Fibromyalgia is a sensitive subject for many people. It can be an extremely debilitating disease, causing chronic pain, chronic fatigue and cognitive disorders. Those who have Fibromyalgia may experience headaches, nausea, and inflammation of the muscles and joints. Many suffer silently; with mood disorders, anxiety and depression often occurring as a result or as a precursor.
You may not know it, but approximately 5% of the population suffers from Fibromyalgia. In addition, 2/3 of those who are diagnosed are women. Because the cause is still unknown, there has been no real treatment for Fibromyalgia, only steps to help control the symptoms. These steps usually result in a variety of prescriptions for pharmaceutical and pharmacological drugs for managing pain. However, recent studies have found great success in monitoring the effectiveness of cannabis, specifically THC and CBD, on mitigating these symptoms.
What is Fibromyalgia?
Fibromyalgia is a multi-syndrome medical condition that affects patients both physically and mentally. For example, symptoms include; chronic musculoskeletal pain and heightened pain responses, chronic fatigue, insomnia and cognitive issues. These issues with cognition, or the “fibro fog,” can include impaired concentration and memory problems. Similarly, it can result in an inferior speed of performance and attention while increasing cognitive overload chances. In some cases, people also report bowel and bladder conditions, numbness or tingling in extremities, restless leg syndrome and sensitivity to outside stimuli. In most cases, Fibromyalgia is associated with anxiety, depression and post-traumatic stress disorder. However, the underlying symptom of chronic pain is present in all cases.
Causes of Fibromyalgia
The cause of Fibromyalgia is still unknown. However, professionals believe it is due to a combination of genetic and environmental factors. There are several genes that play a role in the develpment of fibromyalgia. As a result, they create a higher probability of Fibromyalgia pasing down genetically to children. Environmental factors can include things like infections, psychological stress and trauma. For instance, the pain associated with them appears to result from a pain processing disorder in the central nervous system. These disorders often manifest as a condition known as “central sensitization,” where certain parts of the body become wildly sensitive to pressure.
Several hypotheses as to the cause of Fibromyalgia have been developed. The theory of “central sensitization” proposes that those who suffer from the disease have a lower pain threshold. This is due to the increased reactivity of the pain-sensitive nerve endings in the brain and spinal cord. This results in a high occurrence of both neuropathic pain and major depressive disorder. In these cases, illness or psychological stress can cause abnormalities in the pathways that control inflammation and tension in the body. In other words, these pain receptors are operating higher than normally, and their counter inhibitors lower than normal. This causes the sensation of pain to be magnified by the brain and can affect energy, mood and sleep.
Medical History and Classification
Fibromyalgia was originally defined in 1990, with updates to these criteria coming just ten years ago in 2011. Being a relatively new condition, it has been met with much skepticism, both by medical professionals and specific medical fields. Neurologists and other pain specialists regard Fibromyalgia as a pathology. This is due to the dysfunction of muscles and connective tissues combined with abnormalities in the central nervous system. Similarly, Rheumatologists define it in the context of “central sensitization.” Sensitization is a heightened brain response to normal stimuli in the muscles, joints and connective tissues.
In contrast to these beliefs, those in psychiatry often diagnose Fibromyalgia as an affective mood disorder. They put the same spectrum symptoms as mania, major depressive disorder or bipolar disorder, a combination of the two. Like psychiatrists, those who work in psychosomatic medicine view Fibromyalgia as a somatic symptom disorder. In these cases, the body physically manifests ailments that suggest illness or injury but have no other direct correlation to mental disease or other medical conditions.
Dr. Frederick Wolfe was the lead author of the 1990 paper that first gave definition and diagnostic guidelines for Fibromyalgia. He stated in a 2008 interview that he believes it is “clearly” not a disease but a physical response to depression and stress. In 2013, Wolfe would again revise his position by adding that the causes of Fibromyalgia “are controversial in a sense.” In addition, he would continue to say “there are many factors that produce these symptoms – some are psychological, and some are physical, and it does exist on a continuum.”
Unfortunately, there is no universally accepted treatment or cure for Fibromyalgia. Treatment for this disease typically consists of symptom and pain management and generally relies on pharmaceutical drugs, therapy and regular exercise. It has been found that treatment plans that incorporate medication, education, training and cognitive behavioural therapy have been effective at relieving symptoms of Fibromyalgia.
