Medical Marijuana for Fibromyalgia

Medical marijuana is a controversial issue—socially, legally, and politically. However, scientific evidence continues to mount suggesting that it could be a safe and effective treatment for numerous pain conditions, including fibromyalgia.

We have some synthetic versions of tetrahydrocannabinol (THC) on the market, which is the substance associated with the "high" of marijuana. Studies suggest, though, that other compounds in the plant may have therapeutic value as well.

Before discussing the specific effects of medical marijuana on fibromyalgia, it helps to know a little about something called the endogenous cannabinoid, or endocannabinoid, system.

What Is the Endocannabinoid System?

"Endogenous" refers to something that originates from inside your body—something that's naturally there.

"Cannabinoid" comes from the word cannabis, which is the technical name of the marijuana plant and refers to parts of your body that react to cannabis. We all have natural cannabinoids in our body, and more can be introduced by smoking or ingestion of marijuana or synthetic versions of it.

The endocannabinoid system is involved in multiple processes, many of which are known or theorized to be impaired in fibromyalgia. These include:

• Energy metabolism
• Immune function
• Memory
• Pain processing
• Sleep
• Stress response
• Temperature regulation
• The autonomic nervous system

A 2004 paper on the endocannabinoid system proposed that fibromyalgia, irritable bowel syndrome, and related conditions be classified as "clinical endocannabinoid deficiency syndromes." It also cites research implicating problems with this symptom in schizophrenia, multiple sclerosis, Huntington's disease, some cases of Parkinson's disease, some cases of anorexia, and chronic motion sickness.

The growing body of research suggesting that fibromyalgia may involve a deficit in endocannabinoids raises an obvious question: does increasing the amount of cannabinoids in the body help improve function and reduce symptoms? If so, what symptoms would medical marijuana (or synthetic equivalents) help alleviate?

What the Research Says

A 2014 review of research on marijuana for treating fibromyalgia, as well as the related conditions irritable bowel syndrome and migraine, suggested:

• Endocannabinoid deficiencies play a role in these conditions
• Marijuana has the ability to block mechanisms of spinal, peripheral and gastrointestinal pain
• Clinical experience corroborates these findings

Studies suggest that marijuana can significantly:

• Reduce pain (including nociceptive pain, which is a component of fibromyalgia)
• Reduce stiffness
• Lower inflammation (including myofascial inflammation, which may play a role in fibromyalgia)
• Enhance relaxation
• Increase sleepiness
• Increase feelings of well-being

One study also saw that cannabis users had a significantly higher mental health score than non-users. Another one, which looked at the effect of a synthetic cannabinoid called nabilone, suggests that a low dose at night can improve sleep in fibromyalgia and can be considered an alternative to the popular antidepressant amitriptyline.

A 2012 study looked at the prevalence of marijuana use in fibromyalgia. Researchers found that about 13% of participants were using the drug to help relieve their symptoms. Of these, more than 80% were using it illegally.

Researchers also discovered that marijuana use was more likely in fibromyalgia patients with unstable mental illness. The relationship between marijuana use and mental illness in this group isn't known.

Marijuana use also was more prevalent among men, unemployed participants, and those receiving disability payments.

Side Effects

A 2011 review stated that cannabinoids appear safe and were associated with mild or moderate side effects that were generally well tolerated, and that the drop-out rate due to side effects was low. Reported side effects included:

• Dizziness
• Nausea
• Dry mouth
• Ataxia (reduced control of bodily movements)

However, a 2014 study points out that we need longer-term studies in order to know what the long-term adverse effects could be, as well as the potential risks of misuse and addiction.

Marijuana-Based Treatments

Some synthetic forms of marijuana are on the market in the U.S. These drugs include:

• Marinol (dronabinol)
• Cesamet (nabilone)

Medical marijuana is legal in several states. This form of the drug can be smoked, eaten (such as in baked goods), or vaporized. Eaten or vaporized forms may be safer and easier for some people to tolerate.

Because of its accessibility as a recreational drug, some people opt to self-treat with marijuana illegally. This comes with its own risks, including:

• Being arrested, charged and convicted of a crime
• Receiving marijuana with potentially dangerous substances included
• Receiving a substandard product

People using marijuana illegally may also be reluctant to tell their healthcare providers about it. This can lead to problems with drug interactions or, in case of a severe negative reaction, cause healthcare providers to misdiagnose the issue. For your own safety, you should always inform your healthcare provider and pharmacist about all drugs you are taking.

CBD oil is also an option for those looking to treat fibromyalgia without the psychoactive properties of THC.

Other Endocannabinoid System Treatments

Research suggests that many other drugs, both prescription and over-the-counter, affect the endocannabinoid system. These include:

• Painkillers (acetaminophen, NSAIDs, opioids, glucocorticoids)
• Antidepressants (amitriptyline, duloxetine)
• Antipsychotics
• Anxiety drugs
• Anti-seizure drugs (pregabalin, gabapentin)

Non-drug treatments that may also be effective include:

• Massage
• Myofascial manipulation
• Acupuncture
• Supplements
• Herbal medicines

Lifestyle factors including diet and exercise may also lead to changes in the endocannabinoid system. As with any treatment or management approach, you should talk to your healthcare provider about what the best options are for you.