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fibromyalgia thc or cbd

Fibromyalgia thc or cbd

Studies have indicated that ROA appears to have a distinct influence on health outcomes from cannabis use, with some ROAs having a higher instance of adverse health effects than others (Aston et al. 2019; Russo 2016). The most common ROAs include smoking, inhalation via vaporization, oral administration, and transdermal (Bridgeman and Abazia 2017). As revealed in multiple systematic reviews, respiratory problems such as coughing and wheezing, increased phlegm production, reduced pulmonary function, bronchodilation, and chronic bronchitis have been associated with smoking cannabis (Gates et al. 2014; Ghasemiesfe et al. 2018; Martinasek et al. 2016; Tashkin 2014). Additionally, researchers have noted that daily cannabis use via inhalation may cause adverse pulmonary effects over an extended period (Nugent et al. 2017). Habib and Artul (2018) noted that patients whose primary ROA was smoking were more likely to report transient adverse side effects of dry mouth and redness of the eye. Russo (2016) noted that smoking is undesirable for therapeutic application of cannabis, particularly with patients who have chronic conditions.

Fibromyalgia is associated with widespread musculoskeletal pain that is commonly accompanied by additional symptoms such as fatigue, cognitive problems, mood disturbances, and problems with sleep (Clauw 2015; Palagini et al. 2016). In the absence of a definitive cure for fibromyalgia, treatment primarily focuses on symptom management and improving patient quality of life. Fibromyalgia is significantly more common in women and has a prevalence rate of 4% across Europe and North America with an approximated worldwide prevalence of 5–7% (Lan et al. 2016; Queiroz 2013). Additionally, some fibromyalgia patients experience psychological, social, and behavioral symptoms that further affect overall functioning and quality of life. While once considered a mysterious or unspecified condition of psychological or emotional origin, there is now empirical evidence, such as brain imaging studies, which have highlighted several biological underpinnings of many common fibromyalgia symptoms (Pomares et al. 2017; Schmidt-Wilcke and Diers 2017).

Critical review of selected studies

We followed Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines in searching the PubMed and Medline databases using the search terms “cannabis + fibromyalgia” and then “cannabinoids + fibromyalgia.” Inclusion criteria were a) English language, b) published in peer review journals, c) published from 2015 to 2019, d) all study designs except for systematic reviews and meta-analyses, and e) all cannabis preparations.

Widely understood to be a safer alternative, recent studies suggest that vaporization of the cannabis flower may provide distinct therapeutic advantages as compared to other ROAs (Aston et al. 2019; Lanz et al. 2016; Russo 2016). Vaporization of the botanical cannabis flower should not be confused with the use of the e-cigarette (vaping), which heats a concentrated form of cannabis oil to a high temperature and has recently been implicated in vaping-related acute lung injury (VpRALI) and adverse effects on the cardiovascular system (Fonseca Fuentes et al. 2019; Qasim et al. 2017). Only one of the studies selected for this review utilized vaporization in 100% of study participants (Van de Donk et al. 2019).

Conclusion

A significant limitation to establishing the utility of cannabis in fibromyalgia patients is the large variability in the examination of different types of cannabinoids both within and across studies. Botanical cannabis products were assessed as therapeutic agents in each of the selected studies; however, each study examined a different cannabis preparation. Botanical cannabinoids are plant-based with a varied composition that is challenging to determine as it varies even within parts of the same plant (Silver 2019).

Fibromyalgia thc or cbd

Acetaminophen 1,000 mg thrice a day, used clinically even with little evidence of efficacy

All patients began cannabis therapy in the form of decoction in accordance with Italian law. After titration, six responsive patients switched from decoction to vaporization (n = 2) or oil extract (n = 4), primarily due to the unpleasant taste of cannabis and disgust.

Treatment regimen

Fibromyalgia syndrome (FMS) is a common chronic pain syndrome that significantly impacts patient quality-of-life. FMS is characterized by widespread musculoskeletal pain, sleep and mood disorders, fatigue, cognitive disorders, and various somatic symptoms (Bellato et al. 2012); however, it is not associated with signs of tissue inflammation, deformity, or damage. Normal laboratory and medical tests are often suggestive of FMS; however, its pathogenesis has not yet been clearly identified (Schmidt-Wilcke and Clauw 2011). The prevalence of FMS in the general population varies from 0.5 to 7% (Croft 2002; Vincent et al. 2013) with a female-to-male ratio of 3:1 (Queiroz 2013; Wolfe et al. 1995). FMS typically occurs between 40 and 60 years of age (Branco et al. 2010; Mc Beth et al. 2001), while the genetic etiology of FMS remains unclear (Arnold et al. 2013).

Analgesic efficacy

Table 14 shows the number of patients taking different drugs at 3 and 12 months. Prior to MC therapy, all patients responsive to MC were taking one or more drugs. After 3 and 12 months of MC therapy, 33.3% and 66.7% of patients were taking MC alone, respectively. After 12 months of MC therapy, one patient, who experienced no analgesic effect, but had an increase in sleep hours, was taking four drugs. Two patients continued taking duloxetine for depression, and one patient continued to take low-dose steroids for associated psoriatic arthritis.