Until the early 1900s, cannabis (usually in the form of tinctures) used to be one of the most common pharmaceutical treatments for many different kinds of ailments. Later, it became controversial and remains more or less illegal in most places, even though it is far less risky than many other painkillers (e.g. NSAIDs or opioids).
Cannabis can help types of pain that often respond poorly to NSAIDs, acetaminophen/paracetamol and opioids, such as neuropathic pain. Cannabinoids reduce inflammation, act as muscle relaxants and even have neuroprotective effects. They can boost the efficacy of opioids, allowing for lower doses to be used.
Types of Medical Marijuana
Medical marijuana refers to either flowers of suitable strains of the actual hemp plant (Cannabis sativa) or isolated cannabinoids, either natural or synthetic. Cannabis flowers are often smoked, but they can also be eaten or vaporized, which creates much fewer toxic substances than smoking.
The most well-known isolated cannabinoid product is probably Sativex, a combination of THC (tetrahydrocannabinol) and CBD (cannabidiol), the two most important cannabinoids in marijuana, though the ratio (1:1) is quite different than in most cannabis strains. Sativex is mostly used for nausea and in the treatment of multiple sclerosis, administered as a mouth spray for rapid delivery.
Nabilone (Cesamet) is similar to THC, but less intoxicating. It is mostly used for nausea and to combat weight loss in cancer and AIDS, but sometimes also for pain. It is taken as tablets.
Dronabinol (Marinol) contains a synthetic derivative of THC in capsule form. It is mostly used to alleviate nausea and weight loss.
Often, synthetic forms of cannabis are preferred by authorities, because they are thought to cause less "high" (and, of course, enable pharmaceutical companies to make money off them). Many patients feel cannabis is more effective than isolated cannabinoids - not very surprising as it contains dozens of cannabinoids and some other substances, which may work synergistically.
Medical Marijuana in Fibromyalgia
Since marijuana has pain-relieving properties, both against muscle pain and nerve pain, trying it in fibromyalgia makes a lot of sense. Cannabis can also relieve sleeping problems and lift the mood, sometimes even help fatigue and cognitive problems.
Abnormally low levels of endocannabinoids (cannabinoids produced by our own body) have been found in fibromyalgia, as well as some other conditions, such as depression, migraine and IBS. These illnesses have even been proposed to be caused by an endocannabinoid deficiency.
In one study, nabilone proved superior to the popular tricyclic antidepressant amitriptyline (Elavil) in improving sleep of fibromyalgia patients. Peculiarly in this study neither drug helped pain. In another double-blinded study, however, nabilone significantly reduced pain and anxiety and improved functionality in fibromyalgia patients with few side effects.
In a fairly large study tetrahydrocannabinol (THC) alone was found to be an effective treatment for fibromyalgia, reducing pain and psychiatric symptoms. Up to 92 % of patients noted improvement and side effects were mostly minor. There was no placebo group (but then again, with cannabinoids people usually know whether they are receiving the medication or placebo).
Problems with Medical Marijuana
Cannabis is often demonized as an addictive drug, but it is far less addictive than many prescription medications. Psychological addiction is rarely noted in medical users. The "high" tends to dissipate in chronic use, but cannabis can also cause dizziness, dry mouth, anxiety, lethargy, hypoglycemia (low blood sugar), hypotension (low blood pressure) and in large doses nausea.
There is no clear evidence of cannabis increasing the risk of lung cancer or other cancers. While the smoke does contain carcinogenic substances, THC itself and some other constituents of the hemp plant have antitumor activity and are being studied as cancer treatments.
A bigger risk is that cannabis use may rarely trigger psychosis in susceptible individuals. Using CBD together with THC or THC-like chemicals may reduce this risk, as CBD has antipsychotic properties (and antipsychotic drugs based on it are being developed).
Cannabis alleviates inflammation, reducing excess immune activity. It may also be beneficial for autoimmune diseases, but in some cases (such as in acute infections) this property may even be harmful.
Cannabis has no real drug interactions, except that sedatives and intoxicants (including alcohol) may increase any intoxication. It may work synergistically with opioids, including low dose naltrexone (LDN) therapy.
Of course, the main problem with medical marijuana is that it is illegal in many countries. In others it may only be available on named-patient basis (or through other special systems), only to people with certain illnesses (like cancer or MS) or may be extremely expensive. While legal restrictions on important medical treatments are unfortunate, use of illegal substances is definitely never to be recommended.
Sources:
- 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 Feb-Apr;25(1/2):31-9.
- Ware MA, Fitzcharles MA, Joseph L, et al. The effects of nabilone on sleep in fibromyalgia: results of a randomized controlled trial. Anesth Analg. 2010 Feb 1;110(2):604-10.
- Weber J, Schley M, Casutt M, et al. Tetrahydrocannabinol (Delta 9-THC) Treatment in Chronic Central Neuropathic Pain and Fibromyalgia Patients: Results of a Multicenter Survey. Anesthesiol Res Pract. 2009;2009. pii: 827290.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
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