Fibromyalgia causes debilitating pain that is difficult to treat. With no cure for the condition and very few effective traditional treatment options, it’s no surprise that patients may research the effectiveness of medical marijuana for fibromyalgia. Learn more about marijuana and fibromyalgia to determine if it’s a good treatment option for you or a loved one.
The disorder of Fibromyalgia is most often known for the excruciating pain it causes, along with issues surrounding sleep, memory, and even fatigue. The primary symptom of Fibromyalgia is debilitating pain. The condition has no known cure and many treatment options have been found to be unhelpful. Fortunately, Fibromyalgia has been recognized as a qualifying Florida medical marijuana condition. Contact a Florida Medical Marijuana doctor today to see if medical cannabis can help treat your Fibromyalgia.
Common symptoms of Fibromyalgia
- Pain, aching and stiffness (worse in the morning)
- Poor sleep or fatigue
- Irritable bowel symptoms
- Concentration and memory difficulties
- Pain, lasting for at least 3 months
- Pain is felt on both sides of the body, and above and below the waist
What is Fibromyalgia?
Fibromyalgia is a chronic condition whose etiology and cause are unknown. Among other symptoms, it is characterised by chronic widespread musculoskeletal pain, with a low threshold for pain. As tends to happen in patients suffering chronic pain, there is often hyperalgaesia (greater than anticipated sensitivity to pain for a given stimulus) and allodynia (where normally non-painful stimuli, such as the rubbing of clothes, is found to be painful).
Chronic pain tends to be accompanied by other symptoms, fundamentally anxiety and depression, fatigue and various types of insomnia. However, there may also be paresthaesia (pins and needles), stiffness in joints, headaches, a sensation of swelling in the hands and problems with concentration and memory. The natural course of fibromyalgia is chronic, with the intensity of the symptoms fluctuating over time. Some phases are easier to tolerate, with less pain and some improvement in other symptoms. The variations sometimes depend on the time of year. In many cases, emotional factors also have a very notable influence, as do family situation, socio-economic level, etc. The diagnosis for fibromyalgia is clinical. There is no objective test for the disease, and nor are there any decisive analytical, imaging or anatomo-pathological tests.
Types of Fibromyalgia
Fibromyalgia is a complex pain issue that afflicts patients in varying ways. If you have fibromyalgia, your symptoms may vary from those of others living with this condition.
If you’re seeking medical marijuana for fibromyalgia, it’s helpful to understand what type of fibromyalgia you intend to treat. The following is a list of the seven different types of this condition that patients experience most:
- Hyperalgesia: In hyperalgesia, normal pain responses are amplified and a patient experiences discomfort more severely than an individual without this condition.
- Joint pain: Fibromyalgia characterized primarily by joint pain is one of the most common forms on this condition. Joint pain is defined by aches or swelling of any joints in the body.
- Central Sensitization (Allodynia): Allodynia, also known as central sensitization, is often associated with fibromyalgia because patients experience skin discomfort that can signal widespread pain.
- Pelvic Pain: Severe and long-term pelvic pain is often defined by symptoms such as pain during intercourse, an increase in urinary frequency, pain during urination and general bladder discomfort.
- Headaches/Migraines: Most fibromyalgia patients experience tension headaches or migraines, a more severe headache disorder. These issues can lead to sleep complications, dizziness and visual changes in addition to pain.
- Abdominal Pain: Chronic abdominal pain can stem from irritable bowel syndrome (IBS), indigestion and other digestive issues. Many fibromyalgia patients with abdominal pain also experience acid reflux, diarrhea and nausea.
- Neuropathic Pain: Many fibromyalgia patients experience neuropathic pain that manifests as pinched, burning or itching sensations. These sensations can affect nerves throughout the body but often affect the arms or legs.
The symptoms of fibromyalgia can occur randomly and may afflict different parts of the body over time.
Side Effects of Fibromyalgia
Unlike some conditions with outward signs, fibromyalgia symptoms are largely unseen by others, but the patient feels them intensely. Pain is often the symptom associated with the disease. However, many other possible signs accompany the pain and may lead to a fibromyalgia diagnosis. The difficulty lies in the fact that common fibromyalgia symptoms are also common symptoms of other diseases and conditions.
In addition to the painful and uncomfortable symptoms that come with fibromyalgia, the condition can affect daily life. The pain can make it difficult or impossible to handle regular daily tasks. In some cases, that may include duties required for a job. The fatigue associated with fibromyalgia can interfere with regular activities and work duties. With few options for effective treatment, many people with fibromyalgia continue suffering and dealing with the life disruptions.
