Medical Cannabis and Fibromyalgia: A Comprehensive Approach to Improving Quality of Life
The limited success of conventional treatments for fibromyalgia has made medical cannabis an increasingly sought-after option for patients and their healthcare teams who are struggling to manage the chronic pain and other symptoms associated with the disease. Although there is no quick fix, Santé Cannabis’ extensive clinical experience with patients living with fibromyalgia has shown true potential for benefit.
Patients who commit themselves to a comprehensive approach that combines a carefully monitored medical cannabis treatment with physical activity, improved sleep hygiene and mental health treatment can often significantly improve their quality of life.
“Fibromyalgia is a disease that we see a lot at Santé Cannabis and we have a good deal of success with its treatment. We can work to improve it over time, but it requires full participation by the patient and, if possible, their families or support system.”
– Santé Cannabis Medical Director Dr. Michael Dworkind
Fibromyalgia is characterized by chronic musculoskeletal pain and diagnoses usually include other symptoms, such as chronic fatigue, poor sleep, mood and cognitive issues. The condition is thought to affect slightly less than two percent of Canadians, and is most common among women over 40 years of age.
While the pathophysiology of the disorder remains poorly understood, several possible mechanisms have been advanced, including central sensitization, suppression of descending inhibitory pathways, excessive activity of glial cells, and abnormalities in neurotransmitter release. A clinical endocannabinoid deficiency has also been hypothesized as an underlying pathophysiology but there remains insufficient evidence to support the theory. [i]
FINDING THE RIGHT CANNABIS STRAIN AND DOSE
Patients react to cannabinoids differently so it’s important to find the specific dose and strain that meets their personal needs. Through trial and with the continuous assessment of a supportive healthcare team, patients can attain that goal.
Although treatments at Sante Cannabis are initiated with products that have balanced levels of THC and CBD (THC:CBD), patients with fibromyalgia seen by our physicians generally report greater relief from THC-rich products. Patients who are inexperienced with cannabis should introduce THC slowly to avoid possible adverse effects. Inhaled THC-rich products are usually recommended to treat breakthrough pain.
Quebec physicians who want to learn more about the different strains of medical cannabis and administration methods can sign up to the Sante Cannabis Prescriber Training Program for convenient online access to clinical guidelines, education material and support.
SLEEP AND CHRONIC PAIN
Finding the right type of cannabis is not the only requirement for success in the treatment of fibromyalgia. Research and clinical experience show that an overwhelming number of fibromyalgia patients suffer from poor non-restorative sleep, often because they are frequently awoken by pain throughout the night.
Optimal sleep is critical in the treatment of fibromyalgia, with no more and no less than eight hours of nourishing deep sleep needed most nights. This may require an inhaled sedating strain of medical cannabis to induce the sleep, combined with the use of either a longer acting medical cannabis oil, a pharmaceutical cannabinoid or an edible medical cannabis product to maintain sleep.
The ability to induce and maintain a good quality of sleep is a solid indication that a medical cannabis treatment is effective.
PHYSICAL ACTIVITY AND MENTAL HEALTH
Another important component of treating fibromyalgia is physical activity. When fibromyalgia pain is adequately controlled, and patients are sleeping well, they can gradually become more active on a daily basis. Simple aerobics or brisk walking, preferably in a natural surrounding, can make a marked difference, as vigorous daily activity often leads to an improved mood and outlook, something that can be difficult for those with living chronic pain.
Chronic fibromyalgia patients may suffer from depression or adjustment disorders from years of poor treatments. The support of mental health professionals can be an important aspect of some fibromyalgia patients’ treatment plan.
Physicians and nurses should also emphasize lifestyle components in the ongoing treatment of all fibromyalgia patients. In our experience, mindfulness is another way to create positive lifestyle changes. By incorporating mindfulness approaches into their daily lives, patients can learn strategies and techniques to calm their minds and reduce anxiety, a symptom that frequently accompanies chronic pain conditions.
SYNERGY BETWEEN OPIOIDS AND CANNABINOIDS
Activity not only improves physical conditioning but it also stimulates the endorphins system, our body’s opioid system. Clinical experience indicates a synergy between cannabinoids and opioids that sees a mutual increase in therapeutic effects without increasing plasma levels. Working together, both cannabinoid receptors and opioid receptors can combine to better control the pain symptoms. Synergism between opioids and cannabinoids has been postulated and subsequently demonstrated in a number of animal models, and there is some evidence that cannabinoids might increase the synthesis or release of endogenous opioids. [ii]
“There is no cure for fibromyalgia,” says Dr. Michael Dworkind. “But we’ve seen this approach help patients find a life that is much more active and not centered on pain, a life in which the patient can better control the intensity and impact of a previously debilitating condition.”
Physicians with patients who might benefit from this Santé Cannabis approach can find a referral form to our clinic here. Patients who have questions about medical cannabis as a possible treatment option can access more information on our patient services page.
[i] Russo, E. B. (2008). Clinical endocannabinoid deficiency (CECD): can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuro Endocrinology Letters, 29(2), 192–200.
[ii] Abrams, D. I., Couey, P., Shade, S. B., Kelly, M. E., & Benowitz, N. L. (2011). Cannabinoid-opioid interaction in chronic pain. Clinical Pharmacology and Therapeutics, 90(6), 844–851. https://doi.org/10.1038/clpt.2011.188 ; Cichewicz, D. L. (2004). Synergistic interactions between cannabinoid and opioid analgesics. Life Sciences, 74(11), 1317–1324. https://doi.org/10.1136/bmj.f7339