Cannabis Research – Fibromyalgia, Back Pain
Fibromyalgia patients frequently self-report using cannabis therapeutically to treat symptoms of the disease,[1-2] and physicians – in instances where it is legal for them do so – often recommend the use of cannabis to treat musculoskeletal disorders.[3-4] To date however, there are few clinical trials assessing the use of cannabinoids to treat the disease.
Writing in the July 2006 issue of the journal Current Medical Research and Opinion, investigators at Germany’s University of Heidelberg evaluated the analgesic effects of oral THC in nine patients with fibromyalgia over a 3-month period. Subjects in the trial were administered daily doses of 2.5 to 15 mg of THC and received no other pain medication during the trial. Among those participants who completed the trial, all reported a significant reduction in daily recorded pain and electronically induced pain.
A 2008 study published in The Journal of Pain reported that the administration of the synthetic cannabinoid nabilone significantly decreased pain in 40 subjects with fibromylagia in a randomized, double-blind, placebo-controlled trial. “As nabilone improved symptoms and was well-tolerated, it may be a useful adjunct for pain management in fibromyalgia,” investigators concluded. A separate 2010 trial performed at McGill University in Montreal reported that low doses of nabilone significantly improved sleep quality in patients diagnosed with the disease.
Most recently, a 2011 observational, case-control trial reported that the use of cannabis is associated with beneficial effects on various symptoms of fibromyalgia, including the relief of pain and muscle stiffness. Investigators at the Institut de Recerca Hospital del Mar in Barcelona, Spain, assessed the associated benefits of cannabis in patients with fibromyalgia compared with FM patients who did not use the substance. Twenty-eight users and non-users participated in the study.
Authors reported: “Patients used cannabis not only to alleviate pain but for almost all symptoms associated to FM, and no one reported worsening of symptoms following cannabis use. … Significant relief of pain, stiffness, relaxation, somnolence, and perception of well-being, evaluated by VAS (visual analogue scales) before and two hours after cannabis self-administration was observed.” Cannabis users in the study also reported higher overall mental health summary scores than did non-users. Investigators concluded: “The present results together with previous evidence seem to confirm the beneficial effects of cannabinoids on FM symptoms.”
Previous clinical and preclinical trials have shown that both naturally occurring and endogenous cannabinoids hold analgesic qualities,[9-12] particularly in the treatment of pain resistant to conventional pain therapies. (Please see the ‘Chronic Pain‘ section below for further details.) As a result, some experts have suggested that cannabinoids are potentially applicable for the treatment of chronic pain conditions such as fibromyalgia, and have theorized that the disease may be associated with an underlying clinical deficiency of the endocannabinoid system. Dr. Ethan Russo, a neurologist who has studied the cannabinoids (the natural medicines in marijuana) for many years, reported that cannabinoids have demonstrated the ability to block spinal, peripheral and gastrointestinal mechanisms that promote pain in headache, fibromyalgia, IBS and related disorders. He suggested that patients suffering with these conditions may have an underlying clinical endocannabinoid deficiency that may be suitably treated with cannabinoid medicines. This concept is currently being investigated in laboratories all over the world.
 Swift et al. 2005. Survey of Australians using cannabis for medical purposes. Harm Reduction Journal 4: 2-18.
 Ware et al. 2005. The medicinal use of cannabis in the UK: results of a nationwide survey. International Journal of Clinical Practice 59: 291-295.
 Dale Gieringer. 2001. Medical use of cannabis: experience in California. In: Grotenhermen and Russo (Eds). Cannabis and Cannabinoids: Pharmacology, Toxicology, and Therapeutic Potential. New York: Haworth Press: 153-170.
 Schley et al. 2006. Delta-9-THC based monotherapy in fibromyalgia patients on experimentally induced pain, axon reflex flare, and pain relief. Current Medical Research and Opinion 22: 1269-1276.
 Skrabek et al. 2008. Nabilone for the treatment of pain in fibromyalgia. The Journal of Pain 9: 164-173.
 Ware et al. 2010. The effects of nabilone on sleep in fibromyalgia: results of a randomized controlled trial. Anesthesia and Analgesia 110: 604-610.
 Fiz et al. 2011. Cannabis use in patients with fibromyalgia: Effect on symptoms relief and health-related quality of life. PLoS One 6.
 Burns and Ineck. 2006. Cannabinoid analgesia as a potential new therapeutic option in the treatment of chronic pain. The Annals of Pharmacotherapy 40: 251-260.
 Wallace et al. 2007. Dose-dependent effects of smoked cannabis on capsaicin-induced pain and hyperalgesia in healthy volunteers. Anesthesiology 107:785-96.
 Cox et al. 2007. Synergy between delta9-tetrahydrocannabinol and morphine in the arthritic rat. European Journal of Pharmacology 567: 125-130.
