Alcohol, caffeine may ease some MS symptoms but worsen others

Using psychoactive drugs such as alcohol, caffeine, nicotine, cannabis, or opioids may help ease certain symptoms of multiple sclerosis (MS) — but many of these substances can make other MS symptoms worse, a study found.

The researchers also found that the specific symptoms a patient experiences significantly affect whether that person is likely to use a particular substance, particularly alcohol and opioids.

“Insights from studies like this could prompt a person with multiple sclerosis to reflect on what they are putting into their bodies and how it is impacting their symptoms,” Anna Kratz, PhD, co-author of the study and a professor at University of Michigan Health, said in a university news story.

The researchers encouraged people with MS to discuss the use of nonprescription drugs with their healthcare providers, and called on doctors to enter these discussions with an open mind and a willingness to listen.

The study, “Daily Temporal Associations Between Use of Psychoactive Substances and Fatigue, Pain, Stress, and Depressive Symptoms in People With Multiple Sclerosis,” was published in the Archives of Physical Medicine and Rehabilitation.

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“Having a better understanding of how these substances impact patients with multiple sclerosis will be beneficial for providers,” Kratz said. “Patients using psychoactive substances is not going to go away. Being able to understand the role these substances play and the pros and cons of each will allow providers to better advise their patients when it comes to use of these products.”

MS is a neurological disorder that can cause a wide range of symptoms, including fatigue, pain, and depression. People with MS often are prescribed medications to help manage some of these symptoms, but they may also rely on nonprescription psychoactive substances to cope on a day-to-day basis.

“Just as many people look to a cup of coffee in the afternoon for a pick me up, people with multiple sclerosis may seek caffeine to help with fatigue or alcohol to manage pain,” Kratz said.

However, it remains unclear whether the presence of certain symptoms influences the use of psychoactive substances and how using certain substances can affect symptom severity. Kratz and colleagues set out to understand the relationship between MS symptoms and the use of five psychoactive substances: alcohol, caffeine, nicotine, cannabis, and opioids.

The researchers asked 258 adults with MS to use a study smartphone to report their symptoms and their substance use four times daily for two weeks. The scientists then used statistical analyses to look for associations between reported symptoms and substance use.

“To our knowledge, this is the first study to examine daily temporal within-person associations between common symptoms experienced by people with MS, including fatigue, pain, stress, and depressive symptoms, and psychoactive substance use,” the team wrote.

The scientists found that certain MS symptoms predicted future substance use. For example, patients who reported momentary increases in stress or more pain were less likely to use alcohol in the near future, while more pain was associated with an increased likelihood of using opioids.

“Interestingly, none of the symptoms significantly predicted the use of caffeine, nicotine, or cannabis,” the scientists wrote. “This finding indicates that these substances may be consumed more habitually or recreationally, rather than as a direct response to momentary symptom fluctuations.”

At the same time, use of certain substances was associated with changes in near-future symptom severity. Patients who used alcohol, nicotine, or cannabis, for example, were more likely to report increases in fatigue, while use of caffeine was associated with lower fatigue.

Caffeine use also predicted increased stress levels; however, alcohol use was linked with reduced stress. Cannabis use was tied to more momentary pain, and opioid use was associated with more severe average pain.

“These results underscore the importance of caution, even with socially accepted substances such as caffeine and nicotine, particularly given their potential to worsen key symptoms in MS,” the scientists wrote. “Health care providers should engage in open conversations with patients about substance use patterns and consider the impact on symptom management in daily life.”