Posted on March 28, 2016 in Diseases & Conditions, Opinion, Pain Medication with 6 Comments
By Ginevra Liptan, MD
Editor’s Note: Ginevra Liptan, MD is both a fibromyalgia patient and physician specialist. Her new book The FibroManual: A Complete Fibromyalgia Treatment Guide for You…And Your Doctor releases May 3, 2016.
My last blog post examined the current legal and medical status of using marijuana as medicine. But how about specifically for treating fibromyalgia symptoms?
Many of my fibromyalgia patients report that medical marijuana/cannabis reduces their pain and improves sleep. A study of 28 fibromyalgia patients reported that two hours after use of cannabis they had a significant reduction of pain and stiffness.
The use of cannabis to relieve symptoms of fibromyalgia is not new. Around 2000 BC, the Chinese Emperor Shen-Nun described marijuana’s ability to diminish pain and inflammation and noted that it “undoes rheumatism” (an antiquated term for fibromyalgia). Fast forward to the U.S. in the early 1900s and we find medicinal cannabis extracts marketed by Merck, Bristol-Meyers, and Eli Lilly, among other pharmaceutical companies, along with medical textbooks listing numerous indications for cannabis including joint and muscle pain.
But then cannabis use was outlawed in 1936. All access for medical purposes was lost until 1996, when California became the first state in U.S. to legalize medical marijuana use. So now we find ourselves about 60 years behind in medical understanding of the cannabis plant.
We do know that the two primary active ingredients of cannabis are THC and CBD (cannabidiol). THC is a strong analgesic (pain reliever) and is also strong anti-inflammatory—in fact, it is 20 times stronger than aspirin! THC is responsible for the psychoactive effects or “high” of cannabis. CBD also has some pain-relieving and anti-inflammatory properties, along with strong anti-anxiety and muscle relaxation effects. CBD has the effect of lowering the psychoactive effects of THC, so cannabis with equal amounts of CBD to THC tend to be the most medicinally effective by providing desired pain relief with less of the undesirable “high.”
But we currently don’t have any standardized medication options beyond the two THC- only prescription medications, dronabinol and nabilone, which are expensive and tend to cause lots of side effects. Pharmaceutical companies are now racing to better find ways to produce standardized ingredients and dosing of cannabis.
In Canada and Europe, a cannabis-based medical extract is approved for use as an oral spray (Sativex). It is entirely derived from a specially grown plant with extensive quality control and balanced amounts of THC and CBD, and it has been shown to significantly lessen pain and improve sleep for rheumatoid arthritis, with few side effects. This product is currently undergoing clinical trials in the U.S. and will hopefully be available within the next few years.
But for now, patients who want to try medical cannabis for fibromyalgia—or any health condition—are at the mercy of the knowledge of the dispensary or growers that are providing them the cannabis. Here is a scenario I see quite frequently: a patient gets a medical marijuana card and goes to a dispensary. There, the employees are the only guide to strain and dose. It’s the equivalent of someone walking into a drugstore with a blank prescription and asking the cashier what medicine they should purchase. Some dispensary employees are quite knowledgeable, but often they are more recreational marijuana enthusiasts who have no idea what to recommend for a fibromyalgia patient.
One of my patients, who is 65 and had never used marijuana in her life, went to a dispensary and was directed to buy a cookie that contained a high amount of THC. An hour later she was hallucinating and so terrified that she called 911!
Is there anyone who should not try cannabis? There are some people for whom it is absolutely a bad idea, including those with uncontrolled psychiatric conditions characterized by psychosis or active substance abuse. Marijuana can also increase pulse rate, so should be used with caution in people with heart problems such as atrial fibrillation.
In general, you want to look for strains with roughly equal THC to CBD ratio. Start with very low dosages; one study found that while low-to-moderate doses lowered pain, high doses actually increased pain! Avoid smoking cannabis, as this is damaging and irritating to lung tissue. Instead, consider edibles, tinctures (liquid cannabis extracts), or topical balms or salves. My fibromyalgia patients report that cannabis balms and salves applied topically to sore muscles can be a very effective pain reliever with little to no brain “high.”
If you are serious about trying cannabis as medicine, you need to first educate yourself, because your doctor or your grower/dispensary staff may not be able to give you much guidance. I highly recommend the book Cannabis Pharmacy: The Practical Guide to Medical Marijuana by Michael Backes. Another helpful resource is the website www.leafly.com, which is like the Yelp of marijuana, with user reviews on different strains.
Remember, we are just beginning to uncover exactly how to use the cannabis plant safely and most effectively.