Fibromyalgia & Medicinal Cannabis
By Dr Janelle Trees, BSC (HONS), MBBS (HONS), FRACGP
Fibromyalgia is a disorder causing debilitating pain musculoskeletal and lethargy. Sufferers also have problems with memory, concentration, mood and sleeping. While many patients had a clear trigger for the onset of the disease—physical or psychological trauma—the exact cause of the disease is still an area of research. Can cannabis-based pain relief help?
The evidence suggests that it can help some people. I’m going to write a brief overview of the disease and how we treat it, then, explore some of the research, considering marijuana pain relief for fibromyalgia specifically.
Fibromyalgia affects more women than men. Research has shown that it can cause more intense pain and disability in younger patients—causing untold distress at a time of life when people are normally bursting with energy.
Fibromyalgia is diagnosed after months or years of pain and a battery of tests, which will usually show normal results. It’s a disease we know little about and have no cure for. Little wonder, then, that depression and anxiety are common among people with fibromyalgia. The social isolation engendered by suffering from the disease is aggravated by many people’s lack of understanding of it.
It is a relapsing and remitting disease—it comes and goes. Individual patients sometimes develop insight over years into what triggers a flare of the disease, but trying to live with the restrictions the disease imposes is an ongoing challenge. I’ve cared for several fibromyalgia patients who have had to reduce their working hours or change the type of work they do.
Most people can work, play or party to the point of exhaustion and recover within a day or two. A patient with fibromyalgia cannot do that. One of my patients said, ‘It’s like getting a flu every time you get overtired’.
Treating fibromyalgia symptoms usually involves finding a GP or other specialist, for example a pain specialist or rehabilitation consultant, who has some education in the management of the illness. A GP experienced with managing fibromyalgia often works closely with a pain specialist. A physiotherapist, exercise physiologist, masseur or other allied health worker may be part of your treatment team, too.
The latter can really help, because, as any chronic pain sufferer will tell you, the medicines we use to treat pain are not perfect. They all have side effects and none can get rid of pain altogether. NSAIDs (like Naproxyn or Ibuprofen) and the stronger Opioids (like Oxycondone) are often ineffective for fibromyalgia. Sometimes they help with an acute flare of disease. But they can give have grievous side effects if used over a long time or in incorrect doses. Opioids can even make the pain worse.
Gabapentin (or other anti-seizure drugs) can help with nerve pain. Amitriptyline can alleviate nerve pain and anxiety. Some patients have benefited from hospital admissions for Ketamine infusion.
Many fibromyalgia patients find themselves on a lot of medication, often including medicines prescribed to help manage side effects of the medicines they need for pain relief. Regular medication review by the doctor is important.
With time and patience, most fibromyalgia patients find a way to manage their condition. As well as medicines, a good sleep routine, gentle, regular exercise and avoiding overcommitment—all means of managing stress—have been shown to help. Some patients use diet to try to decrease inflammation in the body. Reducing consumption of processed foods containing sugar, flour and toxic fats is good for everybody’s health. Quitting smoking must help, too. Some patients have found acupuncture and massage provide relief, but others do not.
Some fibromyalgia patients live with debilitating distress in spite of the best that doctors and other health workers have to offer. At times a medication regime that worked well for months or years stops working. These are the patients exploring medicinal marijuana for pain control, insomnia and anxiety.
Medical marijuana for pain management is an evolving field. Most studies are small and research has been conducted under such a variety of conditions that doctors still have to review the evidence themselves. Many researchers reached contradictory conclusions.
Positive results of a double-blind, placebo-controlled, randomised study—the kind that doctors respect—were published in Canada in 2008. In a relatively small study of 40 fibromyalgia patients, Nabilone, a synthetic cannabinoid, gave measurable pain relief and improvement in function. That is, patients felt better and they could do more. Those taking the placebo had no improvement.
A systematic review of trials of marijuana-based medicines in 2011 found that there was evidence that the medicines had a ‘modest benefit’ for management of chronic non-cancer pain and improved function (being able to do things).
A variety of cannabis-based medicines were reviewed for many different chronic pain conditions. In spite of these variables, researchers concluded that the used of cannabis for pain management for inflammatory conditions like rheumatoid arthritis and fibromyalgia was warranted. More research, on a larger scale and over longer time, is needed.
The US National Academy of Sciences, in their comprehensive 2017 study, noted that cannabis was widely used for pain management and that it can be beneficial, but that more research is needed into what types of medical marijuana and what doses are effective.
Most of the research they reviewed studied THC medicines or smoked flowering herb. Smoking marijuana may be helpful for people with fibromyalgia, but because the type of herb smoked and the actual growing conditions and content of it are beyond the buyers control, results are highly variable. Strains that are high in THC, for example, might aggravate anxiety or paranoia. To avoid this problem, there is a much greater range of medicines, with controlled ingredients and dosages, now available.
Marijuana-based pain medication is definitely worth considering for patients who have been unable to manage their fibromyalgia symptoms with other medicines.
If this is your situation, talk to your GP or pain specialist about working with an Australian medical marijuana clinic to trial some of these medicines. Perhaps one of them, in the right dose, will allow you to reduce the other medications you need to take and give you a better quality of life.