Cannabis Use in Patients with Fibromyalgia: Effect on Symptoms Relief and Health-Related Quality of Life
Farre M (2011) Cannabis Use in Patients with Fibromyalgia: Effect on Symptoms Relief and Health-Related Quality
of Life. PLoS ONE 6(4): e18440. doi:10.1371/journal.pone.0018440
Cannabis Use in Patients with Fibromyalgia: Effect on Symptoms Relief and Health-Related Quality of Life
Jimena Fiz 0
Marta Dura n 0
Dolors Capella` 0
Jordi Carbonell 0
Mag Farre 0
Antonio Verdejo Garca, University of Granada, Spain
0 1 Human Pharmacology and Neurosciences Unit, Institut de Recerca Hospital del Mar - IMIM, Parc de Salut Mar , Barcelona , Spain , 2 Universitat Auto` noma de Barcelona , Barcelona , Spain , 3 Fundacio Institut Catala` de Farmacologia , Barcelona, Spain, 4 Rheumatology Unit, Parc Salut Mar, Barcelona , Spain
Background: The aim of this study was to describe the patterns of cannabis use and the associated benefits reported by patients with fibromyalgia (FM) who were consumers of this drug. In addition, the quality of life of FM patients who consumed cannabis was compared with FM subjects who were not cannabis users. Methods: Information on medicinal cannabis use was recorded on a specific questionnaire as well as perceived benefits of cannabis on a range of symptoms using standard 100-mm visual analogue scales (VAS). Cannabis users and non-users completed the Fibromyalgia Impact Questionnaire (FIQ), the Pittsburgh Sleep Quality Index (PSQI) and the Short Form 36 Health Survey (SF-36). Results: Twenty-eight FM patients who were cannabis users and 28 non-users were included in the study. Demographics and clinical variables were similar in both groups. Cannabis users referred different duration of drug consumption; the route of administration was smoking (54%), oral (46%) and combined (43%). The amount and frequency of cannabis use were also different among patients. After 2 hours of cannabis use, VAS scores showed a statistically significant (p,0.001) reduction of pain and stiffness, enhancement of relaxation, and an increase in somnolence and feeling of well being. The mental health component summary score of the SF-36 was significantly higher (p,0.05) in cannabis users than in non-users. No significant differences were found in the other SF-36 domains, in the FIQ and the PSQI. Conclusions: The use of cannabis was associated with beneficial effects on some FM symptoms. Further studies on the usefulness of cannabinoids in FM patients as well as cannabinoid system involvement in the pathophysiology of this condition are warranted.
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Funding: The work was partially supported by grants from Ministerio de Sanidad - Plan Nacional sobre Drogas (SOC/3386/2004), Instituto de Salud Carlos III
(FISRed de Transtornos Adictivos -RTA RD06/0001/1009) and Generalitat de Catalunya (AGAUR 2009 SGR 718). No additional external funding was received for this
study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
The main complaint of patients with fibromyalgia (FM) is
chronic generalized pain, although many patients suffer from
concomitant symptoms, such as tiredness, morning stiffness, sleep
and affective disturbances [1]. The pathophysiology of the
disorder is poorly understood. Several mechanisms have been
suggested including central sensitization, suppression of
descending inhibitory pathways, excessive activity of glial cells, and
abnormalities of neurotransmitter release [2]. In addition, blunting
of the hypothalamic-pituitary-adrenal-axis (HPA-axis) and
increased autonomic nervous system responsiveness have been
consistently reported in FM patients. Emerging clues suggest that
such dysfunction of the stress response system may be crucial in
the onset of the symptoms of FM [3]. Treatment is based on the
symptomatic relief of symptoms but usually modest results are
obtained. The overall patients satisfaction and the health-related
quality of life are consistently poor.
Potential therapeutic uses of cannabis in different types of
pain are currently extensively investigated. Data from clinical
trials with synthetic and plant-based cannabinoids provide a
promising approach for the management of chronic neuropathic
pain of different origins [4]. Additionally, a large body of
evidence currently supports the presence of cannabinoid
receptors and ligands, thus an endocannabinoid
neuromodulatory system appears to be involved in multiple physiological
functions [5].
There is little clinical information on the effectiveness of
cannabinoids in the amelioration of FM symptoms. Three clinical
trials have suggested the possible benefit of cannabinoid in the
management of FM [68]. Furthermore, a clinical
endocannabinoid deficiency (CECD) has been hypothesized to underlie the
pathophysiology of fibromyalgia, but a clear evidence to support
this assumption is lacking [9].
The aim of this study was to describe the patterns of cannabis
use and the associated benefits reporte (...truncated)