Fibromyalgia. Could Medical Cannabis Be The Answer?
By Dr Anthony Ordman Consultant in Pain Medicine
Have you considered medical cannabis to treat your fibromyalgia symptoms?
Dr Anthony Ordman, is one of the UK’s most experienced and respected specialists in the treatment of pain. He Founded and ran the highly respected Chronic Pain Clinic at London’s Royal Free Hospital for 20 years and continues in private medical practice.
For his contribution to Pain Medicine, Dr Ordman was awarded Fellowship of the Royal College of Physicians in 2005, and he is now Past President of the Pain Medicine Section of the Royal Society of Medicine.
Dr Ordman continues to innovate, finding new ways to help people with long-term pain, and as Senior Consultant at Integro Medical Clinics, he is continuing to work on the use of cannabis- based medicines for pain.
Dr Anthony Ordman talks about fibromyalgia and tells us why medical cannabis is an option worth considering.
Back in November 2018 came the news that cannabis medicine could at last be legally prescribed in the UK, after years of campaigning. It was a victory celebrated by many. Of course, there were caveats and controls in place to ensure the medication was appropriately administered, but nobody expected that, over two years later, that cannabis-based medicines (CBM’s) would still be on the fringes, and beyond the reach of most doctors’ pharmaceutical toolkits.
Hopes that CBM’s would become easily accessible for those suffering from a myriad of conditions, ranging from the chronic pain of fibromyalgia to Crohn’s disease, Parkinson’s, and ADHD and depression and anxiety, have yet not been widely realised, and certainly not in the NHS. Most medics still feel they just don’t know enough about cannabis medicines to advise their patients, leaving only a small percentage of sufferers able to access them, mostly through the private sector.
The Department of Health and Social Care says more research is still needed before CBM’s can be routinely be prescribed which, not surprisingly, makes CBM’s virtually unobtainable in the NHS. This is unfortunate, because there are many repots in the medical literature of significant improvements in pain with CBM’s, and this is particularly so for fibromyalgia.
Thinking of my 20 years working in an NHS pain clinic, we did manage to help many of our patients with the various conventional resources at our disposal. But I also came to realise that for many other patients with long-term conditions, our conventional medicines, physio and CBT had little to offer. Standard pain medicines didn’t generally work for long-term pain, and they all tended to have side effects which would make people’s lives worse, not better. This was especially true for fibromyalgia, where no drugs are available specifically to treat this condition.
So, in the four years since I retired from the NHS, I’ve continued in my search, looking for new ways of trying to help people with pain. And as events often unfold, 2018 brought us an opportunity to study the newly-legalised cannabis-based medicines (CBM’s). Joining Integro Medical Clinics as senior consultant allowed me to put my new knowledge into practice, and within three or four months of prescribing CBM’s at Integro, I had something of a revelation. So many patients with pain, unable to be helped by conventional medical treatment, had gone on to feel much better in terms of pain, mood, sleep, and physical activity once we’d started cannabis medicines and found the right CBM prescription for them. And we were able to go further and reduce some of their long-term pain medicines as well, allowing people to feel better still. This whole process might take somewhere between 1 and 4 months to achieve.
At Integro, we aim never to add to a patient’s side effects when finding the right CBM prescription them, and usually succeed at this. We never accept from our CBM prescribing any of the side-effects such as sedation, forgetfulness, constipation and dependency that conventional pain medicines often cause.
Ever since medical school, I have cared about the ‘whole person’ in health, and been fascinated by the interactions between the mind and the body, which of course goes in both directions. Mind and body influence each other so much more than we realise. Pain is a very complicated entity, and it can cause such emotional and psychological upset that really you have to address all of someone’s pain and suffering together. Pain tends to cause anxiety, fear and misery as secondary effects, and living with chronic pain can cause worries about your job or your relationship, about losing your place in society and so on.
There seem to be several factors which can pre-dispose people to developing long-term pain, and this seems to be particularly true in fibromyalgia. Some people’s nervous systems seem to have a genetic predisposition to processing pain differently. In others, quite often people who’ve had long-term stress in life or adverse events in the past, often during childhood, can be at increased risk of having long-term pain. All of this is true in fibromyalgia, and over the years I have seen many, many people with fibromyalgia in my clinics, and it has become something of a special interest for me.
Fibromyalgia (FM) is a common, chronic widespread pain disorder.
It is an extremely troublesome and debilitating condition that can cause severe chronic pain all over their body. People often feel as if the pain is coming deep from within their bones and joints, and they can experience tactile allodynia, where innocuous light touches on the skin can feel like an unpleasant raw or burning sensation.
Those who live with fibromyalgia also commonly experience extreme fatigue, and ‘brain-fog’ or ‘fibro-fog’, where clear though and memory become difficult. Irritable Bowel Syndrome (IBS) is also a frequent symptom associated with fibromyalgia.
Fibromyalgia can be is difficult to pinpoint and diagnose, and up to 75% of sufferers may go undiagnosed. Many patients are seen initially in rheumatology clinics, because fibromyalgia produces disabling tight muscle spasms, which patients often feel must be coming from their joints or bones.
Our understanding of FM has increased substantially in recent years, with research showing a cause from within the body’s central nervous system; that is the brain and the spinal cord.
Figure 1. Pain signals are processed in the spinal cord. In fibromyalgia, this processing is faulty.
The ‘posterior grey matter’ of the spinal cord [Figure 1.] consists of hundreds of thousands of nerve cells, or neurons. These neurons constantly monitor information coming in from the body’s sensory nerves, and process the information. Usually they ‘decide’ not to send unimportant information up to the brain, and we never become aware of them.
