WHAT DOES RESEARCH SAY ABOUT THE USE OF CANNABIS IN FIBROMYALGIA?

Fibrogmyalgia is a condition where you suffer from chronic pain in muscles and connective tissue, but recent research suggests that cannabis may be able to alleviate symptoms. In this blog, we list what fibromyalgia is and how cannabis can help improve the well-being of fibromyalgia patients.

What is fibromyalgia?

Fibromyalgia is a complex, chronic condition that causes pain in muscles and connective tissues all over the body. Other symptoms are also possible, such as brain fog, sleep problems, muscle stiffness and mood symptoms. According to an open-label, randomised crossover study conducted by the Department of Anaesthesiology at LUMC (Leiden), cannabis with high THC content (specifically Bedrocan and Bediol) was found to effectively relieve pain in fibromyalgia patients. A total of 20 participants received four different cannabis forms (two high-THC, one high-CBD and one placebo) via inhalation. Results: after inhalation of THC-rich cannabis, participants could tolerate significantly more pressure - CBD-rich cannabis had no effect before this test

Unfortunately, there is no cure for this condition and it is difficult to treat. Doctors usually have no choice but to prescribe painkillers and antidepressants. These drugs are only symptom relief and do not address the cause of the disease. But as more and more is known about the use of medicinal cannabis to treat various symptoms, people with fibromyalgia are also interested in it.

A significant number of patients have reported using cannabis to supplement their treatment, often without direct medical supervision - something that can carry risks. CBD is also in the spotlight. A survey in the US found that 70% of participants had swapped their prescription medication for CBD. Below, we discuss what is known about cannabis and fibromyalgia.

Research on cannabis and fibromyalgia

Dr Ethan Russo, a well-known scientist who specialises in cannabis, conducted research on the potential of cannabis for fibromyalgia. He even suspects that fibromyalgia could be caused by a deficiency in the endocannabinoid system (ECS). The study (The role of cannabis in treatment-resistant fibromyalgia women), took place in 2022. A WHO questionnaire, the Quality of Life Bref questionnaire, was used to investigate the impact of cannabis on the quality of life of 30 women aged 18 to 70. All these women suffered from fibromyalgia that was difficult to treat.

Many people with fibromyalgia report feeling better with the use of cannabis or CBD. Yet it is worth noting that medical science has yet to make any clear statements on this. The studies conducted so far are often small in size or lack a control group, making it uncertain whether the results can really be attributed to cannabis.

The Dutch College of General Practitioners (NHG) also states that there is currently insufficient evidence to recommend cannabis as a standard treatment for chronic pain. So the results are hopeful, but certainly not conclusive yet. It is therefore important to always discuss this with your doctor. They can look with you to see what is safe and appropriate in your situation - especially if you are already taking other medications.

The researchers concluded that the results indicated that cannabis played a significant role in the symptoms caused by fibromyalgia in these women. Cannabis can have a positive effect on quality of life in the short term by affecting pain, sleep and physical and psychological symptoms. While this study is hopeful, it was a small-scale study on just 30 women. Two years ago, there was a UK study ( Assessment of clinical outcomes in patients with fibromyalgia: Analysis from the UK Medical Cannabis Registry), which examined the data of 300 UK fibromyalgia patients. These patients were registered with the UK Medical Cannabis Registry, managed by the Sapphire Medical Clinic.

After the patients received treatment with medicinal cannabis, they reported that they experienced improvements in their fibromyalgia symptoms as well as in their overall health and quality of life. On top of that, a statistically significant reduction in opioid use was also reported.

What did this study show?

There were 306 people participating in the study, all of whom had been diagnosed with fibromyalgia. They were prescribed cannabis by Sapphire Clinics. 70% of the patients were women and on average they were 45 years old. Interestingly, already 41% of the participants had already used cannabis in the past. The patients were given different cannabis products; on average, they received 100 mg of THC and 20 mg of CBD.

The questionnaires patients had to answer aimed to measure fibromyalgia symptoms, as well as sleep, anxiety, pain and quality of life. They also looked at the use of opioid drugs. Questionnaires were completed at 1, 3, 6 and 12 months. Significant improvements were seen in fibromyalgia symptoms, pain, sleep and anxiety.

