Is Cannabis A Future Fibromyalgia Treatment?

In recent years, evidence has been mounting in favour of cannabis’ therapeutic prowess. Used for decades to treat ailments like chemotherapy-induced nausea, and now invoked for the treatment^[1] of two types of severe epilepsy, cannabinoids are featuring more and more in modern medicine. As such, researchers are delving further into if, and how, cannabis and its derivatives might be of use to those with fibromyalgia.

Below, we take a look at the current state of medical research on using cannabis to ease symptoms of fibromyalgia. But first, let’s review the complex condition that is fibromyalgia (FM).

WHAT IS FIBROMYALGIA?

Fibromyalgia is a disorder defined by chronic muscle and joint pain, and accompanied by related symptoms such as fatigue, trouble sleeping, and memory and mood issues. It is not well understood what causes fibromyalgia, but it is thought that fibromyalgia amplifies painful sensations by affecting the way the brain processes pain signals.

Many times, fibromyalgia symptoms occur after physical trauma such as surgery or infection, but it can also be caused by stress. There are also cases where fibromyalgia develops without an obvious cause. Women are more likely to develop fibromyalgia than men. Those who are diagnosed with FM often suffer from anxiety and depression, and are frequently also found to have psycho-physiological conditions such as irritable bowel syndrome, temporomandibular joint disorder (TMJ), and headaches.

There is no cure for fibromyalgia, but various options—from pain medications to exercising and techniques for relaxation and reducing stress—can provide a certain amount of relief. Could cannabis be a promising treatment option for those suffering from fibromyalgia?

THE ENDOCANNABINOID SYSTEM

Cannabis has actually been under the spotlight of the pharmaceutical industry for quite some time. What makes cannabis interesting from a medicinal perspective is that it contains hundreds of potentially valuable substances known as cannabinoids and terpenes. The way these compounds interact with the endocannabinoid system (ECS) in the human body—a network of naturally occurring cannabinoid receptors in the brain, nervous system, immune system, and other parts of the body—is chiefly of interest to researchers. There are two main cannabinoid receptors in the endocannabinoid system: CB1 and CB2.

• CB1 exists mainly on neurones in the brain and nervous system, and in certain tissue and organs such as the spleen and heart.
• CB2 receptors exist mainly on immune cells called microglia located throughout the brain and spinal cord. Their function is still largely unclear, however, they do play a role in pain perception in the brain, and are thought to play an important role in the development of chronic pain specifically.

CANNABIS AND FIBROMYALGIA

The potential therapeutic uses for cannabis, including for conditions like fibromyalgia, become increasingly evident when we understand the functions of the endocannabinoid system.

Fibromyalgia is frequently associated with the following symptoms:

• Chronic pain
• Muscle stiffness
• Sore and aching joints
• Fatigue and headaches
• Bowel and bladder problems
• Insomnia and sleep disturbances
• Depression and low mood

Interestingly, the ECS mediates these very same bodily functions and phenomena, which has led researchers to associate fibromyalgia with this regulatory network.

Dr. Ethan Russo, former Senior Adviser at GW Pharmaceuticals and now Director of Research and Development at the International Cannabis and Cannabinoids Institute, claims that deficient cannabinoid levels may be the underlying cause of numerous conditions alleviated by cannabis.

According to Russo’s scientific paper on clinical endocannabinoid deficiency^[2] as a possible reason for fibromyalgia, migraine, irritable bowel syndrome, and other treatment-resistant syndromes, an imbalance of cannabinoids in our body could cause communication between the brain and certain body parts and functions to become disrupted. He explains how THC fills in for one of our body’s own natural endocannabinoids—anandamide, which reduces hypersensitivity.

But Russo is not the only researcher to conduct studies on the effects of cannabinoids for treating fibromyalgia.

