaxes the Muscles

CBD is a great muscle relaxant. Unlike painkillers, muscle relaxants work to solve the issue of muscle cramps rather than just numbing the pain that results from it.

The beauty of CBD is that it gets to the root of the problem and influences the chemical signals that cause muscle spasms (as mentioned in the last section).

Unlike spasmolytic and neuromuscular blockers, CBD has few negative side effects and works with your body’s natural functions rather than against them.

Spasmolytic muscle relaxants are particularly dangerous, especially for older people. They can increase heart rate, blood pressure, and can be incredibly addictive as this type of medication is part of the opioid group.

CBD certainly isn’t dangerous, doesn’t increase the heart rate, and there are no documented cases of addiction to the cannabinoid.

CBD Reduces Stress

CBD helps reduce stress which can be a trigger for muscle spasms.

There is a lot to say about CBD reducing stress and anxiety [2]. The cannabinoid is commonly used to help these problems by people all over the world.

Although stress is not directly related to muscle spasms, it can be one of the reasons you’re experiencing these issues.

It’s important to address the cause of an issue. If stress is giving you muscle spasms, you should work toward reducing or eliminating it completely. Lowering stress levels using CBD could be a great long-term treatment if stress is the cause.

CBD Can Aid Sleep

Lack of sleep and exhaustion can cause muscles to spasm. CBD can help you get to sleep faster and achieve a full nights’ rest.

If you struggle with sleep, high-doses of CBD before bedtime can help you doze off into a deep sleep. Stress is often the cause of lack of sleep, so both factors go hand in hand.

Some research shows that CBD can have an effect on cortisol levels [3].

Cortisol regulates your sleep cycle. Some people (particularly insomnia sufferers) have high levels of cortisol at night which keeps them awake.

Taking high doses of CBD at night can decrease cortisol levels, getting you to sleep easier and faster.

CBD Aids Muscle Recovery

CBD is believed to aid in muscle recovery [4]. Many athletes and fitness fanatics use CBD as it can speed up the muscle recovery process.

If you’re experiencing muscle spasms after exercise or excessive physical activity, this benefit will help you get instant and long-term relief.

During strenuous exercise, the muscles tear and rebuild during the recovery period. During this period some people experience cramping and spasms. If you can recover more efficiently you will experience less discomfort.

How Much CBD to Take for Muscle Spasms?

High-potency CBD oil is the best treatment for muscle spasms.

How much you take will depend on you and how your body reacts to the CBD. If you’ve never used CBD before it’s best to start small and work your way up.

The dosage needed to stop muscle spasms will vary from person to person, so a bit of self-experimentation is needed to find your balance. Steadily increase your dosages until you get the effect you’re looking for.

Oils are the easiest way to find out how many milligrams of CBD you need to control muscle spasms. You can adjust the dosage by increasing or decreasing the drops of oil taken.

Final Thoughts: Does CBD Work for Muscle Spasms?

CBD is a great way to reduce muscle spasms and pain you may have as a result of them. Unlike other muscle relaxants and painkillers, CBD has few negative effects on your body and is a natural product.

As well as solving the problem directly, CBD has a number of benefits that work together to reduce muscle spasms for the long-term.

If you got to the end of this read, you’ll know exactly how CBD can help muscle spasms and what to look for when it comes time to purchase a treatment.

If you have any questions about CBD and muscle spasms, please comment down below.

Thanks for reading.

References Used in This Article

  1. Shenglong Zou and Ujendra Kumar. (2018). Cannabinoid Receptors and the Endocannabinoid System: Signaling and Function in the Central Nervous System. International journal of molecular science,19(3): 833.
  2. Esther M. Blessing, Maria M. Steenkamp, Jorge Manzanares, and Charles R. Marmar. (2015). Cannabidiol as a Potential Treatment for Anxiety Disorders. Springer Neurotherapeutics, 12(4): 825–836.
  3. Scott Shannon, Nicole Lewis, Heather Lee, and Shannon Hughes. (2019). Cannabidiol in Anxiety and Sleep: A Large Case Series. The Permanente Journal, 23: 18-041.
  4. Danielle McCartney, Melissa J. Benson, Ben Desbrow, Christopher Irwin, Anastasia Suraev, and Iain S. McGregor. (2020). Cannabidiol and Sports Performance: a Narrative Review of Relevant Evidence and Recommendations for Future Research. Springer Sports Medicine-Open, 6: 27.
Livvy Ashton

Livvy is a registered nurse (RN) and board-certified nurse midwife (CNM) in the state of New Jersey. After giving birth to her newborn daughter, Livvy stepped down from her full-time position at the Children’s Hospital of New Jersey. This gave her the opportunity to spend more time writing articles on all topics related to pregnancy and prenatal care.