However, almost a quarter of patients did experience side effects, which were generally described as mild or moderate (mentioned were dry mouth, fatigue and decreased concentration). The researchers do indicate that this is nevertheless somewhat higher than reported in the overall population of the registry. It also appears that there seems to be a link between cannabis treatment and a reduction in opioid use. There is a significant reduction in oral morphine dosage 3 months after the start of treatment, compared with the baseline.

More research on cannabis and fibromyalgia needed

While these results seem to indicate that cannabis in fibromyalgia seems to be able to give good results, the researchers also say that caution is needed. This study also has its limitations, namely the lack of a control group. As a result, bias cannot be ruled out, but the scientists do call for further research with a randomised control group. "The study shows that there were not only improvements in pain symptoms, sleep and quality of life, but also a decrease in opioid use," they said. Medicinal cannabis-based products were also well tolerated."

Fibromyalgia is a disease that has a lot of impact on daily life, where the pain and fatigue can severely hamper your daily activities and work. Hopefully, research will continue, and it will soon become clear what cannabis can do for people with this condition. If you are interested in using cannabis for fibromyalgia, make an appointment with your GP. They can give you more information about the possibilities and help you find a legal supplier of medicinal cannabis.

Source of information not medical advice

This blog is intended as a source of information, it is not medical advice. While some studies report positive effects of cannabis in people with fibromyalgia, it is important to put these findings in perspective. Much of the available research is small-scale, observational in nature or based on self-reporting, which limits the reliability of the results. According to a systematic review published in Current Rheumatology Reports ( 2021), there is still insufficient evidence to routinely recommend cannabis as a treatment for fibromyalgia. The researchers stress the need for large-scale, randomised controlled trials to definitively establish the efficacy and safety of medicinal cannabis in this condition.

Therefore, it is important to always discuss cannabis use with a doctor, especially given the possible side effects, interactions with other medication and the lack of standardised doses.

Key studies & publication details

1. Khurshid, H., Qureshi, I. A., Jahan, N., Went, T. R., Sultan, W., Sapkota, A. & Alfonso, M. ( 2021)A Systematic Review of Fibromyalgia and Recent Advancements in Treatment: Is Medicinal Cannabis a New Hope? Cureus , 13(8), e17332.
- Review of 22 studies with conclusions that medicinal cannabis may be safe, but that more research is needed (researchgate.net,cannabisclinicians.org).

2. Strand, N. H., Maloney, J., Kraus, M., Wie, C., Turkiewicz, M., Gomez, D. A., Adeleye, O. & Harbell, M. W. (2023),Cannabis for the Treatment of Fibromyalgia: A Systematic Review, Biomedicines , 11(6), 1621.
- Systematic review to October 2022, showed limited evidence but possible short-term pain relief (researchgate.net).

Full references (APA style).

1. Pilot study - quality of life in 30 women
Eytan, D., Russo, E. B., Perez, S., Kaye, S., Pecora, A., & Monaco, A. (2022)The role of cannabis in treatment-resistant fibromyalgia women: A prospective cohort study. Pain Practice, 22(4), 365-372. (https://doi.org/10.1111/papr.13179 (pubmed.ncbi.nlm.nih.gov)

2. Observational - UK Medical Cannabis Registry
Wang, C., Erridge, S., Holvey, C., Coomber, R., Usmani, A., Sajad, M., ... Sodergren, M. H. (2023).Assessment of clinical outcomes in patients with fibromyalgia: Analysis from the UK Medical Cannabis Registry. Brain and Behavior, 13(7), Article e3072. (https://doi.org/10.1002/brb3.3072 (pubmed.ncbi.nlm.nih.gov)

Warning: Self-medication and legal aspects of cannabis use

Although more and more people with fibromyalgia claim to benefit from the use of (medicinal) cannabis, it is important to be cautious about self-medication. Cannabis is not an officially approved medicine for fibromyalgia and its use can carry risks, such as side effects, interactions with other medication and dependence. In addition, the legal use of cannabis is highly dependent on the laws in your country or region. In the Netherlands, medicinal cannabis can only be obtained on doctor's prescription through a licensed pharmacy. Growing or buying cannabis yourself outside the medical circuit is illegal in many cases and can have legal consequences. Never use cannabis without medical advice and always consult a doctor before starting, especially if you are already taking other medication or have health problems.