RECENT STUDIES ON EASING FIBROMYALGIA PAIN WITH CANNABIS

In a study published in 2019 called “Safety and Efficacy of Medical Cannabis in Fibromyalgia”^[3], researchers examined 367 fibromyalgia patients who used cannabis for six months. The researchers wanted to determine whether cannabis has the potential to help with fibromyalgia-related pain, and what possible side effects it may have on patients.

Of the 367, 261 patients remained in the study, as some dropped out mid-study. The patients started the six-month trial with a baseline pain intensity of 9.0 on a scale of 0 to 10. At the end of the study, the median pain intensity reported was down to 5.0. Furthermore, 194 patients (81.1%) said they experienced at least some improvement in their condition without any serious side effects.

Noteworthy is that patients were able to reduce or replace their prescription meds while taking cannabis: 22% of patients stopped or reduced their dosage of opioids, and 20% of patients reduced their use of benzodiazepines.

In 2017, the National Academies Press (NAP) published a comprehensive review^[4] of the therapeutic effects of cannabis. According to the review, substantial evidence suggests cannabis is effective at treating chronic pain in adults.

In the 2011 study “Cannabis Use in Patients with Fibromyalgia: Effect on Symptoms Relief and Health-Related Quality of Life”^[5], 28 cannabis users were asked to report perceived benefits of cannabis for fibromyalgia symptoms. An additional 28 FM patients who were non-users were also observed. Results showed a “statistically significant… reduction of pain and stiffness, enhancement of relaxation, and an increase in somnolence and feeling of well being [in the cannabis group]. The mental health component summary score of the SF-36 was significantly higher in cannabis users than in non-users”.

Moreover, it’s worth noting that none of the participants noted any worsening of fibromyalgia symptoms when using cannabis.

In a 2018 study^[6], 25 people with fibromyalgia took part in a placebo-controlled test on the pain-relieving effects of marijuana. Researchers administered three different types of cannabis, each with a different THC and CBD content, as well as a placebo.

Results showed that 44% of patients reported a 30% reduction in pain, while 24% reported a 50% reduction in pain. Interestingly, the study found that none of the treatments had an effect greater than placebo on spontaneous or electrical pain responses, but those who received Bediol (which contained 13.4mg of THC in addition to CBD) displayed a 30% decrease in pain scores compared to placebo (90% vs 55% of patients). This led the researchers to conclude that “cannabis varieties containing THC caused a significant increase in pressure pain threshold relative to placebo”.

Based on these results, more research is required to understand if cannabinoids, and which ones, might be effective for treating pain-related fibromyalgia symptoms.

CANNABIS FOR TREATING OTHER FIBROMYALGIA SYMPTOMS

For patients suffering from fibromyalgia, muscle and joint pain is just one of numerous potentially debilitating symptoms. With the pain often comes trouble sleeping, depression, nervousness, stress, and other psychological issues.

While it is yet unclear whether cannabinoids can suppress fibromyalgia in a statistically significant way in a large human population, there is some evidence that cannabis can help improve sleep^[7] in people with fibromyalgia in the short-term. Consider the following from “Chapter 4: Therapeutic Effects of Cannabis and Cannabinoids” published in The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research (2017):

“There is moderate evidence that cannabinoid meds, primarily nabiximols, are an effective treatment to improve short-term sleep outcomes in individuals with sleep disturbance associated with obstructive sleep apnoea syndrome, fibromyalgia, chronic pain, and multiple sclerosis”.

These findings are backed by an earlier study performed in 2010^[8] that investigated the effects of nabilone, a synthetic form of cannabis, on sleep in FM patients. Researchers found that nabilone was indeed effective at improving sleep in fibromyalgia patients, and that a low dose of nabilone administered at bedtime “may be considered as an alternative to amitriptyline”. 

CONCLUSION

Judging by the information above, in our hunt for safe, inexpensive, and effective treatments for fibromyalgia, cannabis could be at the forefront. Most evidence herein is still anecdotal, but the high-quality research performed thus far is encouraging. Research is ongoing, and more extensive studies are surely in the pipeline.