EXPLORING THE EFFICACY AND SAFETY OF CANNABIS IN THE MANAGEMENT OF FIBROMYALGIA
DOI:
https://doi.org/10.22159/ijcpr.2022v14i1.44109Keywords:
Fibromyalgia, Medicinal cannabis, Chronic pain, Fatigue, Licensed medicinesAbstract
Fibromyalgia is a chronic health condition characterized by chronic pain fatigue, sleep disturbances and many other symptoms affecting a patient’s quality of life. Patients with fibromyalgia often visit rheumatology outpatients with a long list of symptoms and often receive multiple medications. Many have seen multiple specialists and have done a lot of reading about alternative modalities of treatment. The limited effectiveness of conventional therapy coupled with widespread media attention raises the question of cannabis use.
This review examines the literature on cannabinoid use in fibromyalgia against the context of the international variation in legal frameworks, the available products and the outcomes reported. A detailed review was performed using the EMBASE and PUBMED databases.
It was concluded that despite the interest in the use of cannabinoids in the management of fibromyalgia, there is insufficient evidence to prescribe the currently available licensed medicines or to recommend the complementary health products available for legal purchase.
There is a need for more global clinical randomised trials to accurately determine medicinal cannabis short and long-term long efficacy and safety for its acute and chronic use.
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Bazzichi L, Giacomelli C, Consensi A, Giorgi V, Batticciotto A, Di Franco M, Sarzi-Puttini P. One year in review 2020: fibromyalgia. Clin Exp Rheumatol. 2020;38(1);Suppl 123:3-8. PMID 32116216.
Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum. 1995;38(1):19-28. doi: 10.1002/art.1780380104, PMID 7818567.
Branco JC, Bannwarth B, Failde I, Abello Carbonell J, Blotman F, Spaeth M, Saraiva F, Nacci F, Thomas E, Caubère JP, Le Lay K, Taieb C, Matucci-Cerinic M. Prevalence of fibromyalgia: a survey in five European countries. Semin Arthritis Rheum. 2010;39(6):448-53. doi: 10.1016/j.semarthrit.2008.12.003, PMID 19250656.
Spaeth M. Epidemiology, costs, and the economic burden of fibromyalgia. Arthritis Res Ther. 2009;11(3):117. doi: 10.1186/ar2715, PMID 19591654.
Hauser W, Urrutia G, Tort S, Uçeyler N, Walitt B. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia syndrome. Cochrane Database Syst Rev. 2013;1(1):CD010292. doi: 10.1002/14651858.CD010292, PMID 23440848.
Häuser W, Walitt B, Fitzcharles MA, Sommer C. Review of pharmacological therapies in fibromyalgia syndrome. Arthritis Res Ther. 2014;16(1):201. doi: 10.1186/ar4441, PMID 24433463.
Moore AR, Straube S, Paine J, Phillips CJ, Derry S, McQuay HJ. Fibromyalgia: moderate and substantial pain intensity reduction predicts improvement in other outcomes and substantial quality of life gain. Pain. 2010;149(2):360-4. doi: 10.1016/j.pain.2010.02.039, PMID 20347225.
Sommer C, Welsch P, Klose P, Schaefert R, Petzke F, Hauser W. Opioids in chronic neuropathic pain. A systematic review and meta-analysis of efficacy, tolerability and safety in randomized placebo-controlled studies of at least 4-W durationopioids in chronic neuropathic pain. A systematic review and meta-analysis of efficacy, tolerability and safety in randomized placebo-controlled studies of at least 4 weeks duration. Schmerz. 2015;29(1):35-46. doi: 10.1007/s00482-014-1455-x, PMID 25376548.
Li X, Vigil JM, Stith SS, Brockelman F, Keeling K, Hall B. The effectiveness of self-directed medical cannabis treatment for pain. Complement Ther Med. 2019;46:123-30. doi: 10.1016/j.ctim.2019.07.022, PMID 31519268.
