Living with Multiple Sclerosis often means managing unpredictable symptoms such as fatigue, pain, stress, and depression. A newly published study in the journal Archives of Physical Medicine and Rehabilitation explored how people with MS use psychoactive substances like alcohol, caffeine, nicotine, cannabis, and opioids in response to these symptoms throughout the day. The findings reveal a complex and bidirectional relationship between symptom fluctuations and substance use.
Researchers followed 258 adults with MS over multiple monitoring periods using ecological momentary assessment, also known as EMA. Participants completed smartphone surveys four times daily for 14 days at baseline, one year, and two years later. This method allowed researchers to track real-time changes in symptoms and substance use behaviors instead of relying on memory-based surveys.
The study examined whether symptoms predicted later substance use and whether substance use later influenced symptom severity. Researchers focused on four major MS symptoms:
The psychoactive substances tracked included:
One surprising finding was that increased stress levels predicted lower odds of alcohol use later in the day. This contrasts with previous studies in non-MS populations where stress often increased drinking behavior.
Researchers suggested that many participants in this study were likely social drinkers rather than individuals using alcohol as a coping mechanism. Interestingly, alcohol use later predicted lower stress levels, suggesting some participants may experience short-term stress relief after drinking.
However, alcohol consumption also predicted increased fatigue later on, highlighting a potential trade-off between temporary relaxation and worsening physical symptoms.
The study found that participants with higher average pain levels were more likely to use opioids. This finding supports previous evidence showing that chronic pain management remains a major challenge for people with MS.
At the same time, people who used opioids more frequently still reported higher pain levels overall. Researchers noted this could indicate that opioids may not provide sufficient relief for many forms of MS-related pain, especially neuropathic pain caused by nerve damage.
The findings also raised concerns about opioid-induced hyperalgesia, a condition where long-term opioid use may actually increase sensitivity to pain.
Another major takeaway involved fatigue, one of the most debilitating symptoms of MS.
Researchers found that:
While caffeine appeared helpful for reducing tiredness, it also came with drawbacks. Participants who consumed caffeine later reported increased stress levels.
This highlights the balancing act many people with MS face when trying to manage symptoms through everyday substances.
Although many people with MS report using cannabis for pain management, the study found no evidence that increased pain predicted later cannabis use.
Instead, cannabis use was associated with slightly higher pain levels afterward. Researchers suggested that cannabis use in this population may often be habitual or recreational rather than directly tied to momentary symptom changes.
This finding challenges some assumptions surrounding cannabis and symptom management in MS care.
This study provides one of the most detailed real-time looks at how people with MS interact with psychoactive substances in daily life. Previous research mostly relied on cross-sectional surveys that captured only broad trends rather than moment-to-moment changes.
The EMA approach allowed researchers to observe how symptoms and behaviors shift throughout the day. This matters because MS symptoms are highly variable and often fluctuate significantly within hours.
Understanding these patterns may help healthcare providers:
Although the findings are valuable, researchers acknowledged several limitations.
First, most participants had relapsing-remitting MS and moderate symptom severity, which may limit how broadly the results apply to people with progressive forms of the disease.
Second, all substance use was self-reported. The study did not measure exact dosage, timing, or methods of consumption. Researchers also could not distinguish between prescribed and recreational opioid use.
Finally, the study identified associations rather than direct causation. While substance use and symptoms were connected, the research cannot prove one directly caused the other.
The findings suggest that even socially accepted substances such as caffeine and alcohol can have unintended effects on MS symptoms. Some substances may offer short-term relief while worsening fatigue, stress, or pain later.
People living with MS may benefit from tracking how certain substances affect their symptoms personally. Open discussions with healthcare providers about alcohol, caffeine, cannabis, nicotine, and prescription medications may also improve long-term symptom management.
Importantly, the study reinforces that symptom management in MS is highly individualized. What helps one person may worsen symptoms for another.
This groundbreaking research sheds light on the dynamic relationship between daily MS symptoms and psychoactive substance use. While some substances appeared to offer temporary symptom relief, others contributed to increased fatigue, stress, or pain over time.
The study highlights the need for more personalized approaches to symptom management in MS care. As researchers continue exploring these connections, healthcare providers may gain better tools to help patients navigate both the benefits and risks associated with substance use.
Kim J, Ehde DM, Alschuler KN, Fritz NE, Kratz AL. “Daily Temporal Associations Between Use of Psychoactive Substances and Fatigue, Pain, Stress, and Depressive Symptoms in People With Multiple Sclerosis.” Published in April 2026 in Archives of Physical Medicine and Rehabilitation.
This article is for informational and educational purposes only and does not constitute medical advice, diagnosis, or treatment. Individuals with Multiple Sclerosis should consult a qualified healthcare professional before making changes to medications, substance use habits, or treatment plans.
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