Cannabis for fibromyalgia

Fibromyalgia has a significant impact on the quality of life and affects millions of people worldwide. It is a chronic pain condition that on average affects 2-4% of the general population with a higher prevalence for women compared to men and an increasing incidence with age. Apart from a general and chronic pain, patients with fibromyalgia also suffer from other related symptoms which results in physical and mental exhaustion and reduces quality of life even further.¹

Since we are still facing challenges in effective treatment of fibromyalgia, cannabis might be a good supplement to alleviate some of the direct or related symptoms. We at Canify Clinics will make your path towards medical cannabis as easy as possible and support you in every step of the way:

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What is fibromyalgia?

The disease was in the beginning of the 1900´s termed “fibrositis” and used for local pain in muscles and joints. This term was later broadened to a more generalised pain and named “fibromyalgia”.¹ Although the disease has existed for many years, patients can feel accused of imagining their symptoms. It can be hard for healthy people to understand the constant pain as there is no underlying disease, injury or inflammation on any organs in the body but rather an amplification of the pain sensation.^1,2

What are the symptoms of fibromyalgia?

Fibromyalgia is characterized by a chronic widespread pain in many parts of the body including the skin, muscles and joints. The level of pain varies from day to day and also during the day, which makes it very hard for patients to plan activities as they never know their energy level. In addition, the pain is often accompanied by other symptoms or diseasessuch as fatigue, sleep disturbances, concentration problems, anxiety and depression.² 

How is fibromyalgia diagnosed?

The disease is usually diagnosed between the ages of 40 and 60, but the disease can also occur in children and teenagers. In many cases it is a major challenge for patients with fibromyalgia to reach a diagnosis and many are without a diagnosis for years or even misdiagnosed. Various symptoms that are different from patient to patient have to be taken into account and it cannot be confirmed by laboratory values or x-ray, which makes diagnosing challenging. The most widely used diagnostic tools include standardised questionnaires targeted Fibromyalgia plus physical examinations and blood tests to rule out other diseases.^1,2,3

What are the causes of fibromyalgia?

The exact causes of fibromyalgia is still a mystery but scientists speculate that it might be due to a combination of several factors. The suggested initiators include genetic factors or the experience of a stressful event like emotional, physical or sexual abuse, but there is not a single trigger defining the disease.The most accepted theory is that the pain is caused by pain pathways being altered in a way that makes the patient much more prone to feel pain than others.^1,3

Fibromyalgia: Alleviating pain through therapy

Currently there is no treatment that will completely remove all symptoms of fibromyalgia so the treatment goal with the current toolbox is to improve symptoms and increase life quality but not to cure the disease. Treatment strategies can be both pharmacological and non-pharmacological and the optimal choice is most likely a combination of both due to the complex nature of the disease.³

Fibromyalgia: pain therapy & standard therapy

Standard analgesics for chronic pain such as ibuprofen and paracetamol cannot be used for fibromyalgia due to the often poor effect. Opioids are also not the first line of choice due to the risk of addiction. Instead, doctors try to stabilise or inhibit the pain pathways with antiepileptic medication and antidepressants such as Amitriptyline, Duloxetine and Pregabaline, but the effects are often not sufficient. Hence. it is proposed to initiate several treatment strategies, where medication is one dimension supplemented by non-pharmacological methods such as yoga, acupuncture, cognitive behavioural therapy, mindfulness, massage, psychotherapy etc. or other non-pharmacological therapies. Also exercise or light sports like walking or cycling has proven a good effect in these patients.^2,3,4,5

Can cannabis help with fibromyalgia?

Since 2017 is has been possible for doctors to prescribe medical cannabis on a narcotic prescription under certain conditions. These conditions include if there is a serious illness which is therapy resistant, for which no standard therapy is available or for which the effects or adverse reactions are unacceptable. In addition, a medical assessment must conclude that there is a chance of symptom improvement with cannabis.