Hill KP, Palastro MD, Johnson B, Ditre JW. Cannabis and pain: A clinical review. Cannabis Cannabinoid Res. 2017;2(1):96-104. doi: 10.1089/can.2017.0017, PMID 28861509.
Giorgi V, Bongiovanni S, Atzeni F, Marotto D, Salaffi F, Sarzi-Puttini P. Adding medical cannabis to standard analgesic treatment for fibromyalgia: a prospective observational study. Clin Exp Rheumatol. 2020;38(1);Suppl 123:53-9. PMID 32116208.
Guillouard M, Authier N, Pereira B, Soubrier M, Mathieu S. Cannabis use assessment and its impact on pain in rheumatologic diseases: a systematic review and meta-analysis. Rheumatology (Oxford). 2021;60(2):549-56. doi: 10.1093/rheumatology/keaa534, PMID 33159797.
Rocco M, Rada G. Are cannabinoids effective for fibromyalgia? Medwave. 2018;18(1):e7154. doi: 10.5867/medwave. 2018.01.7153, PMID 29474351.
Nugent SM, Morasco BJ, O’Neil ME, Freeman M, Low A, Kondo K, Elven C, Zakher B, Motu’apuaka M, Paynter R, Kansagara D. The effects of cannabis among adults with chronic pain and an overview of General Harms: A systematic review. Ann Intern Med. 2017;167(5):319-31. doi: 10.7326/M17-0155, PMID 28806817.
Campbell G, Hall WD, Peacock A, Lintzeris N, Bruno R, Larance B, Nielsen S, Cohen M, Chan G, Mattick RP, Blyth F, Shanahan M, Dobbins T, Farrell M, Degenhardt L. Effect of cannabis use in people with chronic non-cancer pain prescribed opioids: findings from a 4 y prospective cohort study. Lancet Public Health. 2018;3(7):e341-50. doi: 10.1016/S2468-2667(18) 30110-5, PMID 29976328.
Greis A, Larsen E, Liu C, Renslo B, Radakrishnan A, Wilson-Poe AR. Perceived efficacy, reduced prescription drug use, and minimal side effects of cannabis in patients with chronic orthopedic pain. Cannabis Cannabinoid Res. 2021. doi: 10.1089/can.2021.0088, PMID 34767730.
National health services (NHS), Fibromylagia. Available from: https://www.nice.org.uk/guidance/ng144. [Last accessed on 12 Dec 2021].
Herkenham M, Lynn AB, Little MD, Johnson MR, Melvin LS, de Costa BR, Rice KC. Cannabinoid receptor localization in brain. Proc Natl Acad Sci USA. 1990;87(5):1932-6. doi: 10.1073/pnas.87.5.1932, PMID 2308954.
Di Marzo V, Bifulco M, De Petrocellis L. The endocannabinoid system and its therapeutic exploitation. Nat Rev Drug Discov. 2004;3(9):771-84. doi: 10.1038/nrd1495, PMID 15340387.
Guindon J, Hohmann AG. The endocannabinoid system and pain. CNS Neurol Disord Drug Targets. 2009;8(6):403-21. doi: 10.2174/187152709789824660, PMID 19839937.
Russo EB. Clinical endocannabinoid deficiency (CECD): can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuro Endocrinol Lett. 2004;25(1-2):31-9. PMID 15159679.
Van Houdenhove B, Egle UT. Fibromyalgia: a stress disorder? Piecing the biopsychosocial puzzle together. Psychother Psychosom. 2004;73(5):267-75. doi: 10.1159/000078843, PMID 15292624.
Hillard CJ, Weinlander KM, Stuhr KL. Contributions of endocannabinoid signaling to psychiatric disorders in humans: genetic and biochemical evidence. Neuroscience. 2012;204:207-29. doi: 10.1016/j.neuroscience.2011.11.020, PMID 22123166.
Lee MC, Ploner M, Wiech K, Bingel U, Wanigasekera V, Brooks J, Menon DK, Tracey I. Amygdala activity contributes to the dissociative effect of cannabis on pain perception. Pain. 2013;154(1):124-34. doi: 10.1016/j.pain.2012.09.017. PMID 23273106.
