The endocannabinoid system in MS could address both symptoms and disease progression | Research

The takeaway

A comprehensive review found that cannabinoids can treat MS symptoms (spasticity, pain) with clinical evidence, while preclinical data suggest endocannabinoid modulation may also slow disease progression through neuroprotective effects.

Read this if you have MS and want to understand the full range of ways cannabinoids might help, from symptom relief to potentially slowing disease progression.

Clinical evidence for symptom control; preclinical evidence for neuroprotection in MS

What the researchers found

This extensive review examined both clinical and preclinical evidence for cannabinoid-based interventions in MS. The authors distinguished between two therapeutic levels: symptom management and disease modification.

For symptom management, both preclinical and clinical data support cannabinoids for controlling spasticity and chronic pain in MS. These are the established therapeutic uses, with Sativex approved in many countries for MS spasticity.

For disease modification, only preclinical data were available, but they were encouraging. Cannabinoids and endocannabinoid modulators showed neuroprotective effects in animal models of MS, suggesting they could potentially slow disease progression by reducing neuroinflammation and protecting neurons from damage.

The review connected these findings to other neuroinflammatory diseases, noting that the mechanisms through which cannabinoids reduce inflammation and protect neurons in MS models are relevant to conditions like Parkinson's disease, Alzheimer's disease, and other neurodegenerative disorders.

Why it matters

Most MS treatments either manage symptoms or attempt to slow progression, but rarely do both. If cannabinoid-based approaches can address both levels, they could offer a unique therapeutic profile. The current clinical evidence supports symptom management, while the preclinical neuroprotection data point toward a potentially broader role.

The numbers in context

Clinical evidence supports: spasticity and chronic pain management. Preclinical evidence supports: neuroprotection, reduced neuroinflammation, slowed disease progression. Sativex approved for MS spasticity in multiple countries. Connections drawn to Parkinson's, Alzheimer's, and other neurodegenerative diseases.

How the study worked

Comprehensive narrative review of preclinical and clinical studies examining the endocannabinoid system as a therapeutic target in MS, with attention to both symptom control and neuroprotective/disease-modifying potential, and connections to other neuroinflammatory conditions.

What this study cannot tell us

Disease modification evidence comes exclusively from animal models. Translating neuroprotective effects from preclinical models to human MS has historically been challenging. The review covers a vast amount of data at varying evidence levels. Specific dosing, formulation, and timing questions remain unanswered.

How to read the evidence

This is a comprehensive review covering strong clinical evidence for symptoms and preliminary preclinical evidence for disease modification.

When this study was published

Published in 2018. Research on cannabinoids for MS neuroprotection continues.

The bigger picture

MS is the most common inflammatory demyelinating disease of the central nervous system, and despite improved understanding, there remains an unmet need for treatments, especially for progressive forms. The endocannabinoid system represents a therapeutic target that could bridge symptom management and disease modification.

Questions still open

Can the neuroprotective effects of cannabinoids be demonstrated in human clinical trials? Would early cannabinoid intervention in MS slow long-term disease progression? How should cannabinoid treatment be integrated with existing MS disease-modifying therapies?

Common questions

Can cannabis slow MS progression?

Animal studies suggest that cannabinoids may have neuroprotective effects that could slow MS progression, but this has not been confirmed in human clinical trials. Current clinical evidence supports cannabinoids for symptom management (spasticity and pain) only.

How does the endocannabinoid system relate to MS?

The endocannabinoid system plays roles in both immune regulation and neuroprotection, which are central to MS. Cannabinoids can reduce neuroinflammation and protect neurons in MS animal models, while also alleviating symptoms like spasticity and pain through direct receptor effects.

Read the original research

The endocannabinoid system and its therapeutic exploitation in multiple sclerosis: Clues for other neuroinflammatory diseases.

Progress in neurobiology, 160, 82-100

View on PubMed ↗Publisher’s paper ↗

Citation

Chiurchiù, Valerio; van der Stelt, Mario; Centonze, Diego; Maccarrone, Mauro. (2018). The endocannabinoid system and its therapeutic exploitation in multiple sclerosis: Clues for other neuroinflammatory diseases.. Progress in neurobiology, 160, 82-100. https://doi.org/10.1016/j.pneurobio.2017.10.007