In a nationwide survey of cannabis-based therapy use among Americans with multiple sclerosis (MS), almost half of respondents endorsed such products, primarily for nerve-based pain and sleep disturbances, and the perceived benefits for sleep and pain were highly correlated.
The reported scores for perceived pain were generally worse among recent or current cannabis users, the results showed.
These findings identified gaps between community and clinical use and illustrated the need for studies that investigate the impact of cannabis therapies for chronic MS symptoms.
The survey results were described in the study, "Cannabinoid use among Americans with MS: Current trends and gaps in knowledge," published in the Multiple Sclerosis Journal – Experimental, Translational and Clinical.
Chronic pain commonly affects people with MS and is frequently associated with sleep disturbances and fatigue. Given the lack of treatment options for these symptoms, there is a growing use of cannabis among people with MS.
Despite increasing public support for the clinical use of cannabis-based treatments, evidence supporting its benefits to treat pain and sleep disturbances is scarce, as are specific guidelines on its use in patients with different symptoms and co-conditions.
Studies are therefore needed to investigate the benefits and harms of cannabis-based therapies in various neurological conditions, according to researchers. Data including real-world MS patient experiences, and national estimates of cannabis use and its perceived benefits and side effects, may help guide clinical practice and much-needed research, investigators say.
Thus, a team from the University of Michigan assessed the prevalence of cannabinoid use among MS patients in the U.S., exploring the therapy's impact on healthcare provider guidance, and investigating the association between cannabis use and nerve-based (neuropathic) pain and sleep disturbances.
A nationwide survey was conducted with an aim of collecting data to characterize pain in adults with MS.
Of the 1,217 survey respondents, a total of 1,027 (84%) answered the question about cannabis use in the past year. Among these, 427 (42%) endorsed cannabis use and 386 (90%) of this subgroup used cannabis for either medical purposes only or for medical and recreational purposes.
According to the results, the choice to use cannabis was influenced by the patients’ own independent research or advice from family or friends. Only 18% discussed using cannabis with their healthcare provider, and less than 1% received provider assistance on the types of formulations available. Specifically, almost none of the patients received any guidance from providers regarding the ratio of tetrahydrocannabinol (THC) — the principal psychoactive component of cannabis — and cannabidiol (CBD), which is a non-psychoactive compound in cannabis.
In the past year, 188 (44%) of the 427 respondents using cannabis expressed a specific preference for a THC:CBD ratio, while 177 (41%) were unsure. For those who expressed a preference, the majority preferred formulations that were mostly composed of CBD.
Compared with those who did not use cannabis products, those who endorsed cannabis were more disabled. As measured by PROMIS, a patient-reported outcomes measure, those taking cannabis products reported significantly worse symptoms compared with those not using such therapies. The patients using cannabis had a significantly higher median pain intensity (52.1 vs. 46.3), higher depression (56.8 vs. 52.1), higher anxiety (55.4 vs. 52.1), higher fatigue (60.4 vs. 57.3), and more sleep disturbances (53.3 vs. 52.2). These individuals also had lower cognitive abilities scores (42.8 vs. 45.1).
Cannabis use also was associated with a higher pain centralization score, a measure of pain radiating from the spine, and greater neuropathic pain, usually described as a burning sensation with affected areas often sensitive to the touch. Activity levels reported by patients did not differ by cannabis use.
Pain and sleep were the most common reasons for using cannabis-based products. As assessed by a numerical rating scale, in which a score of zero meant no relief and 10 was extreme relief, the mean impact of cannabis use ranged from 6.1 to 8 for symptoms including sexual dysfunction, MS relapses, sleep problems, tremors, nausea, anxiety, pain, and fatigue.
The scores for sleep and pain relief were highly correlated, or linked, "indicating a significant benefit in pain-related insomnia symptoms," the researchers wrote.
Among the 240 (56%) people who used cannabis as a sleep aid, 78% said it provided more than one sleep benefit. However, the ability to fall asleep was reported as the most common benefit by 82% of respondents. This group preferred THC formulations primarily due to improvements in falling asleep and in managing pain that prevents sleep.
These findings suggested "differential benefits for specific insomnia types, with greatest benefits reported for sleep initiation," the researchers wrote.
PROMIS pain interference scores were found to be significantly lower — meaning less pain — in people who preferred pure CBD or CBD-predominant formulations. Further, patients using high formulations of THC and CBD scored worse in average PROMIS anxiety, fatigue, and cognitive abilities and scored higher in centralized pain.
The painDETECT questionnaire to assess neuropathic pain found that individuals who used THC as a single treatment reported less pain than those using other formulations.
That a higher proportion of patients who preferred high THC formulations found benefits in specific sleep symptoms "raises questions about potential disparate effects of individual cannabinoids on sleep," the researchers wrote. However, they cautioned about the lower numbers of these users and pointed out that "various THC:CBD ratios for MS-related pain and other symptoms are not well understood."
Overall, the team concluded that "cannabinoid use is common in MS [patients], despite a paucity of provider guidance," suggesting "crucial gaps between community use and clinical care."
The findings highlight "an immediate need for prospective, mechanistic studies focused on the effects of cannabinoids for chronic MS symptoms, as well as interactions between MS symptoms," the researchers noted. Steve Bryson PhD