Fibromyalgia is a chronic condition whose etiology and cause are unknown. Among other symptoms, it is characterised by chronic widespread musculoskeletal pain, with a low threshold for pain. As tends to happen in patients suffering chronic pain, there is often hyperalgaesia (greater than anticipated sensitivity to pain for a given stimulus) and allodynia (where normally non-painful stimuli, such as the rubbing of clothes, is found to be painful).

Chronic pain tends to be accompanied by other symptoms, fundamentally anxiety and depression, fatigue and various types of insomnia. However, there may also be paresthaesia (pins and needles), stiffness in joints, headaches, a sensation of swelling in the hands and problems with concentration and memory.

The most obvious symptoms of fibromyalgia

  1. The most obvious symptom of fibromyalgia is widespread musculoskeletal pain. The pain generally occurs in several areas throughout the body. However, it might start in one region, such as the neck and shoulders, and then appear in other areas after a time.
  2. Fatigue and sleep disorders. Most people with fibromyalgia suffer some degree of fatigue. This may be the logical result of insufficient restorative sleep; a person who does not get enough continuous rest is unlikely to have normal physical activity. Tiredness is sometimes a much more serious problem than the pain itself. Sleep disorders are also common, varying in nature from one person to another. Some patients have problems falling asleep, i.e. sleep-onset insomnia.
  3. Cognitive disorders. Mood swings are a common symptom of fibromyalgia. However, as with any chronic disease, patients can feel depressed on occasions when they have to endure pain and their mood can be affected when the symptoms are not properly controlled.

Cannabinoids and fibromyalgia

The symptoms suffered by fibromyalgia patients can be treated with cannabinoids. The different symptoms of the disease can be treated with substances from the same chemical family. Cannabinoids are classically indicated to treat pain, with THC and CBD essentially being used in a ratio of 1/1, as confirmed by the majority of studies.

If the patient is already using opiates, it is important to begin with low doses and reduce the opiate intake once the cannabinoids begin to take noticeable effect. Cannabinoids and opiates can cause hypotension and it is therefore necessary to check blood pressure.

It is also important to watch for possible constipation caused by the cannabinoids. Nonetheless, opiates are much more astringent than cannabinoids. In both cases CBD has a greater effect than THC.
  • CBD has an antioxidant, anxiolytic and anti-depressant effect, and its anti-inflammatory effect is very useful in treating fibromyalgia, which can have multiple inflammatory foci in the musculoskeletal system.
  • For treating pain, the analgesic effect of CBD on its own is not as powerful as when THC is used in association. However, depending on the intensity of the pain, it may sometimes be sufficient.
  • CBD also has an anti-inflammatory effect which will be useful. We therefore recommend using a 1/1 ratio of CBD and THC for treating pain, provided that the patient tolerates it well.

The right dose must be calculated based on the patient’s weight. It is also important to rule out any contraindications as well as any possible interactions with previously prescribed medications. We therefore recommend that THC and CBD be used in in different proportions to treat patients with fibromyalgia.

Most patients who are going to respond to treatment with cannabinoids will experience a rapid response, with an improvement in symptoms during the first days of treatment.

When this happens, the expectations for success of the treatment are high. However, if a patient treated with the right dose sees no response in a period of 2 -3 weeks, the treatment will probably never be effective.

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