Q: What causes muscle and joint pain and a tired feeling for no apparent reason and affects between 2-6% of the population (mostly women) typically between the ages of 20 and 50? 

A: Fibromyalgia.

This hard to diagnose disease can wear on physical and mental health, leading to anxiety and depression, headaches, menstrual pain, numbness of the hands and feet, and sleep and memory issues.

Due to the lack of reproducible blood test or x-ray abnormalities, fibromyalgia is infamously difficult to test for. Lab tests only rule out other conditions and experts are still not sure about the varied causes of fibromyalgia. Links suggest it can be brought on by things like an accident, stress or hormonal changes.

Dr Mark Kimmins, Medical Director for Natural Health Services; clarifies some common misconceptions about the disease: “There is some evidence to suggest fibromyalgia is caused by an underlying autoimmune disorder, and symptoms are very similar to those of known autoimmune conditions. However, without the presence of reproducible detectable antibodies, and other classic markers of autoimmune disease such as tissue destruction, it does not meet criteria for classification as an autoimmune disease at present. Many people with fibromyalgia also have a known autoimmune condition, and the strong overlap does suggest a connection between the two. At some level, it appears that fibromyalgia is a set of symptoms that result from a reset or hypersensitivity of the bodies’ pain perception signaling system. There is evidence that this may be the result of some poorly understood imbalance of the endocannabinoid system (ECS).”

While the mechanism and reasons that the resetting of the body’s perception of pain is poorly understood, and may be caused by stress, infection or other disease, it can potentially be mitigated through cannabis use, which can be a prescribed treatment for chronic pain.

Also of note, as Dr Kimmins points out, is that there is no tissue destruction associated with the pain in fibromyalgia. Unlike rheumatoid arthritis where the pain/inflammation destroys joints or Crohn’s disease where the pain/inflammation can destroy portions of intestine. The pain signaling system in fibromyalgia is, in effect, stuck on ‘on’.

In agreement with the theory that fibromyalgia may be a [deficiency of the endocannabinoid system] is Dr Ethan Russo, a prominent neurologist, pharmacologist and well-respected cannabis researcher. [https://www.liebertpub.com/doi/pdf/10.1089/can.2016.0009]

So HOW might cannabis help rebalance the endocannabinoid system? When cannabinoids like THC and CBD found in cannabis activate CB1 or CB2 receptors, they appear to act as neuromodulators in that they alter the flow of other neurotransmitters like serotonin, dopamine and glutamate.  

Studies suggest, fibromyalgia patients have increased levels of glutamate, an excitatory neurotransmitter, as well as elevated markers of inflammatory compounds such as cytokines and C-reactive protein. [https://www.ncbi.nlm.nih.gov/pubmed/28033157]

Dr Kimmins explains: “We don’t fully understand how the ECS affects neurotransmission. It appears that when cannabinoids act as neuromodulators, they may function as both agonists and antagonists, depending on the physiologic situation. In this way, they seem to act like a train conductor helping move substances across the synaptic junction. Sometimes they act to speed transmission up (agonist), and sometimes to slow transmission down (antagonist). When functioning normally, the ECS appears to help balance the neurotransmitters and the levels of inflammation, pain, etc…  When functioning abnormally the opposite could occur.”

Conventionally speaking, doctors often prescribe antidepressants, analgesics, muscle relaxants and anti-epilepsy drugs in treating fibromyalgia. Relief with conventional medications is possible but sometimes comes with side effects. Some patients choose to add cannabis to their treatment plan to help guard against pain, mood instability, insomnia and inflammation. Regulated medicinal cannabis is non-toxic and adds no stress to organs, such as liver, kidney and GI tract, when consumed as recommended. Because of the low evidence of contraindications, it may also work well as an adjunct to other prescribed medications.

Strains and terpenes which may help with these symptoms include:

Once you have a recommendation from your physician, edible oil, gel caps, sublingual spray, activated powder, or dried flower are the primary ways cannabis is readily available through Licensed Producers. Once you have the dried flower, you may choose to make your own tinctures, topicals, suppositories, and/or edibles from the plant.

Look to sites like Leafly and Lift.co or Facebook groups like SheCann for further subjective takes on best medicinal cannabis strains for fibromyalgia.

— Kait Shane, Community Outreach Educator Natural Health Services. Follow Natural Health Services on Twitter @NatHealthserve.

For further insight into all things cannabis, don’t forget to check out The Cannabis Show (new episodes every Wednesday) and connect with us on Facebook, Twitter and Instagram. The Cannabis Show is also available as an audio podcast, subscribe on iTunes, Google Play, Stitcher, TuneIn, and Overcast.

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