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NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Mack A, Joy J. Marijuana as Medicine? The Science Beyond the Controversy. Washington (DC): National Academies Press (US); 2000.

Marijuana as Medicine? The Science Beyond the Controversy.

7 MARIJUANA AND MUSCLE SPASTICITY

Coping with stiff, aching, cramping muscles is a way of life for most of the 2.5 million people in the world who have multiple sclerosis. Many of the 15 million people with spinal cord injuries also suffer from the same symptoms, which cause pain, limit movement, and rob people of needed sleep. Although several conventional medications can reduce these patients’ discomfort, taking them rarely provides complete relief. Often the drugs cause weakness, drowsiness, and other side effects that some patients find intolerable.

Given this outlook, it is not hard to understand why some people with multiple sclerosis and spinal cord injuries have sought relief through marijuana. Several such patients told the IOM team that their muscle spasms decreased after smoking marijuana (see Chapter 2). Some also said they valued the drug because it relieved nausea or helped them sleep. Likewise, in a 1982 survey of people with spinal cord injuries, 21 of 43 respondents reported that marijuana reduced muscle spasticity 1 (a condition in which muscles tense reflexively and resist stretching), while nearly every participant in a 1997 survey of 112 regular marijuana users with multiple sclerosis replied that the drug lessened both pain and spasticity. 2 This is not to say that most people with multiple sclerosis find relief with marijuana but only that the marijuana users among them do.

Animal research, too, suggests that marijuana calms muscle spasticity. Spasms are thought to originate in areas of the brain that control movement, including several sites with abundant cannabinoid receptors. In one experiment, researchers found that rodents became more animated under the influence of small amounts of cannabinoids but less active when they received larger doses. Many marijuana users also note that the drug affects movement, making their bodies sway and their hands unsteady. The exact mechanism(s) by which cannabinoids exert these effects remains unknown.

Despite these suggestive findings and the depth of anecdotal evidence, marijuana’s antispasmodic properties remain largely untested in the clinic. The few existing reports are extremely limited in scope; for example, none of the studies discussed in this chapter included more than 13 patients, and some were conducted on a single patient. Also, in several cases the patients’ subjective evaluations of improvement contrasted with objective measures of their physical performance. Still, the lack of good universally effective medicine for muscle spasticity is a compelling reason to continue exploring cannabinoid drugs in the clinic.

MULTIPLE SCLEROSIS

Multiple sclerosis (or MS) is a progressive disease of the nervous system with no known cure. It appears to result from a malfunction of the immune system, which inflames nerves in the brain, brain stem, and spinal cord. Specifically, the disease destroys the protective coating called myelin that sheaths the neural fibers like insulation on electrical wire. Without an intact myelin layer, nerve cells lose some or all of their ability to transmit impulses. This situation produces an array of symptoms, including fatigue, depression, vertigo, blindness, incontinence, and loss of voluntary muscle control, as well as muscle spasticity. MS is characterized by scarring—“sclerosis”—that occurs in the white matter of the central nervous system after nerves and myelin are lost.

Approximately 90 percent of MS patients develop spasticity. Some people experience this condition merely as muscle stiffness; others endure constant ache, cramps, or involuntary muscle contractions (spasms) that are both painful and debilitating. These spasms often affect the legs and can disrupt sleep. Most people with MS experience intermittent “attacks” of spasticity that become increasingly disabling the longer they have the disease. In the worst cases, patients become partially or even completely paralyzed.

The drugs most commonly prescribed to treat the symptoms of MS include baclofen (Lioresal) and tizanidine (Zanaflex) which relieve both spasticity and muscle spasms but often only partially and sometimes not at all. Both are sedatives, so they cause drowsiness; additional side effects include dry mouth and muscle weakness. The latter is especially problematic for people with MS, whose muscles get weaker as the disease progresses.