Other people who suffer from fibromyalgia also deal with anxiety. This can be from the pain itself and from the misunderstanding that often comes from other people. Patients may have to deal with people saying the pain is all in their heads or that the condition isn’t real. They may face people who think they need to “suck it up.” Colleagues and bosses may be insensitive to the condition. These situations make the fibromyalgia diagnosis even more difficult to deal with.
Cannabinoids against fibromyalgia symptoms
Recent studies show that cannabinoids might be a useful treatment option for patients with fibromyalgia. For example, researchers from the Clinical Cannabis Research Institute in Israel have analysed data from fibromyalgia patients between 2015 and 2017 in a prospective observational study. The result: 81 percent of the study participants noticed a positive effect from cannabinoid therapy.
The average pain intensity of the participating patients before treatment was 9 (on the pain scale from 1 to 10). By the end of the observation period, this value had dropped to 5. The most common side effects were mild, especially dizziness, dry mouth, and gastrointestinal problems.
Participants were given cannabis drugs in different compositions. They took cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) in the form of cannabis flowers and/or oil. The CBD and THC content of the medication also varied from person to person.
Fibromyalgia and weed
In 2003 one of the leading marijuana researchers, Ethan B. Russo, published a paper that explored the concept that a clinical endocannabinoid deficiency (CECD) underlies the pathophysiology of migraine, fibromyalgia, irritable bowel syndrome and other functional conditions that have been found to symptomatically respond to treatment with medical cannabis. Since then, investigation has found that cannabinoids can block spinal, peripheral and gastrointestional mechanisms that promote pain in these conditions. Subsequent research has confirmed that underlying endocannabinoid deficiencies indeed does play a role in migraine, fibromyalgia, irritable bowel syndrome and a growing list of other medical conditions.
The symptoms suffered by fibromyalgia patients can be treated with cannabinoids. The different symptoms of the disease can be treated with substances from the same chemical family. Cannabinoids are classically indicated to treat pain, with THC and CBD essentially being used in a ratio of 1/1, as confirmed by the majority of studies. If the patient is already using opiates, it is important to begin with low doses and reduce the opiate intake once the cannabinoids begin to take noticeable effect. Cannabinoids and opiates can cause hypotension and it is therefore necessary to check blood pressure.
It is also important to watch for possible constipation caused by the cannabinoids. Nonetheless, opiates are much more astringent than cannabinoids. In both cases CBD has a greater effect than THC.
CBD has an antioxidant, anxiolytic and anti-depressant effect, and its anti-inflammatory effect is very useful in treating fibromyalgia, which can have multiple inflammatory foci in the musculoskeletal system. In most cases, this anti-inflammatory effect is reinforced by the use of THC. The analgesic effect is also boosted by the use of THC in different proportions. However, it is always necessary to prioritise avoidance of the psychoactive effect of THC, which could limit the patient’s activity. THC also has a relaxing effect, which will enhance the effect of the CBD in combatting insomnia. Both the quantity and THC/CBD ratio of the nocturnal and diurnal doses may be different. Ultimately, it will be the patient who will determine the right nocturnal dose for inducing sleep and the right diurnal doses of analgaesics, depending on the intensity of the pain and tolerance to treatment, though naturally, any decision must be taken with advice from their doctor. Cannabinoids and opiates may be used together; it is just a matter of establishing the right dose to prevent interaction.
For treating pain, the analgesic effect of CBD on its own is not as powerful as when THC is used in association. However, depending on the intensity of the pain, it may sometimes be sufficient. CBD also has an anti-inflammatory effect which will be useful. We therefore recommend using a 1/1 ratio of CBD and THC for treating pain, provided that the patient tolerates it well.
If, however, the patient does not tolerate this proportion well, it will be necessary to start with higher doses of CBD than THC. It is possible to begin treatment with CBD alone and then assess its effects to consider the need to combine different proportions of THC to control the pain.
The right dose must be calculated based on the patient’s weight. It is also important to rule out any contraindications as well as any possible interactions with previously prescribed medications. We therefore recommend that THC and CBD be used in in different proportions to treat patients with fibromyalgia.
It is worth remembering that the same quantity of THC from cannabis indica or sativa will have different effects, because of the other components of the plant (cannabis has around 400 active substances per variety).
We recommend the use of THC from cannabis sativa during the day, and from cannabis indica for the night-time dose. In most cases it works better, although there are always exceptions.
Cannabinoids are not effective for all patients. In some cases, patients report a partial improvement in symptoms from the first doses. It is very important to check that the cannabinoids are working properly, in order to continue adapting the dose to the patient’s needs.
If correctly dosed, most fibromyalgia patients for whom cannabis is going to be useful already begin to notice an improvement in symptoms from the first doses, especially in terms of pain and insomnia.
To sum up, fibromyalgia patients may start to respond in the first days of treatment, with some even reporting an improvement after the first doses.
