What is fibromyalgia?
Fibromyalgia is a syndrome affecting the bones, muscles and joints, causing extreme pain and other non-specific symptoms such as depression, insomnia, and exhaustion.
Is there a connection between fibromyalgia and inflammation?
Yes - there is evidence that those with fibromyalgia have increased inflammation in tissues and in the spinal cord. However, fibromyalgia isn't an inflammatory disorder. The inflammation is thought to arise as a result of nervous system dysfunction.
Does the endocannabinoid system play a role?
Some researchers think that a clinical endocannabinoid deficiency is at the root of fibromyalgia and some of the symptoms commonly associated with fibromyalgia.
Does the research support cannabis for fibromyalgia?
In a number of studies, cannabis has been shown to reduce inflammatory markers of fibromyalgia and to reduce pain and improve sleep in fibromyalgia patients.
Fibromyalgia is an anomaly of the medical world, with doctors not knowing exactly what causes it or why it happens. Diagnosis is also very tricky, and testing is usually conducted to rule out other diseases rather than to diagnose fibromyalgia itself. In any case, pain and exhaustion are two characteristic symptoms of fibromyalgia and some patients who use cannabis report symptom improvement.
There are a number of reasons why cannabis might be helpful for fibromyalgia patients:
- Firstly, cannabis is anti-inflammatory, and there is evidence for systemic inflammation in fibromyalgia patients
- Cannabis is analgesic, and fibromyalgia is characterised by extreme pain
- And, arguably the most interesting reason is that a clinical endocannabinoid deficiency might be at the root of fibromyalgia. In which case, cannabis is a very handy tool to have around
Fibromyalgia is a complex disorder that patients often spend their whole lives trying to manage. Because we know so little about its aetiology and how it’s treated, effective alternative treatments are welcomed. One of the primary goals of fibromyalgia treatment is pain management — and that puts cannabis at the forefront as a potential treatment option.
What is fibromyalgia and what causes it?
Fibromyalgia is a painful syndrome affecting the bones and muscles. It’s characterised by pain at multiple different locations (especially joints), and systemic symptoms like exhaustion, insomnia, mood disorders and cognitive dysfunction.
As you can imagine, diagnosing fibromyalgia is hard. It’s commonly misdiagnosed because its symptoms are so non-specific. Doctors typically look for an underlying organic disease that explains these symptoms, but if non presents, it’s then that doctors might consider fibromyalgia as a diagnosis.
Although it’s unclear what causes fibromyalgia, it’s thought that the disease is the result of a dysfunction in the way the spinal cord and brain process pain signals. This is why testing the site of the pain reveals almost nothing — because the “injury” or “dysfunction” itself is not at the site of pain, but in the spinal cord and brain.
While the cause remains unknown, there are certain risk factors which increase vulnerability to fibromyalgia:
- Being a woman
- Having another painful disease such as arthritis
- Having depression or anxiety
- Having a history of physical or emotional abuse, or PTSD
- Very little exercise
- Another family member has fibromyalgia
What’s the link between fibromyalgia and inflammation?
What continues to rise to the surface in modern medical research is an association between inflammation and many of the most common chronic disorders. Fibromyalgia was actually once considered an “inflammatory disorder” but has since been reclassified as a neurological disorder.
But this reclassification didn’t occur because inflammation isn’t an aspect of fibromyalgia, but because it’s not caused by a dysfunction of the immune system or inflammatory process (like arthritis). It’s caused by a dysfunction of the central nervous system. However, there is ongoing evidence that fibromyalgia-related inflammatory mechanisms are activated by the central nervous system, causing inflammation in the tissues and in the spinal cord.
It has also been proposed that inflammation plays a role in the pathogenesis of fibromyalgia — it might not just be a symptom after all. However, more research is needed to understand how inflammatory processes might contribute to the development of fibromyalgia.
There is a strong link between fibromyalgia and inflammation, whether it’s that inflammation may contribute to its development or whether it is a symptom and biomarker of fibromyalgia. Hang onto this connection for when we talk about cannabis and its impact on inflammation later in this article.
Clinical endocannabinoid deficiency and its role in fibromyalgia.
It was Ethan Russo who first coined the term “clinical endocannabinoid deficiency”, aka CED. In his research, Russo points out his theory that underlying many treatment resistant conditions is actually a dysfunction of the endocannabinoid system. Of the specific diseases he references, fibromyalgia is prominent (along with IBD and migraine).
This theory becomes particularly interesting when we look at how common the overlap is between fibromyalgia, inflammatory bowel disease (Crohn’s) and migraine. It is extremely common for fibromyalgia patients to experience IBD and migraine, and they often arise as comorbidities.
To give you an idea of how common these comorbidities are for fibromyalgia patients:
- In one study including 201 fibromyalgia patients, 97% of them experienced primary headache
- 31% of IBD patients of one study also fit diagnostic criteria for fibromyalgia
- And in another study, 32% of fibromyalgia patients also fit the diagnostic criteria for IBD.
In 1998, hypoactivity of the endocannabinoid system in the spinal cord was observed in patients with hyperalgesia (constant and extreme pain). The researchers concluded that this is the pathogenic mechanism for hyperalgesia. It was from here that the connection was drawn between fibromyalgia and other hyperalgesic conditions and the endocannabinoid system.
The endocannabinoid is heavily implicated in fibromyalgia thanks to this research, and it’s not a farfetched concept when we also consider the interconnectedness between fibromyalgia and inflammation. The endocannabinoid system is interlaced with immune function, and it often regulates immune responses such as inflammation. This puts cannabis in a great position as a potential treatment alternative for fibromyalgia.
How can cannabis help fibromyalgia patients?
Given everything we’ve spoken about so far in this article, the most obvious benefit cannabis can provide for fibromyalgia patients is a safe means to pain relief. Pain relief is one of the primary objectives of fibromyalgia treatment as management of this primary symptom increases quality of life and gives better outcomes for other symptoms. Exercise, medication, and occupational therapy are the most common ways to treat fibromyalgia.
Above and beyond this, cannabis is anti-inflammatory. Several studies show that cannabis can downregulate cytokine and chemokine reduction which are the most important biomarkers of systemic inflammation.
In one Israeli study, 383 patients with fibromyalgia were surveyed. Of those, 84% reported using cannabis. Of the cannabis consumers, 94% reported a reduction in pain after using cannabis, 93% reported improved sleep, 87% reported a reduction in anxiety and 62% reported a reduction in anxiety.
In another study, fibromyalgia patients showed improvements in pain, mood, and sleep. The researchers also found very few side effects, concluding that cannabis was a safe and effective treatment for fibromyalgia.
Quality of life is so important.
Fibromyalgia is a chronic health condition that most patients will spend their whole lives trying to manage. Like arthritis, fibromyalgia is a condition that might not be curable, but when the symptoms are under control the quality of life dramatically increases. Because it is able to improve sleep and decrease pain, cannabis might be able to offer a better quality of life to fibromyalgia patients.
Cannabis does not cure fibromyalgia. But judging from the research, it may be able to address some of the underlying causes of it to decrease symptoms. And each day spent without pain or with a better sleep is a win for a patient with chronic health problems.
Do you or does anybody you know have fibromyalgia? Have you or they tried cannabis as a treatment option? We'd love to hear from you in the comments.