WHAT IS FIBROMYALGIA?
Fibromyalgia is a chronic pain disorder which holds a number of complexities, often making it difficult to treat. About 2% of the United States population lives with from fibromyalgia, with a ratio of about 8 to 2; women to men. A large portion of fibromyalgia patients are middle-aged women, however it affects all ages even children.
In scientific terms, fibromyalgia is a chronic pain state in which the nerve stimuli causing pain originates mainly in the tissues of the body. This results in increased pain with movement and the aggravation of fibromyalgia by strenuous exertion. Often times fibromyalgia can be unbearable, and inflict excruciating pain from head to toe.
Patients who are afflicted with fibromyalgia can experience many symptoms including:
Concentration and memory problems -- known as "fibro fog"
Irritable bowel syndrome
Painful menstrual cramps
Numbness, and tingling in hands, arms, feet, and legs
Urinary symptoms, such as pain or frequency
HOW CAN MEDICAL MARIJUANA HELP?
There has been a handful of research studies which have provided promising evidence supporting medical marijuana in treating symptoms of fibromyalgia. While the evidence is promising, we recommend talking to your primary physician about treating symptoms with medical marijuana. Before we dive into the uses of medical marijuana in treating fibromyalgia symptoms, let’s go over the research that is available.
From NORML.org: Researchers at Germany’s University of Heidelberg published a study in Current Medical Research and Opinion in which they evaluated the analgesic effects of oral THC in nine patients with fibromyalgia over a 3-month period. Subjects in the trial were administered daily doses of 2.5 to 15 mg of THC and received no other pain medication during the trial. Among those participants who completed the trial, all reported a significant reduction in daily recorded pain and electronically induced pain.
Another study published in The Journal of Pain, reported that the administration of the synthetic cannabinoid nabilone significantly decreased pain in 40 subjects with fibromyalgia in a randomized, double-blind, placebo-controlled trial. "As nabilone improved symptoms and was well-tolerated, it may be a useful adjunct for pain management in fibromyalgia," investigators concluded. A separate 2010 trial, performed at McGill University in Montreal, reported that low doses of nabilone significantly improved sleep quality in patients diagnosed with the disease.
More recently, a 2011 observational, case-control trial reported that the use of cannabis is associated with beneficial effects on various symptoms of fibromyalgia, including the relief of pain and muscle stiffness. Investigators at the Institut de Recerca Hospital del Mar in Barcelona, Spain, assessed the associated benefits of cannabis in patients with fibromyalgia compared with fibromyalgia patients who did not use the substance. Twenty-eight users and non-users participated in the study.
Authors reported: "Patients used cannabis not only to alleviate pain but for almost all symptoms associated to fibromyalgia, and no one reported worsening of symptoms following cannabis use. ... Significant relief of pain, stiffness, relaxation, somnolence, and perception of well-being, evaluated by VAS (visual analogue scales) before and two hours after cannabis self-administration was observed." Cannabis users in the study also reported higher overall mental health summary scores than did non-users. Investigators concluded: "The present results together with previous evidence seem to confirm the beneficial effects of cannabinoids on fibromyalgia symptoms.
MANAGING FIBROMYALGIA SYMPTOMS WITH MEDICAL MARIJUANA
Medical marijuana is widely known for its analgesic effects produced from a number of cannabinoids including THC and CBD. Results from an online survey by the National Pain Foundation and NationalPainReport.coms, found that 62% of cannabis-consuming fibromyalgia patients found the herb “very effective” in relieving pain. Marijuana drastically outperformed common prescription drugs like Cymbalta, Lyrica, and Savella. Only 8-10% of patients reported that these drugs were “very effective” in controlling symptoms.
When medicating for pain relief, there are a number of great options available. Patients should seek medication high in myrcene, a terpene associated with pain relieving properties. Patients may also want to medicate with CBD heavy strains that provide pain relief without the psychoactive effects from THC heavy strains. Another noteworthy aspect of CBD heavy strains is that they are effective at tackling the pain from neuropathy.
On the sativa side, Blue Dream is typically high in myrcene, and provides uplifting effects which may also aide in the anxiety and depression often associated with fibromyalgia. On the indica side, OG Kush is typically high in myrcene and can also aide in the sedation necessary for the sleep problems associated with fibromyalgia. For those seeking CBD heavy strains, Cannatonic is known for its pain relieving properties without causing the “high” associated with medical marijuana.