Fibromyalgia Treatment with Pharmaceutical Cannabinoids
Anyone suffering from fibromyalgia will tell you it can be devastating. On some days, simple chores like doing laundry or making breakfast can be exhausting, if not downright impossible. Just ask Teri Robnett, a Denver-based medical marijuana patient’s rights advocate who runs the Rx MaryJane blog:
“There used to be days that I didn’t feel like I could get through the day. I just wanted to cry and go back to bed.”
Only a decade ago, many doctors didn’t believe fibromyalgia was real — “hysterical” women were just imagining it. To this day, it is still misunderstood, and often misdiagnosed. Commonly characterized as a chronic pain condition, a growing body of evidence suggests that fibromyalgia is a complex neurological disorder. Beyond chronic pain affecting muscles and connective tissue, sufferers often complain of joint stiffness, chronic fatigue, insomnia, general weakness, headaches, digestive issues, anxiety, and cognitive issues (e.g., “fibro fog”).
According to the National Institutes of Health, more than 5 million Americans — mostly women — have fibromyalgia.
What causes fibromyalgia?
While the cause of fibromyalgia is widely debated, Dr. Ethan Russo, a prominent neurologist and pharmacologist who has dedicated much of his professional career studying cannabis and the endocannabinoid system, theorized that fibromyalgia could be related to Clinical Endocannabinoid Deficiency (CECD).
The endocannabinoid system is like the Internet of your body — a communications network facilitating communications between your brain, organs, connective tissues, glands, and immune cells. The primary goal of the ECS is homeostasis — helping your body maintain a stable internal environment.
When the endocannabinoid system is out of whack, health suffers. An imbalance can cause a whole host of issues affecting mood, sleep, gastrointestinal health, muscle spasticity, to name a few — symptoms that are also prominent among sufferers of fibromyalgia, thusly supporting Russo’s theory.
Can medical cannabis be used as treatment for fibromyalgia?
Hard to treat and impossible to cure, many sufferers are curious about whether cannabis can help treat their discomfort.
Robnett, who is also the founder and executive director of Colorado-based Cannabis Patients Alliance, was one such patient. Recalling how in 1987 a car accident triggered her fibromyalgia, she later learned that an endocannabinoid deficiency could be to blame. She fell to the floor and cried, but her sadness was swiftly replaced with anger. Recognizing cannabis might be able to help, she asked, “How could the one thing that could supplement what my body wasn’t making [is something] the government could tell me I can’t have?”
For years Robnett took doctor-prescribed pharmaceuticals, but she detested the side effects and was concerned about drug interactions. “In 2009, I started medical marijuana. By 2011, I had quit all of my pharmaceutical medications and now use cannabis exclusively,” she explained.
Robnett said that at first it took her a bit of trial-and-error, but it didn’t take long for her to become convinced cannabis was preferable to pharmaceuticals. “From season to season, even day to day, the severity of symptoms can change because of the weather, stress, or hormones,” Robnett said. “Cannabis allows me to self-titrate. By being able to vary how I consume and types of strains, I can more effectively treat the symptoms.”
At night, Robnett medicates with an edible. Because edibles can take a bit to kick in, she begins her routine by vaporizing with an indica strain which quickly enters the bloodstream and immediately provides relief. While vaporizing works quickly, it doesn’t last through the night. “The edible takes much longer to affect me than vaporizing, but lasts much longer, and I can sleep through the night,” she said. “Getting a good night’s sleep helps keep my symptoms under control the next day.”
During the day, she’ll use something higher in CBD and lower in THC to minimize psychoactive effects while alleviating her symptoms. Chronic fatigue is also a common symptom, and Robnett said the high CBD counters the fatigue, giving her energy to get through the day.
Cannabis for treating fibromyalgia vs. prescription drugs
Robnett is not alone in her experience. The National Pain Foundation conducted a survey in 2014 of over 1,300 patients. Remarkably, nearly a third — 30 percent of respondents — reported having used medical cannabis.
Of the more than 390 survey participants who had used cannabis, compared to FDA-approved pharmaceuticals, far more people reported cannabis as being effective:
- 62% reported cannabis as “very effective” in treating their symptoms
- 33% reported that cannabis “helped a little”
- Only 5% said it did not help at all
Contrast these results to FDA-approved medications:
- A mere 8 – 10% reported Cymbalta, Lyrica, or Savella as “very effective”
- 60 – 68% responded those drugs “[did] not help at all”
No wonder “big pharma” is scared of cannabis! In the hierarchy of evidence, a survey is not weighted the same as a random-controlled trial (RCT). However, given the relative safety profile of cannabis and absence of adverse side effects compared to the FDA-approved medications, the data clearly suggests more research is warranted.