Uçeyler N, Hauser W, Sommer C. Systematic review with meta-analysis: cytokines in fibromyalgia syndrome. BMC Musculoskelet Disord. 2011;12:245. doi: 10.1186/1471-2474-12-245, PMID 22034969.
Abuhasira R, Schleider LB, Mechoulam R, Novack V. Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly. Eur J Intern Med. 2018;49:44-50. doi: 10.1016/j.ejim.2018.01.019, PMID 29398248.
Bar Lev Schleider L, Mechoulam R, Lederman V, Hilou M, Lencovsky O, Betzalel O, Shbiro L, Novack V. Prospective analysis of safety and efficacy of medical cannabis in large unselected population of patients with cancer. Eur J Intern Med. 2018;49:37-43. doi: 10.1016/j.ejim.2018.01.023, PMID 29482741.
Fitzcharles MA, Ste-Marie PA, Hauser W, Clauw DJ, Jamal S, Karsh J, Landry T, Leclercq S, Mcdougall JJ, Shir Y, Shojania K, Walsh Z. Efficacy, tolerability, and safety of cannabinoid treatments in the rheumatic diseases: a systematic review of randomized controlled trials. Arthritis Care Res (Hoboken). 2016;68(5):681-8. doi: 10.1002/acr.22727, PMID 26548380.
Pacher P, Batkai S, Kunos G. The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol Rev. 2006;58(3):389-462. doi: 10.1124/pr.58.3.2, PMID 16968947.
Skrabek RQ, Galimova L, Ethans K, Perry D. Nabilone for the treatment of pain in fibromyalgia. J Pain. 2008;9(2):164-73. doi: 10.1016/j.jpain.2007.09.002, PMID 17974490.
Ware MA, Fitzcharles MA, Joseph L, Shir Y. The effects of nabilone on sleep in fibromyalgia: results of a randomized controlled trial. Anesth Anal. 2010;110(2):604-10. doi: 10.1213/ANE.0b013e3181c76f70, PMID 20007734.
Mackie K. Mechanisms of CB1 receptor signaling: endocannabinoid modulation of synaptic strength. Int J Obes (Lond). 2006;30Suppl 1:S19-23. doi: 10.1038/sj.ijo.0803273, PMID 16570100.
Malfitano AM, Basu S, Maresz K, Bifulco M, Dittel BN. What we know and do not know about the cannabinoid receptor 2 (CB2). Semin Immunol. 2014;26(5):369-79. doi: 10.1016/j.smim.2014.04.002, PMID 24877594.
Ramirez CL, Fanovich MA, Churio MS. Cannabinoids: extraction methods, analysis, and physicochemical characterization. Stud Nat Prod Chem. 2019. Chapter 4;61:143-73. doi: 10.1016/B978-0-444-64183-0.00004-X.
Madras BK. Tinkering with THC-to-CBD ratios in marijuana. Neuropsychopharmacology. 2019;44(1):215-6. doi: 10.1038/s41386-018-0217-3, PMID 30232407.
Stith SS, Vigil JM, Brockelman F, Keeling K, Hall B. The association between cannabis product characteristics and symptom relief. Sci Rep. 2019;9(1):2712. doi: 10.1038/s41598-019-39462-1. PMID 30804402.
Hryhorowicz S, Kaczmarek Rys M, Andrzejewska A, Staszak K, Hryhorowicz M, Korcz A, Słomski R. Allosteric modulation of cannabinoid receptor 1-current challenges and future opportunities. Int J Mol Sci. 2019;20(23). doi: 10.3390/ijms20235874, PMID 31771126.
Union E. Medical use of cannabis and cannabinoids: questions and answers for policymaking. Lisbon, Portugal: European Monitoring Centre for Drugs and Drug Addiction; 2018. p. 48.
Walitt B, Klose P, Fitzcharles MA, Phillips T, Hauser W. Cannabinoids for fibromyalgia. Cochrane Database Syst Rev. 2016;7(7):CD011694. doi: 10.1002/14651858.CD011694.pub2, PMID 27428009.