Pain during the night
Many fibromyalgia patients turn to edibles to get them through the pain during the night. Edibles typically last longer than smoked flower, and can aid in both pain relief and sedation. Edible doses vary from person to person, and each of us has a unique physiology.
We recommend starting very low with edible dosing, around 5 mg, giving it up to four hours to kick in. While four hours may seem like a long time, depending on your digestive system, your diet, and a number of other factors, it can take the cannabis time to travel through your system. Keep a detailed diary on your experiences and increase dosing in small increments to find your comfortable mg dosing.
Should you take too much of an edible, smoking or ingesting CBD heavy strains (or medicine) can help reduce the psychoactive effects of THC.
Many fibromyalgia patients deal with muscle spasms, muscle tightness, and inflammation. Both the cannabinoid CBG and the terpene caryophyllene are known for their ability to combat inflammation. When CBD and THC are combined in a 1:1, ratio they have shown to be effective for reducing muscle spasms and tightness.
For patients medicating with sativa flower, again, Blue Dream serves a valuable purpose with typically high levels of CBG. When medicating with indica, Bubba Kushoften has high levels of caryophyllene which can be effective in treating spasms.
While both sativa and indica strains have benefits, many fibromyalgia patients are finding a 1:1 ratio of THC and CBD to be most effective in reducing muscle spasms. Trokie offers a 1:1 sublingual which has been a huge help for many of our fibromyalgia patients. There are also a number of edible and concentrate options which lie around the 1:1 ratio, ask your dispensary for their available 1:1 (THC:CBD) options.
Living with chronic pain can cause friction and reduce mood, sometimes leading to depression and anxiety. Many fibromyalgia patients have a hard time dealing with such intense pain and keeping in good spirits. For those patients there are a number of options that can assist in mood enhancement. Strains that are high in the terpene Limonene help improve mood, and CBD heavy strains are known to help alleviate anxiety and provide a calming effect.
On the sativa side, Super Lemon Haze is a notable strain that is high in Limonene, providing mood enhancing effects while giving an energetic boost. On the indica side, Berry White is known to carry high Limonene, relaxing the body while improving the mind. For CBD, Good Medicine is known to reduce anxiety and provide a feeling of well being.
Fibromyalgia patients often combat gastrointestinal issues due to muscle spasms, and sometimes deal with irritable bowel syndrome (IBS). Research suggests that cannabis is effective in treating the symptoms of these gastrointestinal disorders in part because it interacts with the endogenous cannabinoid receptors in the digestive tract, which can result in calming spasms, assuaging pain, and improving motility.
The Girl Scout Cookies family seems to provide exceptional relief for gastrointestinal issues, however there are a number of strains which provide excellent inflammation, nausea, and spasm relief. Hybrids and Indicas seem to be most effective, with strains like Thin Mint Cookies, Ghost OG, and Mendocino Purpsaiding in gastrointestinal relief. On the CBD spectrum, Cannatonic is often found to provide inflammation relief, which can help in certain cases.
More often than not, the pain inflicted by fibromyalgia can cause troubles when it comes to sleeping, specifically staying asleep. As mentioned previously, many patients medicate with flower during the day, and prior to bed, take edibles to help keep them comfortable through the night. Typically, indicas are best for assisting in sleep, providing a calm and sedative feeling while producing pain relieving effects
There are a number of brave patients who have come forward with their stories of medicating with cannabis for fibromyalgia. Recently actor Morgan Freeman sat down with the Daily Beast and discussed his experiences medication with medical marijuana for fibromyalgia stating “Marijuana has many useful uses,” he says. “I have fibromyalgia pain in this arm, and the only thing that offers any relief is marijuana.”
Here are three stories of patients finding success in treating fibromyalgia symptoms with medical marijuana.
If you have any questions, please feel free to reach out. We are always happy to help in any way we can. You can reach us directly at (702) 778-7987 and firstname.lastname@example.org.
Schley et al. 2006. Delta-9-THC based monotherapy in fibromyalgia patients on experimentally induced pain, axon reflex flare, and pain relief. Current Medical Research and Opinion 22: 1269-1276.
Skrabek et al. 2008. Nabilone for the treatment of pain in fibromyalgia. The Journal of Pain 9: 164-173.
Ware et al. 2010. The effects of nabilone on sleep in fibromyalgia: results of a randomized controlled trial.Anesthesia and Analgesia 110: 604-610.
Fiz et al. 2011. Cannabis use in patients with fibromyalgia: Effect on symptoms relief and health-related quality of life. PLoS One 6.