What is fibromyalgia?
Fibromyalgia is a chronic, generalized pain disorder that is characterized by abnormal sensitivity and pain at particular point(s) of the body, tiredness, sleep and affective disturbances, and morning stiffness. The exact cause of fibromyalgia is not well understood. Studies have suggested several possible mechanisms as causes of fibromyalgia, such as abnormalities in neurotransmitter metabolism, central sensitization, abnormal activation of microglia, altered hypothalamic-pituitary-adrenal-axis (HPA-axis) activity, and autonomic nervous system response which can contribute to a dysfunctional stress response system and induction of pain pathway.
As of now, there is no effective treatment or cure for fibromyalgia. The available treatments may provide modest symptomatic relief; however, the patient’s overall quality of life remains consistently poor.
For those suffering from fibromyalgia, their only option for relief is to take pain killers daily to mask the symptoms. These medications can cause serious side effects in the long run.
The Role of Endocannabinoid Deficiency in Pain Disorders
The discovery of the endocannabinoid system (ECS) in the human body and its potential role in pain modulation drives the scientific community’s interest to explore the analgesic properties of cannabinoids, particularly phytocannabinoids.
Understanding the endocannabinoid system and its influential role on pain modulation, stress response, and cognitive functions can help us to understand the analgesic and anti-hyperalgesic benefits of cannabinoids. Studies have pointed out the possible role of endocannabinoid deficiency in the pathophysiology of fibromyalgia. Most of the randomized, controlled studies that have been done have shown that cannabinoids can alleviate pain in patients who cannot adequately control their symptoms by other pain management techniques. In fibromyalgia patients, chronic pain may be positively influenced by dysfunctional stress systems via the HPA-axis, in addition to a deregulated autonomous nervous system.
Recent research studies have confirmed that endocannabinoid deficiencies play a key role in the pathogenesis of fibromyalgia and other chronic pain disorders. Therapeutic benefits of cannabis against pain disorders are being studied and available data shows phytocannabinoids can provide a promising treatment approach for chronic pain disorders.
Fibromyalgia patients that do not respond to traditional treatments frequently use medical cannabis to manage their symptoms including pain, fatigue, depression, anxiety, insomnia, etc. Unlike opioid analgesics, marijuana can modulate pain signals from the spinal cord as well as from peripheral nerves.
Evidence-based clinical studies are needed to further demonstrate the health benefits of medical cannabis in a scientifically accepted way. This is quite possible in the near future if the politico-legal barriers get broken and medical bias fades.
What Clinical Trial Studies Reveal
Upon searching the medical literature database, we are able to see a growing body of evidence that supports medical cannabis treatment as a substitute or adjunct for prescription opioids to treat chronic pain disorders, including fibromyalgia.
A Spanish clinical trial of fibromyalgia patients reported significant pain relief and relief of muscle stiffness from medical marijuana. Although no large scale clinical trials have been conducted, the available evidence demonstrates the fact that cannabinoids are an effective treatment for fibromyalgia. Not only clinical trials, but even observational studies have reported symptomatic pain relief benefits from cannabis in chronic pain disorder patients.
Recent research evidence has pointed out the synergistic effects of cannabinoids and opioid analgesics, with remarkable reduction of pain symptoms. These benefits can also reduce the associated side effects from the opioid analgesics, including drug tolerance, dependence, addiction, overdose, and related mortality. Similar results were observed in a small scale clinical trial that enrolled central neuropathy and fibromyalgia patients that were treated with 9-Tetrahydrocannabinol (delta 9-THC).
This evidence empirically indicates the possible therapeutic role of cannabinoids in fibromyalgia treatment, and more large scale studies are needed to demonstrate these findings in a larger population.
An online survey (conducted by the National Pain Foundation) that included over 1,300 chronic pain disorder patients concluded that medical cannabis can outsmart top analgesic drugs that are currently used for fibromyalgia treatment. The survey asked the participants to rate the effectiveness of treatments based on their usage experience. The participants were asked to compare the symptomatic relief benefits provided by cannabinoids, Lyrica, Savella, and Cymbalta.
Nearly 60% of the participants who have tried all three drugs reported ‘poor treatment benefits’. To our surprise, 62% of participants who tried cannabinoids have found it ‘very effective’, while 33% and 5% of patients have reported ‘little benefits’ and ‘no benefits’, respectively. Similarly, a 2012 Canadian survey found that one in every eight fibromyalgia patients relies on medical cannabis to cope with their symptoms.
One study investigated the patterns of cannabis use and associated benefits, including improvement in the quality of life among fibromyalgia patients. When compared to non-users, cannabis users experienced reduction in pain symptoms, stiffness, and somnolence enhancement of relaxation and sense of well-being. These results suggest the remarkable therapeutic benefits of cannabinoids in fibromyalgia treatment.
Based on the available knowledge on anti-nociceptive and anti-hyperalgesic effects of cannabinoids, one pilot study was conducted to demonstrate the reported benefits of THC. The study subjects were assigned to receive a daily dose of 2.5-15 mg of THC with an average increase of 2.5 mg every week until development of adverse events or tolerance. Although no effect on axon reflex flare were observed, significant reduction of pain symptoms was evident after administration of a 10-15 mg dose of THC. Reduction in daily recorded pain was also recorded. These findings suggest that THC can decrease pain perceptions by a central mode of action.
One retrospective study to investigate the medicinal benefits of cannabis on chronic pain found that both genders’ use of medical cannabis were of the same rates. However, the majority of users reported significant pain alleviation, despite barriers in treatment access and delivery modes.
Due to legal restrictions, limited numbers of clinical trials on cannabis have been conducted to date. Nonetheless, we are able to see a number of ongoing and completed clinical trials, and reported analgesic benefits after synthetic cannabinoid use.
Still, most of the patients prefer to choose/use natural cannabis over synthetic cannabinoids, which may cause serious side effects, including death.
Marijuana Strain Does Matter
Research studies have shown that cannabis is generally useful for pain management. However, the efficacy of cannabis greatly depends on the cannabis strains. Among the available cannabis strains, “ACDC” has been shown to be effective for treatment of generalized pain, including fibromyalgia-related pain. This variant contains higher amounts of both THC and CBD, which can potentially relieve the pain symptoms while the CBD can counter the adverse effects of THC. Some experts believe heavy indica strains, such as Mazar I Sharif, Afghan Kush, White Widow, and Blackberry Kush are more effective in relieving pain symptoms. Cannabis activists believe strains that contain high amounts of THC can provide more pain relief. Some of the more THC-rich cannabis strains are Cannatonic and Harlequin. In addition to pain benefits, these strains typically possess anxiolytic, anti-depressive and sedative properties that are useful for alleviation of fibromyalgia symptoms. Marijuana can reduce pain and muscle stiffness while normalizing sleep patterns, which is believed to be one of the causatives of fibromyalgia.
The emerging knowledge on the endocannabinoid system and the possible role of the stress system in the pathogenesis of fibromyalgia suggests that endocannabinoid modulators, including phytocannabinoids, can potentially treat fibromyalgia. Based on the presented evidence, it is clear that medical marijuana has significant pain-modifying potential without causing serious side effects, which can be extremely beneficial for fibromyalgia patients.