Both marijuana and THC have been tested for their ability to relieve spasticity in small but rigorous clinical studies. One double-blind experiment (see Introduction to Part II for an explanation of double-blind methods) included both MS patients and unaffected individuals. 3 Before and after smoking a single marijuana cigarette that contained approximately 15 milligrams of THC—enough to make most people feel “high” and to impair their motor control—patients were videotaped as they stood on a platform that slid back and forth at unpredictable times. The researchers then measured participants’ shoulder movements as an index for how well they kept their balance.

Participants with MS often thought that their symptoms had improved after smoking marijuana. But while their spasticity may indeed have decreased (it was not measured), their posture and balance were actually impaired; this was also the case with the 10 participants who did not have MS. The MS patients had greater difficulty maintaining their balance before smoking and were more negatively affected by marijuana than the healthy participants.

While the fact that every MS patient in the previous study experienced relief is intriguing, it does not constitute strong evidence that marijuana relieves spasticity because marijuana-induced euphoria or pain relief might decrease patients’ perceptions of muscle stiffness or spasticity. The same is true of respondents to the surveys described earlier. Moreover, surveys cannot measure the degree to which respondents feel better simply because they expect to do so. Such placebo effects are signifi cant; for example, in controlled trials of pain medications, as many as 30 percent of the participants who received a placebo reported feeling relief. This does not mean that placebo effects are not “real.” It is possible that the psychological effects of taking a placebo drug cause physiological changes in the brain. But it does mean that the effects are not directly due to the medication being tested.

THC’s effects on spasticity were tested in three separate clinical studies, which together enrolled a total of 30 MS patients. 4 All three were open trials in which participants knew they would be receiving THC. Perhaps not surprisingly, most of the patients—or in one case the investigators who examined them—reported that treatment with THC improved their symptoms (see Figure 7.1). The drug was not effective for all patients, however, and frequently caused unpleasant side effects.

FIGURE 7.1

Effect of THC on tremor caused by multiple sclerosis. In this experiment, a 30-year-old man with multiple sclerosis who suffered from a disabling tremor was treated with 5 milligrams of THC. Researchers compared the man’s handwriting and head movement (more. )

Objective measurements of patients’ symptoms in these studies were often at odds with their subjective reports. In one study researchers measured muscle tremor with a mechanical device, which showed detectable change in only two of eight patients, seven of whom had reported improved symptoms. 5 In another study standardized physician’s measures showed that treatment with THC had not produced any changes in spasticity despite reports of reduced spasticity by 11 of 13 patients. 6 It may be that the measuring techniques used in both studies were not sensitive enough to detect subtle improvements. It is also possible that patients’ reports of symptom improvement were influenced by placebo effects or by effects of THC, such as anxiety reduction, that are only indirectly related to spasticity. Neither possibility can be ruled out due to the small size of these studies.

In addition to these experiments on THC, a single patient who tested the THC analog nabilone—a synthetic compound that activates the same cellular receptors as THC—also reported an improvement in spasticity as well as in other MS symptoms (see Figure 7.2). 7

FIGURE 7.2

Effect of nabilone on multiple sclerosis symptoms. This chart shows the results of a trial in which a 45-year-old man with MS received treatments with the THC analog nabilone, alternating with a placebo. While the results suggest that THC might relieve (more. )

These clinical results are considerably less dramatic than survey and anecdotal reports of marijuana’s effectiveness in relieving muscle spasms. It is possible, however, that a series of larger, better-designed clinical trials would produce stronger evidence in favor of marijuana-based medicines for MS. At this writing such studies are in the planning stages in Britain, where a large proportion of medical marijuana users are people with MS. For example, researchers have proposed a clinical trial to compare the effectiveness of three types of treatment for MS: marijuana extract, delivered by inhaler; dronabinol (Marinol); and placebo.

Clinical trials usually require preliminary experiments on animal models of a disease, which enable researchers to predict its effects on humans. With that knowledge scientists can then design trials that accurately measure the ability of the drug to relieve patients’ symptoms. Existing animal models mimic some MS symptoms, but so far none have succeeded in duplicating spasticity. But researchers can use the best-available indicator of the condition, known as the pendulum test, to study the effectiveness of antispasticity drugs in human subjects.

Participants in this test lie on an examining table with their legs extending over the edge. They let their legs fall, and a video camera records the resulting motion, which is affected by muscle resistance. Computer analysis of the recording enables researchers to determine the degree to which spasticity impeded each patient’s movement. Since THC is mildly sedating it is important to distinguish this effect from any actual decrease in spasticity produced by the drug. Researchers could make such a distinction by using the pendulum test to compare THC’s effects with those of other mild sedatives, such as benzodiazepines.