Patients who have Fibromyalgia are currently being given prescription Anti-depressants, Anti-seizure medications, and Opioids to help them mitigate their pain. In essence, they are given several drugs that provide the same relief as cannabis. It is worth noting that these medications all come with various adverse side effects and can cause serious physical and mental dependencies. As a result, many patients are hesitant to rely on them as a full-time treatment option. Cannabis can provide all of the relief as these medications without any side effects or dependency.
Managing Fibromyalgia with Cannabis
Using cannabis to treat Fibromyalgia, specifically THC and CBD, has been proven to be an effective treatment method. Cannabis helps alleviate pain while also interacting with the pain receptors in the endocannabinoid system to lessen pain sensations. It relieves headaches and muscle stiffness, improves mood and reduces anxiety, all of which are symptoms of Fibromyalgia. Cannabis is also quite useful in combatting sleep disorders and nausea, both of which are also common symptoms of Fibromyalgia.
In addition to medication, there are several steps patients can take to help lessen the symptoms of Fibromyalgia. Regular light exercise is the most recommended lifestyle adjustment and can be combined with massage therapy and acupuncture for best results. Regulating sleep and diet is also key to help reduce symptoms, as the immune system works best when it has controlled amounts of both sleep and nutrition. Many patients also find great relief from behaviour modification therapy, finding that therapy combined with awareness and education of this disease helps their own pain management.
Relevant Studies on the effectiveness of Cannabis on Fibromyalgia
In a 2009 review, it was found that CBD can be used to treat neuropathic pain. Researchers concluded that cannabis and CBD could be useful alternatives to opioids and other pain medications.
A 2010 study investigating the effects of a synthetic drug, Nabilone, showed that it helped improve sleep among those with fibromyalgia. Nabilone is synthesized to produce similar results to those of cannabis, providing analgesia and anti-nausea effects.
In a 2011 study where participants used cannabis for treating pain, 43% had reported substantial pain relief, while an additional 43% reported mild pain relief. Only 7% of participants reported no difference in symptoms. However, 81% of participants reported substantial relief from sleep issues. It is also worth mentioning that the study revealed cannabis users had slightly higher mental health scores than non-using participants.
A 2014 study of the effects of cannabis compared to the three main FDA-approved medications available for Fibromyalgia by The National Pain Foundation has yielded perhaps the most attention on this topic. The study compared the effects of Cymbalta, Lyrica, Savella and cannabis, and the findings were remarkable. Overall, 60-68% of participants said the FDA-approved drugs offered no relief, 22-29% said they offered minimal relief, and 5-10% said they were effective forms of pain relief.
In almost the exact inverse, 5% of participants said cannabis offered no relief, 33% said that cannabis offered minimal relief, and 62% said that cannabis was a beneficial form of pain relief. One participant reported that “I’ve found nothing that has worked for me, apart from marijuana.” Of the participants, 96% were females, with 44% claiming they had lived with Fibromyalgia for over 5 years before being diagnosed.
In a 2017 comprehensive review of the health effects of cannabis, the National Academies Press (NAP) supported substantial evidence that suggests cannabis is effective in treating chronic pain in adults. The review also concluded that there was moderate evidence to suggest that cannabis and its related products can help improve sleep in patients with Fibromyalgia.
A 2019 Dutch study of 20 women with fibromyalgia offered some interesting results. In the study, participants were given access to 4 different types of cannabis. Bediol, a 200mg variety with high THC and CBD. Bedrolite, a 200mg variety with high CBD and low THC. Bedrocan, a 100mg variety with low CBD and High THC and a placebo. The results of the study were quite impressive. In fact, the placebo was reported to offer the same reduction in pain as both Bedrolite and Bedrocan. On average, a 30% reduction in pain over 55% of users. However, Bediol was found to offer a 30% reduction in pain to 90% of participants.
In a 2019 Israeli study, hundreds of patients who have fibromyalgia were observed over a 6-month period. Of those surveyed, 82% were women. Participants were given access to 14 different strains of cannabis, with doses increasing over the 6-month time period. To begin the study, participants were given a median approved dosage of 670mg of cannabis daily. After that, the number would gradually increase to 1000mg per day at the 6-month mark of the trial. When the study began, over 52.5% of the participants described their daily pain levels as “high.” At the 6-month mark, only 7.9% percent of those surveyed reported “high” levels of pain. The study concluded that medical cannabis was “a safe and effective treatment” for Fibromyalgia.
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