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What is Fibromyalgia?

Fibromyalgia is a chronic illness that is considered one of the most common causes of widespread pain throughout the body. It is characterized by diffuse musculoskeletal pain, extreme fatigue, mood problems, and sleep disturbances. Fibromyalgia can have tremendous physical as well as psychological impacts on patients, resulting in physical disability, which can be accompanied by anxiety and depression.

The exact cause of fibromyalgia is not yet well-documented. However, it is stated that both stress and depression play a great role in its development. Recent research indicates that the two systems that are involved mainly with stress, known as the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system, are disturbed in patients with fibromyalgia. Both of these systems play a crucial role when it comes to the management of stress or stressful situations. Therefore, if you have fibromyalgia, then these systems become dysfunctional, and you become less able to cope with stress.

What are the Symptoms of Fibromyalgia?

Despite the fact that chronic pain is the most characteristic symptom of fibromyalgia; however, each patient presents with a different set of symptoms. Also, patients can present with mild symptoms or severe ones. These symptoms can become persistent or occur from time to time, lasting for weeks, months, or years before re-occurring.

Here is a list of the most common symptoms of fibromyalgia:

  1. Chronic pain all over the body.
  2. Patients become sensitive to different stimuli, including heat, cold, light, touch, or smell.
  3. Extreme fatigability.
  4. Disturbed sleep.
  5. Digestion problems.
  6. Cognitive disturbances, known as “fibro fog”.

What is the Management Strategy of Fibromyalgia?

The management of fibromyalgia is challenging since not all people present with the same symptoms. Due to the absence of a clear cause for fibromyalgia, the treatment plan is usually directed to control and alleviate the presenting symptoms, with repeated doctor visits along with modifications to lifestyle and medications.

Since the management of fibromyalgia is directed at treating the presenting symptoms, the physician’s aims for the management plan include:

  1. Medications
  2. Proper sleep
  3. Aerobic exercises
  4. Stress reduction
  5. Relaxation

The treatment plan for fibromyalgia, in general, includes the following:

  1. Physical therapy, meditation, or yoga
  2. Neurological assessment and counseling
  3. Physical exercises
  4. Antidepressants
  5. Massage therapy
  6. Acupuncture
  7. Medications

There is a wide variety of medications that are prescribed to fibromyalgia patients, based on their presenting symptoms and response to the administered drugs:

  1. Pain medications: they are usually used either alone or in combination. They include non-steroidal anti-inflammatory drugs (NSAIDs), which are used to manage the pain. Benzodiazepines are also commonly prescribed for muscle relaxation and tension reduction.
  2. Narcotic analgesics and opioids: they are usually prescribed when other drugs have proven ineffective. However, these drugs can result in dependence, as well as many other serious adverse events.
  3. Antidepressants: they are used to help with pain and sleep disturbances. However, due to their adverse events, tolerance profile, and dependence, they are not considered an optimal option for patients with fibromyalgia.
  4. Anti-seizure drugs: they are usually prescribed to help with sleep due to their anxiolytic actions. However, they also have side effects of weight gain and dependence.

Based on available evidence, the effectiveness of these drugs in alleviating presenting symptoms is still questionable, and most of them cause dependence or other side effects that lead to poor patient compliance with subsequently worse patient conditions. Therefore, researchers have been interested in investigating cannabidiol (CBD) in the management of fibromyalgia.

What are the Benefits of CBD in Fibromyalgia?

Cannabinoid compounds are present naturally inside our bodies along with cannabinoids receptors (CB1 and CB2) in a system known as the endocannabinoid system. The participation of the endocannabinoid system in multiple physiological functions such as pain modulation, stress response system, neuroendocrine regulation, and cognitive functions, among others, is well known.

Cannabidiol can be a promising alternative for current medications in managing the symptoms of fibromyalgia since CBD exerts its therapeutic effects through the endocannabinoid system, which in turn affects inflammations, depression, sleep, and pain.

The benefits of CBD in fibromyalgia include:

  1. Alleviation of chronic pain and inflammation

Recent preclinical research studies highlight the effectiveness of CBD in alleviating the chronic pain associated with fibromyalgia through the indirect activation of the endocannabinoid system by CBD, which may explain the CBD’s analgesic effects.

  1. Promoting healthy sleeping patterns

It has been previously shown that the endocannabinoid system is involved with the regulation of the circadian rhythm, which further highlights the potential role of CBD in promoting healthy sleeping patterns. Also, the promotion of healthy sleep can be the result of CBD’s anxiolytic effects.

2. Reduction of stress through its anxiolytic properties

Many small clinical trials on humans have shown that CBD is effective in treating anxiety. However, more robust trials of larger sample sizes are still needed.

3. Reduction of depression through its anti-depressive actions

Many small clinical trials on humans have shown that CBD is effective in treating depression as well. However, more robust trials of larger sample sizes are still needed.

What Does Human Research Say About CBD?

A recent study conducted in 2018 revealed that all patients with fibromyalgia taking medical cannabis (mean dose of 26 ± 8.3 grams orally) reported a significant improvement in every parameter of the Revised Fibromyalgia Impact Questionnaire (FIQR) and that 50% of patients stopped taking any other pain medications besides medical cannabis.

Similarly, another study showed that 2 hours of cannabis use resulted in significant improvement in Visual Analogue Scale (VAS) scores with a reduction in pain and stiffness, enhancement of relaxation, and an increase in somnolence and feeling of “well-being” among patients with fibromyalgia. The mental health component summary score of the questionnaire used revealed significant improvement in cannabis users.

Moreover, there is moderate evidence that cannabinoids, primarily Nabiximols, are an effective option for improving the short-term sleep outcomes in patients with sleep disturbance related to fibromyalgia.

In late 2018, a researcher conducted a research study on 20 female patients with fibromyalgia to determine the effectiveness of CBD in managing the symptoms associated with their condition. Patients were given CBD (either oral or topical), with an average dose of 43 mg/day. The results showed that the majority of them (85%, 17/20) had benefited from CBD in improving their mood, pain, or sleep. More than half of them (60%) reported that it was primarily useful in alleviating their pain, while 50% of them reported that CBD helped them with their mood problems, particularly in reducing their anxiety. Around 30% of patients reported improvement in their sleeping patterns. Surprisingly, no one reported any serious adverse events. However, a few reported “being sleepy” with the use of CBD.

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