If an antispasmodic drug is developed from THC, its sedative effect could prove beneficial to MS patients whose muscle spasms interrupt their sleep. Drowsiness at bedtime might be welcome, and any mood-altering side effects might be less of a problem than when the patient was awake. It is also possible, however, that THC might disrupt normal sleep patterns in some people.

TOWARD BETTER TREATMENTS

While the same physiological process causes spasticity in both MS and spinal cord injury, it produces quite different symptoms in the two diseases. People with MS tend to experience occasional “attacks” of intense pain, stiffness, or muscle spasms at unpredictable intervals, while people with spinal cord injuries experience only minor fluctuations and persistent discomfort. Nevertheless, it is very likely that the same drugs could be adapted to treat the two groups of patients. People with MS and those with spinal cord injury alike would benefit from medications that relieve pain, stiffness, and spasms without muscle weakening, which occurs with the best currently available treatments. Because of the harms associated with long-term marijuana smoking, it should be discouraged as a means of treating chronic conditions such as spinal cord injury or MS.

Whether marijuana could yield useful medicines for spasticity remains to be determined, for the clinical evidence to date is too sparse to accept. But the few positive reports of the ability of THC and nabilone to reduce spasticity, together with numerous anecdotal accounts from marijuana users with MS and spinal cord injuries, suggest that carefully designed clinical trials testing the effects of cannabinoids on muscle spasticity would be worthwhile.

Two factors complicate the design of such trials. First, while MS patients report that marijuana relieves spasticity, it negatively affects their ability to balance, exacerbating another symptom of the disorder. It may be that patients would become tolerant to the balance-impairing effects of cannabinoids relatively quickly yet continue to get relief from spasticity. It might also be possible to separate these effects by creating chemical variants of natural cannabinoids. Second, human trials should rule out any masking or enhancing effect of anxiety reduction due to THC, since anxiety worsens spasticity in many patients.

If THC or a related compound does prove to relieve spasticity, it would make sense for some patients to take the drug orally. In this way patients could take advantage of THC’s ability to remain active in the body for several hours. People with spinal cord injury, whose symptoms vary little throughout the day, could get extended relief from a pill taken at bedtime or in the morning. On the other hand, MS patients might find more use for an inhaled form of THC to relieve their more intermittent symptoms. Unlike pills, this delivery method would allow patients to feel the drug’s effects quickly and with a minimum of sedation. At nighttime MS patients might actually prefer pills that cause drowsiness as well as relieve spasticity.

People with MS may soon be able to test a cannabinoid inhaler if the previously described British clinical trials receive funding. Additional trials may take place in Canada, where in July 1999 the government issued a request for research proposals to study medical uses of marijuana. While the official announcement did not prescribe specific research topics, it mentioned multiple sclerosis as a possible subject for a clinical trial.

Footnotes

1. Malec J, Harvey RF, Cayner JJ. 1982. “Cannabis effect on spasticity in spinal cord injury.” Archives of Physical Medicine and Rehabilitation 63:116-118.

2. Consroe P, Musty R, Rein J, Tillery W, Pertwee RG. 1997. “The per ceived effects of smoked cannabis on patients with multiple sclerosis.” European Neurology 38:44-48.

3. Greenberg HS, Werness SA, Pugh JE, Andrus RO, Anderson DJ, Domino EF. 1994. “Short-term effects of smoking marijuana on balance in patients with multiple sclerosis and normal volunteers.” Clinical Pharmacology and Therapeutics 55:324-328.

4. Clifford DB. 1983. “Tetrahydrocannabinol for tremor in multiple sclerosis.” Annals of Neurology 13:669-671; Petro D and Ellenberger Jr C. 1981. “Treatment of human spasticity with delta-9-tetrahydrocannabinol.” Journal of Clinical Pharmacology 21:413S-416S; Ungerleider JT, Andrysiak TA, Fairbanks L, Ellison GW, Myers LW. 1987. “Delta-9-THC in the treatment of spasticity associated with multiple sclerosis.” Advances in Alcohol and Substance Abuse 7:39-50.

5. Clifford DB. 1983.

6. Ungerleider JT, et al. 1987.

7. Martyn CN, Illis LS, Thom J. 1995. “Nabilone treatment of multiple sclerosis.” Lancet 345:579.