 Lynch and Campbell. 2011. op. cit.
 Ethan Russo. 2004. Clinical endocannabinoid deficiency (CECD): Can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuroendocrinology Letters 25: 31-39.
 Ellis et al. 2008. Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial. Neuropsychopharmacology 34: 672-80.
 Wallace et al. 2007. Dose-dependent effects of smoked cannabis on Capsaicin-induced pain and hyperalgesia in healthy volunteers Anesthesiology 107: 785-796.
 Wilsey et al. 2008. A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain. Journal of Pain 9: 506-521.
 Ware et al. 2010. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ 182: 694-701.
 Cooper et al. 2013. Comparison of the analgesic effects of dronabinol and smoked marijuana in daily marijuana smokers. Neuropsychopharmacology 38: 1984-1992.
 Lynch and Campbell. 2011. Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials. British Journal of Clinical Pharmacology 72: 735-744.
 Sunil Aggerwal. 2012. Cannabinergic pain medicine: a concise clinical primer and survey of randomized-controlled trial results. The Clinical Journal of Pain [E-pub ahead of print].
 Comelli et al. 2008. Antihyperalgesic effect of a Cannabis sativa extract in a rat model of neuropathic pain. Phytotherapy Research 22: 1017-1024.
 Johnson et al. 2009. Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety and tolerability of THC: CBD extract in patients with intractable cancer-related pain. Journal of Symptom Management 39: 167-179.
 Wilsey et al. 2013. Low-dose vaporized cannabis significantly improves neuropathic pain. The Journal of Pain 14: 136-148.
Other studies about fibromyalgia and medicinal cannabis
Undated – Study –Cannabis Sativa (Marijuana) for Fibromyalgia
1996 – Study Pioro-Boisset M, Esdaile JM, Fitzcharles MA. Alternative medicine use in fibromyalgia syndrome. Arthritis Care and Research. 1996;9(1):13–17. [PubMed]
2004 – Study –Clinical Endocannabinoid Deficiency
2005 – Study ~ Chronic Pain and Cannabinoids.
2006 – News –THC Reduces Pain in Fibromyalgia Patients
2007 – Study ~ Study of analgesic effects of oral THC in Germany.
2007 – News –Synthetic Cannabis for Fibromyalgia Pain
2008 – News Marijuana Ingredient May Cut Fibromyalgia Pain
2008 – Study –Nabilone for the treatment of pain in fibromyalgia
2008 – Study ~ Anandamide and neutrophil function in patients with fibromyalgia.
2008 – Study ~ Marijuana-Based Drug Reduces Fibromyalgia Pain, Study Suggests.
2008 – News –Fibromyalgia and Medical Marijuana
2008 – News ~ Two New Approaches for Fibromyalgia.
2008 – News –Marijuana Ingredient May Cut Fibromyalgia Pain
2008/9 – Study Marschall U, Arnold B, Häuser W. Treatment and healthcare costs of fibromyalgia syndrome in Germany: analysis of the data of the barmer health insurance BEK from 2008-2009. Schmerz. 2011;25(4):402–404, 406–410. (Ger). [PubMed]
2009 – News Medical Marijuana and Fibromyalgia
2009 – News ~ Medical Marijuana and Fibromyalgia.
2009 – Study Oxford Center of Evidence Based Medicine. Levels of evidence (march 2009) .
2010 – News ~ Medical marijuana may help fibromyalgia pain.
2010 – Study Lachaine J, Beauchemin C, Landry P-A. Clinical and economic characteristics of patients with fibromyalgia syndrome. Clinical Journal of Pain. 2010;26(4):284–290. [PubMed]
2010 – Study Häuser W, Thieme K, Turk DC. Guidelines on the management of fibromyalgia syndrome—a systematic review. European Journal of Pain. 2010;14(1):5–10. [PubMed]
2012 – News ~ One in 8 with fibromyalgia uses cannabis as medicine.
2012 – News ~ Pot Popular for Pain in Fibromyalgia.
2012 – Study Häuser W, Jung E, Erbslöh-Möller B, et al. The German fibromyalgia consumer reports—a cross-sectional survey. BMC Musculoskeletal Disorders. 2012;13, article 74 (Ger).
2012 – News Pot Popular for Pain in Fibromyalgia
2013 – Article National Center for Complementary and Alternative Medicine. What is complementary and alternative medicine? 2013
2013 – Clinical Trial Harefuah, 2013, (Hebrew)
2013 – Article Fitzcharles MA, Ste-Marie PA, Goldenberg DL, et al. 2012 Canadian guidelines for the diagnosis and management of fibromyalgia syndrome: executive summary. Pain Research&Management. 2013; 18(3):119–126.