It may seem difficult to believe today, but as recently as 1990, fibromyalgia didn’t exist.
That was the year the Multi-center Criteria Committee of the American College of Rheumatology met and officially designated the disorder. The constellation of symptoms that characterize this painful and debilitating soft-tissue disorder include:
- A history of widespread pain throughout the muscles and connective tissues (tendons and ligaments) that has lasted more than three months.
- Pain occurs throughout all four quadrants of the body (above and below the waist, on both sides).
- There are tender or “trigger” points that are especially sensitive to pressure (initially there were 18 spots, but as of 2010, diagnosis no longer requires these tender points).
- Symptoms of fibromyalgia may also include sleep disorders, bowel disturbances, fatigue, and cognitive impairment (“fibro fog”).
Fibromyalgia sufferers tend to be overwhelmingly female (80-90 percent) and of childbearing age, but men, children, and the elderly are also affected.
The condition tends to be more common among those who suffer from other rheumatic disorders, including lupus, rheumatoid arthritis. and ankylosing spondylitis (spinal arthritis).
Frustratingly for those who live with the condition, there is no known cause for fibromyalgia. It often emerges during middle age or after a traumatic injury.
New Research Grant Announced by Canadian Arthritis Society
Researchers and prevalence tracking estimates place the number of fibromyalgia patients in the United States at roughly 5 million per year, with an additional estimated 520,000 sufferers in Canada. That’s why the December 2016 announcement of a three-year grant from the Canadian Arthritis Society to study oral cannabinoids for fibromyalgia came as welcome news.
“These investments are about leading by example,” Arthritis Society president and CEO Janet Yale said in a press release. “Patients and physicians both need to be able to make informed decisions about whether cannabis has a place in the individual’s treatment plan. With these commitments, The Arthritis Society is doing its part to help fill some of the critical knowledge gaps around medical cannabis.”
She went on to call on the Canadian government to invest $25 million over the next five years in research into medical cannabis.
The lead investigator in the newly announced study, Mark Ware, M.D., said in a CNN interview in 2010, “I have patients with a range of pain syndromes who have failed all their other treatments and for whom herbal cannabis has been the only reasonable option that they have that controls their symptoms.” Dr. Ware is director of clinical research at the Alan Edwards Pain Management Unit of the McGill University Health Centre (MUHC). He has already completed the largest study to date on the long-term safety of cannabis for treatment of chronic pain.
Traditional Medical Treatment for Fibromyalgia
Traditional medical treatment requires a team approach, because every patient presents with different symptoms—sometimes at different hours of different days.
And medications that are prescribed for fibromyalgia symptoms can include a medicine cabinet full of pharmaceuticals. These include antidepressants, benzodiazepines, opioids, sleeping pills, muscle relaxants, anti-convulsants, nerve pain medications, even experimental administration of human growth hormone.
Each medication alone carries individual risk (see the following infographic for an analysis of the risks of just one pharmaceutical product vs. those of cannabis).
Taken together, however, a fistful of pharmaceutical prescriptions raise the specter of polypharmacy (taking more than four prescription medications at one time). This presents an exponentially greater risk over time.
If cannabis can provide proven relief for the widespread soft tissue pain, sleep problems, and associated symptoms, it could provide an additional arrow in the medical team’s quiver as they strive to provide care for their patients.
A small-scale 2011 pilot study has already found statistically significant effects in reduction of pain, sleep aid, and enhancement relaxation.
Beyond traditional medicine, fibromyalgia sufferers have also turned to a wide-ranging constellation of alternative therapies as they seek relief from the condition. Patients working with interdisciplinary teams of medical professionals report turning to such approaches, including:
- Trigger-point therapy
- Light therapy
- Massage therapy
- Tai Chi
- And more
Cannabis, with its 5,000-year history as a medicinal treatment, is just one more option to explore after fifty years of hysterical prohibition.
Fibromyalgia and the Clinical Endocannabinoid Deficiency Hypothesis
Dr. Ethan Russo, a pharmacologist and neurologist who has dedicated more than 15 years to researching the human body’s endocannabinoid system, first published a paper in 2003 suggesting the existence of Clinical Endocannabinoid Deficiency (CECD) as a contributing factor to fibromyalgia and a related group of disorders.
This deficiency, Russo suggested, could result in the familiar array of symptoms including sleep disorders, pain, muscle spasticity, digestive and gastrointestinal problems, and sleep disorders—the same group of symptoms that appear together in sufferers of other syndromes including fibromyalgia, irritable bowel syndrome and migraines.
In a later paper, published in 2008, Russo presented evidence that the THC in cannabis reduces hypersensitivity to pain in both fibromyalgia patients and migraine sufferers. He also pointed out that cannabis can offer anti-nausea benefits, neuroprotective antioxidant properties, and anti-insomnia properties while it acts on the body’s own endocannabinoid system. And treating the sleep problems associated with fibromyalgia is one of the fundamental keys to treating the rest of the symptoms associated with the disorder.
Furthermore, a 2014 literature review further expanded on Russo’s work, extending the hypothesis that an innate deficiency of endocannabinoids may be a common trait in the potentially related syndromes that include migraines, irritable bowel syndrome and fibromyalgia.
As the CECD hypothesis continues to receive further attention, more high-quality, randomized controlled studies are indicated. This new study should offer researchers and clinicians fruitful paths for continued exploration of a place for cannabis in treatment. And it will doubtless provide patients continued hope for a safe, natural, and effective source of relief of their symptoms.