Can Cannabis Help Treat Fibromyalgia & Ease Symptoms?

What is fibromyalgia?

Fibromyalgia is one of those disorders with an unknown cause, but highly incapacitating symptoms. It is precisely because its etiology (cause) isn’t known, plus the lack of specific effective treatment, that it has taken the medical community so long to recognise it as an illness.

However, recent research has been revealing about possible causes and even how cannabis may help treat symptoms of this disorder. For example, this study from 2011 that happens to be one of the rare scientific studies with results that can be immediately clinically useful to both patients and doctors.

What causes fibromyalgia?

There are different theories that attempt to somewhat explain its causes. Today, it’s widely accepted that fibromyalgia is an illness of organic origin, with recognised physical causes. This is despite the fact that there aren’t any definite clinical markers on which to base a diagnosis (as of yet), though there is hope for better diagnosing possibly through urine studies.

A diagnosis can only be given based on clinical manifestations from patients.

Theories to explain the causes range from a deregulation of neurotransmitters (principally dopamine and norepinephrine) to a dysfunction of the physiological mechanisms of chronic stress regulation (what is known in medical jargon as the hypothalamic-pituitary-adrenal, or HPA axis).

Other theories base their explanations for the symptoms on a disruption to the immune system. Whatever the causes, it seems that treatment with cannabis fits in with every one of these theories.

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Why treatment with cannabis may be helpful

We know that the endocannabinoid system is involved in physiological functions that include the regulation of the dopaminergic and serotonergic systems and the regulation of the physiological response to stress. And on top of this, the immune system is richly populated with CB2 receptors, which is why it can be highly influenced by cannabinoids, both endogenous and exogenous.

In fact, the main symptom of fibromyalgia is a very low pain threshold and the subjective feeling of pain is mediated, among others, by the three physiological processes mentioned. This is why, irrespective of what the causes may be, it makes sense to think that the treatment of fibromyalgia with cannabinoids could be a therapeutic option worth considering.

Cannabis may help treat other elusive illnesses

Other disorders that also involve neuropathic pain and have a disruption of the immune system as an etiological basis, such as multiple sclerosis, may be treated with cannabinoids. In addition to fibromyalgia, there’s a diverse group of functional clinical syndromes that have no clear medical explanation to date (such as migraines or irritable bowel syndrome), which cannabis treatments have proven helpful for in some cases.

Neurologist Ethan Russo has suggested as an explanation for this that the common cause of these disorders is rooted in a deficiency of the endocannabinoid system. This seems the most plausible idea, given that they share a certain level of effectiveness of treatment with cannabis. Other symptoms inherent to fibromyalgia, apart from the pain (which is the main symptom) are chronic fatigue, morning stiffness, constant tiredness, and affective disorders.

Studies and statistics on cannabis and fibromyalgia

One study conducted from the Municipal Institute of Medical Research in Barcelona, was published in the open-access scientific journal PloS. Consisting of 56 participants (half were already cannabis users and half who weren’t), the study looked at potential benefits of treating fibromyalgia symptoms with cannabis by using and reviewing:

• Standard 100-mm visual analogue scales (VAS)
• Pittsburgh Sleep Quality Index (PSQI)
• Fibromyalgia Impact Questionnaire (FIQ)
• Short Form 36 Health Survey (SF-36)

According to VAS scores, pain and stiffness drastically dropped and relaxation and general feelings of well-being were increased. The SF-36 also showed a significant increase for the mental health section.

However, the rest of the SF-36 sections didn’t show any significant difference, nor did the FIQ or PSQI. So while it seems promising that cannabis can be beneficial for those suffering from fibromyalgia, there’s clearly a need for more research. A better understanding of how the cannabinoid system is involved with the pathophysiology of fibromyalgia is certainly a start.

Another, more recent study published in the Journal of Clinical Rheumatology also shows that cannabis can help with symptoms. 26 patients from two hospitals participated and completed the Revised Fibromyalgia Impact Questionnaire for both before medical cannabis use and after. All patients reported not only a drastic improvement (on every single part of the questionnaire), but half of them also said they quit taking other medications for fibromyalgia. There were no severe side effects, though eight patients did report experiencing a few very mild ones.

In 2018, the University of Alberta submitted a new guideline proposal for prescribing medical cannabinoids in primary care. This is in response to a review of currently available clinical trials, and while they believe research shows promise specifically for fibromyalgia, they also say the quality of evidence is low.

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Cannabis vs pharmacological treatments

It would be interesting to investigate whether, in women suffering from this condition who are less resistant to treatment, cannabis could be more useful than the pharmacological treatments used.

All in all, these studies show that cannabis treatments for fibromyalgia:

• Significantly reduced or improved symptoms for participants (and better than current medication or placebo)
• Allowed participants to stop taking other fibromyalgia medications
• Produced less notable side effects than traditional medications

On another level as well, in-depth studies like the one carried out by the Municipal Institute of Medical Research will allow us to clarify in the future whether illnesses such as fibromyalgia are due to a deregulation of the endocannabinoid system and in this way gain an insight into the etiopathogenesis of this highly debilitating illness.