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. Wondering if CBD is right for you? We can help. Read on to get the scoop on this increasingly popular compound and its effect on leg cramps.
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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 (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.
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
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.
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.
CBD for Leg Cramps: Does it Help?
Move over aloe vera and ashwagandha; there’s a new healing herb in town: cannabidiol. Better known by its buzzy nickname, CBD, the naturally occurring chemical compound is just about everywhere these days. You can find it in balms, tinctures, gummies, and capsules — even coffee drinks sold at small-town cafes. We’re also starting to see CBD creep its way onto cocktail menus all over the country.
Needless to say, cannabidiol is having a moment right now. And with possible benefits ranging from anxiety relief to sleep support — it’s easy to see why. But can the purported miracle compound help with leg cramps, too? We’ll tell you.
Read on to get the scoop on CBD and find out if it’s right for you.
What Exactly Is CBD?
CBD is one of more than 100 naturally occurring chemical compounds found in cannabis plants — which include both industrial hemp and marijuana. Unlike its close cousin, tetrahydrocannabinol (or THC), CBD doesn’t cause a psychoactive effect (AKA, it won’t get you “high”).
Is CBD Safe and Legal?
First, is CBD legal? The answer is – it depends on where you live — and whether the CBD derives from industrial hemp or marijuana. According to the Farm Bill of 2018, industrial hemp is legal. So any CBD that comes from hemp (which is grown to have less than 0.3 percent THC) is A-OK. CBD from the marijuana plant, on the other hand, is legal in only some states.
Now, as far as safety is concerned, the World Health Organization (WHO) says that cannabidiol does not appear to have the potential to cause harm. In fact, there is no evidence of health-related problems associated with the use of pure CBD to date.
That said, it can produce minor side effects for some people, including irritability, nausea, restlessness, and fatigue. It may also interact with certain medications and supplements, so be sure to check with your primary healthcare provider before use.
What Are Leg Cramps?
Charley horse, spasms, muscle fits — whatever you call them, there’s no denying that leg cramps can be excruciating. They predominantly affect the calf muscles, though they can also occur in the hamstrings, feet, and thighs.
More often than not, leg cramps last just a few moments before the muscle loosens and becomes relaxed, but this can leave pain and tenderness in the affected area for up to 24 hours after.
This pain can vary from person to person. For some, it feels like a clenched, contracted muscle tightened into a knot that feels no worse than a stubbed toe. For others, the pain can be severely uncomfortable and even unbearable.
What Causes Leg Cramps?
While it may seem as though there’s always a cause for a specific condition, this isn’t exactly the case for leg cramps. In fact, many people don’t know why they get them — they just do. These are called idiopathic leg cramps.
That said, there are also secondary leg cramps, which are usually a potential symptom of a more severe condition or underlying issue, such as:
- Too much muscle strain
- Muscle stiffness
- Inadequate stretching before physical exertion
- Liver disease
Leg cramps are also pretty common during pregnancy, often striking in the wee hours of the night during the second and third trimesters. This could be due to carrying extra weight, metabolism changes, fluctuating hormones, or even a vitamin deficiency, but the truth is that nobody really knows.
What we do know, though, is that our Organic Magnesium Lotion seems to help.
Made with just six organic ingredients, our organic sleepy body lotion is a coveted moms-to-be secret that can help calm your body and mind for a restful night’s sleep. Simply apply 2-3 teaspoons of lotion onto areas of pain or cramping before it’s time to hit the hay and catch some much-needed Zzzs — pain-free.
When Should I See a Doctor?
Dealing with leg cramps? Don’t worry; they’re not usually a cause for concern — especially when they follow periods of heavy use or exertion. But if you notice the intensity or frequency of your leg cramps increasing, it’s probably a good idea to get checked out by a doctor.
Schedule an appointment with your primary if your cramps are consistent and accompanied by the symptoms listed below:
- Muscle weakness
- Swelling in the ankle or leg
- Skin discoloration
- Lingering pain
Can CBD Help Leg Cramps?
Without getting too technical, the human body contains an internal system (aka the endocannabinoid system) that is made up of cannabinoid receptors CB1 and CB2. Regardless of whether you use CBD, this incredible system is part of everyone’s biology.
Endocannabinoids are cannabinoids that are made inside the body and help to regulate a number of functions and processes, including:
- Mood and emotion
- Immune response
In the same way that endocannabinoids interact with your body, cannabinoids from the cannabis plant (aka phytocannabinoids) do, too — including cannabidiol. They do this by interacting with the CB1 and CB2 receptors.
With this in mind, many studies have shown that CBD (a naturally-occurring cannabinoid found in plants) can interact with these receptors in the body to reduce inflammation and aid in pain relief.
So, can CBD help with leg cramps?
Since spasms are an inflammatory response, CBD may help with leg cramps, but more research is needed to make sure there aren’t any unwanted side effects.
Are There Alternative Solutions?
Don’t want to use CBD? There are many other options to achieve relief from leg cramps — here are some of them:
- Take a warm bath. Not only is a warm bath oh-so relaxing, but it can help to loosen up cramped muscles, too. Make your bath extra indulgent with our Therapeutic Bath Salts.
- Apply ice. To reduce inflammation, try massaging your cramped muscle with ice.
- Stretch. Stretching boosts circulation, which can help relax the muscles. Gently rub the cramped area and lightly stretch the muscle.
- Drink water. The moment a painful cramp strikes, grab a tall glass of H2O — preferably with electrolytes. In a recent study, experts found that those who consumed electrolyte-enhanced water were less susceptible to leg cramps than those who didn’t adequately hydrate.
- Magnesium. There are a number of studies that suggest the use of magnesium to combat leg cramps — that’s why we use pure magnesium in our Organic Sleepy Body Lotion. Simply lather some lotion onto the areas of pain and watch as your cramps slowly fade away.
So, can CBD help with leg cramps?
At present, clinical evidence that the naturally occurring compound can help with leg cramps is lacking. There is quite a bit of early research that indicates CBD has anti-inflammatory properties — and seeing as spasms are an inflammatory response, it makes perfect sense how the cannabinoid might be able to provide support.
That said, if you’re one of the many moms-to-be struggling with leg cramps, the Food and Drug Administration (FDA) recommends steering clear of cannabis or any type of CBD product as it may cause harm to your developing baby. Instead, reach for a pregnancy-safe solution like our Organic Sleepy Body Lotion made with pure magnesium to combat restless legs and ease pain.
At the end of the day, the choice to use CBD is yours. Just be sure to talk with your doctor first to make sure it’s a good fit for your unique health and wellness needs. While experts say pure CBD is generally safe, there is so much about the cannabinoid that is still unknown so it’s wise to use it with care and under the guidance of a primary healthcare provider.