What is Fibromyalgia?
Fibromyalgia, also known as myofascial pain syndrome is a chronic condition described as musculoskeletal pain, fatigue, and tenderness in localized areas. The pain is often characterized as widespread and resistant to standard pain relief drugs in an estimated 35-40 % of cases1.
Additionally, sufferers may have other symptoms such as sleep issues, stiffness in muscles, headaches, tingling in the extremities, irritable bowl syndrome and painful menstruation 2.
Fibromyalgia has long been a misunderstood condition as the cause is unknown despite being linked to past traumatic events, genes, certain diseases and/or repetitive injuries. the National Pain Foundation and National Pain Report conducted an online survey of over 1,300 fibromyalgia patients which found that 43% fibromyalgia sufferers feel their physician is not knowledgeable about the disorder and 35% feel their physician does not take their fibromyalgia seriously.3
Who is Afflicted?
While men and children are sometimes affected, the overwhelming majority (80-90%) of sufferers are women. Women produce roughly 7 times less serotonin than men and a lack of serotonin leaves a person predisposed to depression. Depression is very often seen in FM sufferers.
Symptoms often present in middle age and are more commonly seen in people with certain rheumatic diseases, such as rheumatoid arthritis, systemic lupus erythematosus (commonly called lupus), or ankylosing spondylitis (spinal arthritis). Presently, it is estimated that 1 in 20 people worldwide are affected by Fibromyalgia.
Some studies suggest that heredity may play a role but there is not yet any firm evidence.
What are the Traditional Pharmaceuticals Recommended?
The first step in treating fibromyalgia is often to prescribe an antidepressant that will work to alleviate pain and reduce sleeplessness. Not unlike cannabinoid therapy, using antidepressants for pain may not work the same way for two different people. Many FM sufferers find that they need to experiment or use a cocktail of antidepressants to address all complaints. Currently there are three drugs FDA-approved specifically for FM.
Cymbalta is a dual-acting norepinephrine and serotonin reuptake inhibitor (AKA antidepressant). Cymbalta works to raise levels of neurotransmitters that are known to prevent pain transmission.
Lyrica, an anticonvulsant originally used to treat seizures has been shown to offer some benefits in relieving anxiety, some sleep problems and pain relating to fibromyalgia. Lyrica affects the pain signals the brain sends out to the nervous system. It may reduce pain, fatigue and sleeplessness.
Similar to Cymbalta, Savella has been approved by the FDA specifically for fibromyalgia treatment.
Occasionally doctors might prescribe benzodiazepines to help relax painful muscles however, benzodiazepines are highly habit-forming and should be used with caution and care.
Remember that National Pain Report study we cited earlier? Those same patients were asked to rate the effectiveness of Cymbalta on their FM symptoms and 60% reported no change to symptoms at all. Among those who tried Lyrica, only 10% said it was very effective and 29% said it helps a little but 61% said it did not help at all and those who used Savella, 22% said it helped “a little” while 68% said “not at all”.
How Can Cannabis Help?
The Journal of Pain conducted a study called Nabilone for the Treatment of Pain in Fibromyalgia 4 in 2008 and found that the synthetic cannabinoid significantly decreased pain in 40 subjects with fibromylagia in a randomized, double-blind, placebo-controlled trial.4 “As nabilone improved symptoms and was well-tolerated, it may be a useful adjunct for pain management in fibromyalgia,” the report concluded. Researchers at McGill University conducted a separate randomized, double-blind, active-control, equivalency crossover trial to compare nabilone (0.5-1.0 mg before bedtime) to amitriptyline (10-20 mg before bedtime) in patients with FM with chronic insomnia. What did they find? While no effects on pain, mood, or quality of life were observed, sleep was improved by both amitriptyline and nabilone, with nabilone indicating superior results to amitriptyline.
Many fibromyalgia sufferers report self-medicating with cannabis with greater success than what they had seen from use of standard pharmaceutical medications. When researchers at the University Of Manitoba used the synthetic cannabinoid Nabilone to treat Fibromyalgia they found that the drug was well-tolerated and decreased pain. At the 4-week mark in the study, patients saw drastic decreases in tender points and anxiety symptoms. They also saw significant improvements in results from Fibromyalgia Impact Questionnaires.
In 2003 Dr. Ethan Russo, a neurologist and pharmacologist 6 suggested that Fibromyalgia might actually be part of a bigger problem he called Clinical Endocannabinoid Deficiency (CECD) 7 as he was able to link IBS, migraine, and fibromyalgia. He further expanded on his research in 2008 8 when he studied the effect of cannabinoid analgesia via the endocannabinoid system and non-receptor mechanisms, as well as randomized clinical trials employing cannabinoids in pain treatment. He points out that THC reduces the hypersensitivity to pain experienced by both migraine and fibromyalgia patients.
We still don’t have all the answers but we are moving closer every day and Canadians living with fibromyalgia have a few more tools to put in their tool kits.