How Cannabis Affects Spasticity
More than 12 million people worldwide experience muscle spasticity, which causes pain, reduced mobility, and prevents restful sleep. Spasticity is often a symptom associated with multiple sclerosis (MS), cerebral palsy (CP), strokes and spinal cord injuries. While some pharmaceutical-based treatments exist, they are often not fully effective and come with side effects of their own.
As part of the effort to discover new treatments, cannabis has emerged as a potential. Could people living with spasticity find relief in cannabis products? Here's what the research tells us.
What is Spasticity?
Spasticity is caused by a disruption in the signals between the brain and body. Spasticity has several uncomfortable effects, including continuous stiffness in the muscles, spasms, and contractions, which can cause pain and restrict movement, according to Johns Hopkins. Spasticity can also make it difficult for people to even walk or perform tasks that require fine motor skills. Further, spasticity in children can lead to growth problems that can cause joint pain and disability as they grow older.
How is Spasticity currently treated?
Currently, spasticity is treated by a team of doctors who combine pharmaceutical approaches with ongoing physical therapy with the goal of improved and more comfortable movements. In some cases, injections or surgical intervention may be required. The specific course of treatment depends on the patient's condition and medical history, but most are only partially effective, and the medications used often come with side effects like weakness and fatigue, mental confusion or falls. However, some patients have sought relief through cannabis, with evidence to support its effectiveness at alleviating the symptoms of spasticity.
What the research says about Cannabis and Spasticity
Like many medical conditions helped by cannabis, researchers first took note of the connection between cannabis and spasticity by collecting and studying anecdotal, subjective evidence from consumers who noticed that cannabis helped alleviate their symptoms. Two of these studies include:
• One 1982 study found that nearly half of a group of 43 respondents living with spinal cord injuries reported that cannabis use eased their symptoms.
• In 1997, a survey of 112 cannabis consumers living with multiple sclerosis suggested the respondents experienced pain and spasticity when consuming cannabis.
Researchers moved on from there to animal models, which offer some insight into how cannabis might affect spasticity. One experiment demonstrated that lab mice became more active after consuming small amounts of phytocannabinoids, but relaxed when consuming higher dosages. Those findings could have implications for the involuntary movements and contractions associated with spasticity.
And finally, there are several human studies which offer cautious optimism about cannabinoids’ potential for treating spasticity.
A 2009 review of six studies found that there was a pattern of reduced spasticity in patients who self-reported results after consuming cannabis. Particularly, the review notes, extracts containing both THC and CBD appeared most effective. Across these studies, patients largely reported an improvement in symptoms post-treatment, as well. A subsequent 2014 review, for example, found orally ingested cannabis extract can reduce muscle spasticity and pain in MS patients.
What are we learning about Cannabis and Spasticity?
For the most part, human studies on cannabis treatment for spasticity have been small and difficult for researchers to rely upon. Most studies include a subject group of a dozen people or less, hardly a sufficient sample size. Further, the results are mixed. For example, one study of self-reporting MS patients noted that spasticity-related symptoms improved (subjectively, again), but also that their balance decreased. As one symptom got better, one got worse.
In other words, researchers are still not sure quite how cannabinoids, the endocannabinoid system (ECS), and spasticity are linked.
Additionally, researchers acknowledged that THC's anxiety-reducing capabilities could be biasing the subjects reporting; when feeling calmer, patients might self-report less pain, despite spasticity symptoms remaining unchanged. Further questions are raised by a study which measured spasticity using the Ashworth scale and found no significant improvement despite subject reports to the contrary.
However, it is clear based on surveys that cannabis subjectively improves many patients' lives by their own reports. For example, patients with spasticity often cannot sleep through the night, as their symptoms often disturb them or keep them up. Researchers have found that a cannabis product with a balanced THC to CBD ratio might be beneficial for promoting restful sleep, something many people living with spasticity often have a difficult time attaining.
For many, cannabis offers some relief from their symptoms, and so it is no surprise that a 2019 study found 38% of patients living with MS also said they were regular cannabis consumers.
Which cannabis products are best for people living with spasticity?
To make the best choice for a patient living with a disorder that causes spasticity, there are some considerations to make while choosing the best cannabis products.
• Phytocannabinoid and terpene profiles. A cannabis product's compound profile is the most important aspect to examine. If your priority is to find a product that promotes restful sleep, research suggests a 1:1 THC to CBD product is best for you. Similarly, the various combinations of terpenes can influence experience as well. A myrcene and linalool heavy product would be a strong option for promoting sleep and alleviating pain, for example.
• The right product type. The route of administration recommended by your doctor makes a difference in how you consume cannabis. Vaporizing cannabis oil, for example, yields different results than an orally ingested food. For long-lasting relief, infused foods might be the best choice as its effects last for hour. But for instant relief, inhaling flower or concentrates may be preferable. Mix and match product types to suit your wellness goals as they change throughout the day and based on circumstance.
• Pick something enjoyable! There are many product options to choose from, and a lot of variety even within the product type that provides the most relief. Choose an ingestible with flavors you like or a concentrate that’s easiest to place in your chosen approved electronic device, for example.
When consuming, taking note of experiences and how well the particular product and strain provides relief can help consumers identify favorites and avoid products that don't work well for them. Everybody is different and cannabis products are widely varied – there is a product out there for everyone, it's just waiting to be found!
Cannabis and quality of life
Although there remains many questions around how cannabis affects spasticity, it is clear that it has the potential to improve the quality of life for many people living with spasticity. While the encouraging anecdotal evidence and survey results points toward cannabis as a treatment option for spasticity, the science is far from conclusive. When it comes to spasticity, researchers have more work to do to understand how cannabinoids influence the condition. Still, spasticity is a qualifying condition for medical cannabis programs in states like Pennsylvania, West Virginia, and Florida.