Below we have summed up some of the available data on the effect of cannabis on fibromyalgia.

Effects of medical cannabis on chronic pain

The Endocannabinoid system plays a role in keeping various important functions in balance including energy, appetite and the regulation of pain sensation. The system consists of cannabinoids produced by the body on demand (endocannabinoids), the enzymes involved in making and degrading the cannabinoids and the receptors, which initiate a response when the cannabinoids bind. These receptors can also be activated by the cannabinoids in the cannabis plant (phytocannabinoids).

Fibromyalgia and cannabis

Cannabis has been used historically since ancient times to treat pain. Nowadays, there is evidence for treating certain types of chronic pain such as neuropathic pain with medical cannabis and based on the limited available data, the chance of a beneficial effect on fibromyalgia also seems promising. This however needs to be confirmed in further clinical studies with consistent study design and methodology to fully build up the evidence for an effect.^1,3 

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Fibromyalgie: cannabis and recent studies

In a randomised clinical trial with 20 fibromyalgia patients, a single inhalation of cannabis containing high THC reduced the pain that is felt when putting pressure on the skin compared to patients taking placebo. 6 A positive result was also obtained in another placebo controlled trial involving 17 women with fibromyalgia. The cannabis group got a THC rich oil and showed significant improvement for “feel good”, “pain”, “do work” and “fatigue” scores in a fibromyalgia specific questionnaire.⁷ In a larger observational study, 211 patients with fibromyalgia were evaluated after 6 months treatment with cannabis. Here, the authors conclude a significant improvement in pain intensity, quality of life and fibromyalgia-related symptoms. They also showed, that cannabis is a safe supplement to standard chronic pain treatments as only mild to moderate side effects were observed including dizziness, dry mouth, nausea/vomiting and hyperactivity. However, this study has several limitations and biases, which further confirms the need for good quality clinical studies.⁸

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Disclaimer and legal information

This article is for information purposes only and does not replace medical advice from a doctor. The content is not intended to motivate self-diagnosis or self-treatment, nor to induce independent changes in medical treatment. Canify Clinics does not make any recommendations or promote any diagnostic methods or treatments. If you wish to change your treatment, this should always be discussed with a doctor. Furthermore, Canify Clinics cannot guarantee the accuracy, timeliness and balance of the content. Therefore, neither the authors of the texts nor Canify Clinics accept any liability for damages resulting from the independent use of the information described here.

Bibliography

1. 1Bourke, S. L., Schlag, A. K., O’Sullivan, S. E., Nutt, D. J. & Finn, D. P. Cannabinoids and the endocannabinoid system in fibromyalgia: A review of preclinical and clinical research. PharmacolTher 240, (2022).
2. 2IQWiG: Gesundheitsinformation.de
3. 3Khurshid, H. et al. A Systematic Review of Fibromyalgia and Recent Advancements in Treatment: Is Medicinal Cannabis a New Hope? (2021) doi:10.7759/cureus.17332.
4. 4Stensson, N. et al. Increased Anandamide and Decreased Pain and Depression after Exercise in Fibromyalgia. Med Sci Sports Exerc 52, 1617–1628 (2020).
5. 5Carson, J. W., Carson, K. M., Jones, K. D., Lancaster, L. & Mist, S. D. Mindful Yoga Pilot Study Shows Modulation of Abnormal Pain Processing in Fibromyalgia Patients. Int J Yoga Therap 26, 93–100 (2016).
6. 6van de Donk, T. et al.An experimental randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia. Pain 160, 860–869 (2019).
7. 7Chaves, C., Bittencourt, P. C. T. & Pelegrini, A. Ingestion of a THC-Rich Cannabis Oil in People with Fibromyalgia: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Pain Med 21, 2212–2218 (2020).
8. 8Sagy, I., Schleider, L. B. L., Abu-Shakra, M. & Novack, V. Safety and Efficacy of Medical Cannabis in Fibromyalgia. J Clin Med 8, (2019).