Martel M WL, Sotoodeh R, Vigano A, Moride Y, Canac Marquis M, Gamaoun R, Kalaba M, Beaulieu P, Desroches J, Ware M, Perez J, Shir Y, Fitzcharles M. Factors associated with pain reduction and improved well-being among fibromyalgia patients using medical cannabis. American College of Rheumatology. New Orleans, USA: Arthritis and Rheumatology; 2021.
Habib G, Avisar I. The consumption of cannabis by fibromyalgia patients in Israel. Pain Res Treat. 2018;2018:7829427. doi: 10.1155/2018/7829427, PMID 30140459.
Habib G, Artul S. Medical cannabis for the treatment of fibromyalgia. J Clin Rheumatol. 2018;24(5):255-8. doi: 10.1097/RHU.0000000000000702, PMID 29461346.
Banerjee R, Erridge S, Salazar O, Mangal N, Couch D, Pacchetti B, Sodergren MH. Real world evidence in medical cannabis research. Ther Innov Regul Sci. 2021. doi: 10.1007/s43441-021-00346-0, PMID 34748204.
Gonen T, Amital H. Cannabis and cannabinoids in the treatment of rheumatic diseases. Rambam Maimonides Med J. 2020;11(1). doi: 10.5041/RMMJ.10389, PMID 32017684.
Sagy I, Bar Lev Schleider L, Abu Shakra M, Novack V. Safety and efficacy of medical cannabis in fibromyalgia. J Clin Med. 2019;8(6). doi: 10.3390/jcm8060807, PMID 31195754.
Boehnke KF, Gagnier JJ, Matallana L, Williams DA. Cannabidiol use for fibromyalgia: prevalence of use and perceptions of effectiveness in a large online survey. J Pain. 2021;22(5):556-66. doi: 10.1016/j.jpain.2020.12.001, PMID 33400996.
van de Donk T, Niesters M, Kowal MA, Olofsen E, Dahan A, van Velzen M. An experimental randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia. Pain. 2019;160(4):860-9. doi: 10.1097/j.pain.0000000000001464, PMID 30585986.
Yassin M, Oron A, Robinson D. Effect of adding medical cannabis to analgesic treatment in patients with low back pain related to fibromyalgia: an observational cross-over single centre study. Clin Exp Rheumatol. 2019;37(1)Suppl 116:13-20. PMID 30418116.
Chaves C, Bittencourt PCT, Pelegrini A. Ingestion of a THC-rich cannabis oil in people with fibromyalgia: A randomized, double-blind, placebo-controlled clinical trial. Pain Med. 2020;21(10):2212-8. doi: 10.1093/pm/pnaa303, PMID 33118602.
Cameron EC, Hemingway SL. Cannabinoids for fibromyalgia pain: a critical review of recent studies (2015-2019). J Cannabis Res. 2020;2(1):19. doi: 10.1186/s42238-020-00024-2, PMID 33526114.
NICE. Cannabis-based medicinal products. NICE Guideline. London: National Institute for Health and Care Excellence; 2019. p. NG144. Available from: https://www.nice. org.uk/guidance/ng144. [Last accessed on 12 Dec 2021]
Olfson M, Wall MM, Liu SM, Blanco C. Cannabis use and risk of prescription opioid use disorder in the United States. Am J Psychiatry. 2018;175(1):47-53. doi: 10.1176/appi.ajp.2017. 17040413, PMID 28946762.
National Academies of sciences E, Medicine, health. Medicine D, Board on Population H, Public Health P. The National Academies Collection: Reports funded by National Institutes of Health. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington (DC): National Academies Press (US). Copyright 2017 by the National Academy of Sciences. All rights reserved; 2017.
Vigil JM, Stith SS, Adams IM, Reeve AP. Associations between medical cannabis and prescription opioid use in chronic pain patients: A preliminary cohort study. PLoS ONE. 2017;12(11):e0187795-e.
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