Because multiple sclerosis is a progressive disease, your pain management plan might need repeated tweaking. Options, include physical therapy and targeted exercises, pharmaceuticals, and surgical procedures. The challenge is finding the right combination of treatment strategies that works for your particular symptoms at a given point in time.
What works well for one person may not work well enough for another, and medication that used to bring symptom relief for problems, such as spastic paralysis and muscle spasms, may suddenly stop being effective. Now, in 17 states and the District of Columbia, there’s a newer option — cannabis sativa, otherwise known as medical marijuana to treat MS symptoms.
“Pain associated with multiple sclerosis can often be very difficult to treat,” says Scott Gottlieb, MD, a pain management specialist at Manhattan’s New York Eye and Ear Infirmary. Licensed to prescribe medical marijuana at his private practice in New Jersey, Dr. Gottlieb says it can be helpful in treating the pain of MS symptoms and can do so without the typical side effects associated with high-dose opioids, a common prescription drug used for managing pain associated with multiple sclerosis. Gottlieb points out that although opioids such as morphine, oxycodone, and methadone are effective pain drugs, many people develop a tolerance to them and require higher doses as time goes on. “As far as I am aware, this is not the case with marijuana,” Gottlieb adds.
California resident Y.W. White agrees. “A few puffs, and I feel relief for the day,” she says, describing the calming effect it has during bouts of spasticity and muscle spasms. “I take pharmaceuticals, too, but they don’t work as well as pot.”
Marijuana Side Effects
“As helpful as marijuana can be, it is not without its own side effects,” cautions Gottlieb. Problems may include:
• Impaired mental functioning
• Decreased inhibitions
• Dry mouth
• Memory problems
• Blurred vision
• Increased anxiety or paranoia
• Respiratory problems
• Dizziness and loss of balance
• Sexual problems
You might encounter some, all, or none of these side effects. When they occur, they’re usually short-lived and go away within 24 hours, Gottlieb says. White’s experiences follow that timetable. She says she’s had temporary memory loss from time to time, but it’s never been long-lasting. She also experienced anxiety from marijuana at one point. That’s when she learned from her doctor that she needed to use the right type of marijuana because different types have different side effects. White was using cannabis indica at the time, and her internist recommended she switch to cannabis sativa. Since she switched, she says, anxiety hasn’t been an issue. And, regardless of the side effects she’s experienced, White says she believes the benefits of cannabis sativa outweigh the risks.
Why Isn’t Marijuana Easier to Get?
White thinks she’s been lucky. “My doctors have been behind me and understand that it is a medicine and is helpful,” she says of her access to cannabis sativa. Two of her main concerns are cost and quality control. She wishes more people understood the benefits of the medication as well as the benefits of having reputable dispensaries so that people who need it can get good quality at a reasonable price.
Outside of being an illegal substance in most states, medical marijuana is not widely available because verifiable data proving its effectiveness has been limited. “There are numerous anecdotal reports of improvements in some of these symptoms with the use of cannabis, yet well-controlled study results demonstrating benefits are scarce,” explains Paul B. Langevin, MD, of the department of anesthesiology and critical care at Hahnemann University Hospital in Philadelphia.
However, researchers have seen the potential and are looking for ways to use derivatives of cannabis as ingredients in pharmaceuticals. Dr. Langevin points to an MS study in the European Journal of Neurology, in which 272 out of 572 participants had at least a 20 percent reduction in spasticity from nabiximols (Sativex), a cannabis derivative. And a British clinical trial called Cannabinoid Use in Progressive Inflammatory Brain Disease (CUPID) found that THC, the main active component of cannabis, taken orally may provide some benefit for people at the lower end of the MS disability scale.
Researchers who’ve seen results from medications derived from extracts of cannabis sativa hope that they’ll be approved for distribution in the United States. This would allow people with MS to decide for themselves if they’re beneficial.