These neurons pass information from one neuron to another by releasing tiny packets of transmitter chemicals from one nerve cell to the next. Some of these ‘neuro-chemicals’ are the naturally- occurring ‘endocannabinoids’ made in the bodies of all animals. These endocannabinoids seem to have the function of stabilising and calming the nervous system back towards normality.
But long-term stress, and resulting poor sleep can cause neuro-chemical imbalances in the central nervous system, impairing the processing of sensations. Then sensations become mis-interpreted, causing pain to be perceived by the brain, in the absence of actual incoming painful stimuli from the rest of the body. This results in abnormal amplification of pain signals, similar to the ‘pain volume control knob’ being turned up too high. At the same time, muscles throughout the body can become tight and go into painful spasm, adding to the pain syndrome.
Research continues to determine the causes of fibromyalgia’s associated fatigue, non-restorative sleep, and thought and memory difficulty, but this must have to do with the fact that people with fibromyalgia often go for years without ever falling into deep, ‘stage 3 and 4’ sleep at night because of stress. This sleep abnormality may be the cause of the whole fibromyalgia syndrome in the first place. Normally, in the deepest stages of healthy sleep, the body undergoes deep muscle relaxation, and our brain stores the memories of the previous day while, at the same time, toxins are flushed out of the brain’s nerve cells. But if deep sleep doesn’t happen, night after night, then it’s not difficult to see that tight, painful muscles and brain-fog may occur, along with changes such as the spinal cord neuro-chemical imbalances already mentioned.
Potentially adding to this problem; if you treat insomnia and its ensuing anxiety with drug like Zopiclone or other benzodiazepines, doesn’t improve deep sleep, only sleep duration. They can end up causing the patient all sorts of problems, adding to brain-fog, and dependency.
There is no one conventional medicine to treat Fibromyalgia. Nerve pain medicines and anti-depressant medicines are often tried. These sometimes do help, but more often add their own side effects to the patient’s difficulties. Most conventional pain medicines such as morphine, amitriptyline and gabapentin/pregabalin, which are available for long-term pain, do not really work effectively for pain in the body’s spinal cord and central nervous system. By contrast, cannabis medicines have their main effect there. And, as I am now seeing, cannabis medicines can offer effective treatment for fibromyalgia, as they seem to re-balance and regulate the human body’s endo-cannabinoid system, to reduce pain and spasm, and restore more normal sleep patterns.
Irritable Bowel Syndrome (IBS) is a frequent symptom in Fibromyalgia and again this can really be helped by cannabis. The gut is an incredibly complex organ that has its own nervous system that is relatively delicate and can be disturbed by fatigue and stress. Cannabinoids can give IBS patients huge relief as they soothe and reduce inflammation whilst simultaneously reducing muscle spasms in the bowel and stomach.
Cannabis was used for medicinal purposes throughout history but was made to be regarded as ‘undesirable’ in the mid-1900’s, and then outlawed in America, UK and many other countries.
However, in the 1990’s medical research began to show that the body has a complex cell-signalling system of cannabinoid molecules and receptor molecules named ‘the endocannabinoid system’. This system not only regulates pain but normalises other bodily functions including mood, sleep, appetite, metabolism, memory and inflammation. Cannabis medicines, derived from the cannabis plant, were shown to influence the endocannabinoid system’s functions by binding to the natural endocannabinoid receptors in the body and the brain, and re-balance the system. Hence the system’s name.
We can use the plant cannabis molecules to rebalance the nervous system to reduce the unhelpful amplification of pain signals in long- term pains. Through modulating the system and rebalancing its activity with cannabis-based medicines.
Figure 2. Cannabinoid receptors on spinal nerve endings, which ‘normalise’ the messaging between individual nerve cells in the spinal cord. The green squiggly lines represent natural cannabinoid receptors.
The production of pharmaceutical cannabis medicines is done under strictly controlled conditions, which monitor the strength and the type of plant substances most suitable to treat individual conditions.
They are produced under the same safe-guarding controls you would expect from any prescribed drug. The highest quality plants are used from selected growers tested in accordance with European The production of medical cannabis is done under strict controlled conditions, which monitor the strength and the type of plant substances most suitable to treat individual conditions. regulations before being turned into medicines in reputable laboratories that are often at the forefront of research.
By contrast, street cannabis is produced by illicit and illegal set ups in backstreet operations without hygiene, controls or testing. And dealers have no real idea what is in the products they sell or what they have been treated with.
Quite a few of my patients have been self-medicating for years with black market cannabis when they initially come to see me because of their desperation, and not being helped by conventional medicines.
I cannot emphasise strongly enough that medical cannabis is really very different from street cannabis. It can only be prescribed on a case-by-case basis by a physician on the specialist register, and only when other reasonable options have been tried or considered and found wanting. The increased safety of medicinal cannabis compared to black market product is significant.
If you are really struggling with you Fibromyalgia symptoms at the moment and feel that none of the conventional medicines your doctor has given you are any longer bringing any relief, I would suggest you consider trying medical cannabis. I am increasingly of the view that we are just at the beginning of understanding the potential of what the cannabis plant can offer in terms of pain relief and new medicines - all without those horrible side-effects.
There are a few medical cannabis clinics in the UK and at Integro Clinics, where I practice, I personally oversee all patient cases. Our ethos is totally patient centric, and we treat each patient as a priority tailoring them a personal treatment package that we closely monitor. We have a specialist nurse available at all times for advice and support.
Our aim at Integro is that your quality of life will improve, and while there is no cure for fibromyalgia, I hope that through carefully listening to our patients and finding the right dosage of medical cannabis, a real and positive difference can be made to their lives.
If you would like further information or to speak to Dr Anthony Ordman or one of his colleagues, please contact Integro Clinics:
Website: www.integroclinics.com
Email: contact@integroclinics.com
Twitter: @clinicsintegro