Synthetic cannabinoids for fibromyalgia
There has been just one double-blind, placebo-controlled randomized, controlled trial (RCT) of synthetic cannabinoids (not to be confused with dangerous, illicitly sold synthetic cannabinoids like “K2” and “Spice). Researchers concluded nabilone was a “beneficial, well-tolerated treatment option” that could be a viable adjunct to other therapies.
But, anecdotally, patients report they prefer botanical cannabis. Only 10% to 20% of the THC makes its way into the bloodstream after metabolizing. Furthermore, nabilone doesn’t come cheap! 30 capsules cost more than $1,000.
Robnett is happy with cannabis. “With cannabis I can vary by strain and consumption method according to how I feel or what time of day it is. More importantly, over the 28 years I’ve suffered from this condition, I found cannabis is by far the most effective and efficient treatment.”
Given the widespread frustration patients have with available treatments, and the devastating nature of fibromyalgia on those who live under its grip, it’s hard to find a morally defensible reason to deprive patients like Robnett the right to not only alleviate their suffering, but find a new lease on life.
Have you used cannabis to treat fibromyalgia? If so, share your experience with us in the comments section.
Pharmaceutical Cannabinoids – THC
THC (delta-9-tetrahydrocannabinol), the major cannabinoid constituent of cannabis, has only limited research as a singular agent for treating fibromyalgia. A 2006 study evaluated just nine fibromyalgia (FM) patients who received a daily dose of 2.5-15 mg of THC, starting with a 2.5mg/day dose with a weekly dose increase of 2.5 mg up to a maximum 15 mg/day dose, as long as no side effects were reported. Daily-recorded pain of the FM patients was significantly reduced but researchers recommended further studies be done prior to concluding definitive effectiveness.
In 2009 a multicenter survey was performed evaluating 172 patients treated with an average of 7.5 mg/day of THC over 7 months. Of these, 48 patients prematurely withdrew due to side effects, insufficient analgesia, or expense of therapy. In the end, 124 patients were assessed for changes in pain intensity, quality of life, anxiety and depression. Pain intensity improved significantly with the THC treatment. Opioid doses were reduced and patients perceived THC therapy was effective with tolerable side effects. About 25% of the patients, however, did not tolerate the THC treatment.
Best strains for fibromyalgia
Whether you should simplify shopping for medical cannabis by asking for an indica-dominant strain is a matter of debate. Some experts say it’s a better bet to seek out strains by name that are known for their mix of CBD, THC, and terpenoids (plant extracts) that produce the desired therapeutic effect. Suggested strains for pain relief include:
- Blackberry Kush: This indica-dominant strain may help with fibromyalgia-induced sleep problems. It’s known for its high THC content of up to 20 percent.
- ACDC: This sativa-dominant strain is known for its high CBD-to-THC profile, which makes it an effective pain killer.
- Harlequin, a sativa-dominant strain, offers high levels of CBD that make it effective for pain relief, tamping down THC’s side effects.
- Cannatonic. This hybrid strain offers a low THC-to-CBD ratio, which some find helpful for pain management.
- Red Dragon is a great hybrid known for its uplifting effects, making it a popular choice for those suffering from depression. Red Dragon can give you a real good hit though, so make sure that you’re comfortable at home when you use this strain. This strain has a complex flavor profile that gives users the classic stoned symptoms: the giggles, the munchies, and for some, paranoia – so it’s best used by those who are experienced in maneuvering a marijuana high. Red Dragon is an excellent strain for treating pain while addressing the emotional rollercoaster that often comes with being diagnosed with fibromyalgia.
- Supernova. This indica-dominant hybrid may have THC content of up to 25%. Some find it effective for fibromyalgia relief.
- Cannatonic: Another high CBD powered strain, this is one of the most celebrated strains to counter fibromyalgia. The intoxication achieved from this strain is pretty mild. If you’re new to the cannabis world, this would be the best strain to begin. If you have been around, don’t worry, you will enjoy its ability to manage pain, anxiety, and all the other above mentioned symptoms.
- Blue Dream: This is the strain that is universally revered for its relief of chronic pain and includes both pain and inflammation. It has about 24% THC, making it one of the most potent strains on this list.This works well for after-work recovery as well as for nighttime relief. Do proceed with caution as not everyone can handle such copious amounts of THC and might make you spiral downwards.
- Blueberry: The name gives away the notes at first glance; it has an unmistakable ripe berry aroma. This strain handles both the physical exhaustion as well as the mental anguish that is brought up by fibromyalgia. The fruity taste, combined with the blissful feeling, makes it an excellent choice for patients who have fibromyalgia.
- Headband: An indica dominant hybrid with a high THC count headband is an excellent reliever of pain. It is especially recommended for night time use as it has strong sedative effects.