Some studies have shown the positive effects of using medicinal cannabis for fibromyalgia in patients with very few adverse effects. There are not many treatments for fibromyalgia and the ones that do exist are not a permanent cure, as the cause is still unknown. But for those who want to bet on an alternative and natural treatment should try cannabinoid based treatments such as hemp oil.

What is fibromyalgia?

Fibromyalgia is one of the most common chronic pain syndromes and is characterised by musculoskeletal pain.  However, in addition to the physical pain, it can also produce severe secondary effects such as extreme fatigue, mood changes, as well as sleep disturbances.  The cause of this is not yet clear.

People who are diagnosed with fibromyalgia can experience significant effects on them being physical or psychological. It can prevent people from being able to carry out basic tasks at home or at work, causing psychological effects of anxiety and depression. The main treatment for this is pain relief medications including analgesics, pregabalin and opiates.

Regarding psychological effects, patients can also be prescribed with tricyclic antidepressants, benzodiazepines or other variations of antidepressants. However, this may not be an easy option as it can be associated with adverse effects such as dependence. Additionally, it may not even help with pain in the long run.

Who can get affected by fibromyalgia?

Fibromyalgia can affect up to 7% of the population and it is much more prevalent among woman than in men.  It roughly affects up to 4 million Americans from 18 years old and older.  However, the average age ranges from 35 to 45 years old.

Although fibromyalgia can be more common in women, it is also prevalent in people who have compromised health.  For example, people who have obesity, people who smoke, if they have other rheumatic conditions such as arthritis or those who have or had trauma to the brain or spinal cord. This can include physical trauma which comes from an injury, repeated injuries or an accident.  Emotional trauma such as post-traumatic stress disorder can also lead to fibromyalgia.

Lastly, researchers also think that a gene or genes may cause abnormal pain, therefore, it may be hereditary if a close relative also suffers from the same symptoms. [1]

Can medicinal cannabis help treat fibromyalgia?

Over the years, there have been various investigations on the effects of medicinal cannabis in fibromyalgia. However, there has not been any concrete scientific evidence of how cannabinoids can work in the endocannabinoid system to treat fibromyalgia.  Regardless, the little evidence that can be found is promising.

In one study, the main finding was that the medical cannabis treatment was associated with significant favourable outcomes in every aspect evaluated in the self-questionnaire regarding quality of life. In some cases, the effects were so significant that the patients had reduced the dosage or type of medications that they have been taking prior to the medical cannabis treatment, therefore reducing the secondary adverse effects of polypharmacy.

The patients’ positive responses even surprised the physicians as they have very rarely experienced such responses in daily practices and existing medicine. All the patients had reported a favourable outcome regarding pain and energy levels.

Other aspects also noted, but less frequent, were improvement of memory problems, and difficulties related to daily household activities or shopping. The patients have also noted a lack of serious adverse effects, the most frequent included dry mouth, eye redness, and increased appetite. [2]

In another study, it was demonstrated that medical cannabis is an effective and safe option for the treatment of fibromyalgia patients’ symptoms such as a significant improvement in pain intensity and overall improvement in their quality of life during the 6 months of medicinal cannabis therapy.

Moreover, there were relatively minor adverse effects with a small number of patients who discontinued the use at six months. Patients in this study often reported that medical cannabis is more tolerable and with fewer adverse events compared to other therapies. The researchers found that medical cannabis use is safe among fibromyalgia patients. At the six months follow-up, there was a relatively low rate of minor adverse events, and only 7.6% stopped using medical cannabis.

The effects of cannabis use

In concordance with the literature, researchers found that dizziness, dry mouth, hyperactivity, drowsiness, and gastrointestinal symptoms are all possible adverse effects of cannabis use. However, after six months, a substantial fraction of patients stopped or decreased the dosage of other medical therapies. For example, 22.2% of opioids users reduced or ceased the use of these medications at six months follow-up. This is a significant result considering the opioid crisis, as it reduces the risk of dependency, and a lower rate of serious adverse effects. [3]

Regarding synthetic medicinal cannabis, in a short-term trial which lasted 2 weeks, nabilone, a synthetic cannabinoid, was superior to amitriptyline, an antidepressant, in reducing sleep problems, but did not differ from amitriptyline regarding pain relief, limitation of health-related quality of life, or mood problems in fibromyalgia patients. In another short-term trial lasting 4 weeks, authors supported the effects of nabilone over a placebo in the reduction of pain and quality of life, but not for fatigue and depression.[4]

Finally, in one observational study, 28 fibromyalgia patients used cannabis against 28 who did not. Within two hours after cannabis self-administration, the cannabis users reported a reduction in pain and stiffness and increased relaxation, accompanied by greater somnolence and feelings of well-being.

Benefits of hemp oil for fibromyalgia

In 2014 the Medical Plants research group at the University of Seville discovered that the hemp seeds from cannabis are beneficial to the body. Its chemical composition has a stupefying effect that can alleviate the symptoms of fibromyalgia.

Hemp oil has omega-3 and omega-6 polyunsaturated fatty acids. It also contains another series of potentially bioactive components such as phenolic compounds, sterols and fatty alcohols, among others. In addition, this oil does not possess any type of addictive component.

To test the benefits of Cannabis Sativa L oil, the researchers in Seville conducted a trial using mice. After administering hemp oil they discovered that it causes cognitive abilities to recover, it can diminish pain and normalize the muscular tone of the mice that did not have fibromyalgia.

The positive results of medical cannabis for fibromyalgia have led the University of Seville to patent the use of hemp oil to prevent and treat fibromyalgia. The patent is of great interest since its composition could be used to be supplied to patients with fibromyalgia through tablets or other solutions, such as a food supplement or by introducing it directly into the food itself.

Conclusion

Cannabis can be a promising treatment for fibromyalgia patients. Regarding the effects of cannabis, scientific research shows that there is potential in helping to improve the symptoms of fibromyalgia.  However, the prejudice and misconceptions do not help.

With the current insufficient evidence, physicians struggle to recommend any cannabinoid preparation for rheumatology patients, and so, cannabis and cannabis-based medicines are not yet prescribed among health professionals as there are still conflicting positions in the professional association.[5]

In conclusion, there is clear evidence and research showing the benefits of medical cannabis in different pathologies, and it is no different in fibromyalgia. However, the evidence we have today on the effects of using medical cannabis for fibromyalgia is still scarce and is not enough to prove the viability of it in fibromyalgia patients. Regardless, what we do know so far is that there are components in cannabis and hemp oil that can help the symptoms of fibromyalgia therefore more research must be carried out and dedicated in this area of treatment.

[1] Walitt, B., Nahin, R. L., et alt (2015). The Prevalence and Characteristics of Fibromyalgia in the 2012 National Health Interview Survey. PLOS ONE, 10(9), e0138024.

[2] Habib, G., & Artul, S. (2018). Medical Cannabis for the Treatment of Fibromyalgia. JCR: Journal of Clinical Rheumatology, 24(5), 255–258.

[3] Sagy, Bar-Lev Schleider, et alt. (2019). Safety and Efficacy of Medical Cannabis in Fibromyalgia. Journal of Clinical Medicine, 8(6), 807.

[4] Fitzcharles, MA., et alt (2016). Efficacy, tolerability and safety of cannabinoids in chronic pain associated with rheumatic diseases (fibromyalgia syndrome, back pain, osteoarthritis, rheumatoid arthritis). Der Schmerz, 30(1), 47–61.

[5] Sarzi-Puttini, P., Ablin, J., et alt. (2019). Cannabinoids in the treatment of rheumatic diseases: Pros and cons. Autoimmunity Reviews, 102409.