Episode 29: The Latest Research Findings - Part III"
Revisiting Part I & II - a RECAP:
I've been focusing on regaining control over my body since my fibromyalgia symptoms reared its painful head 2 years ago, and so far medical cannabis has been a game-changer for me. In part's 1 and 2, I explored legal implications, financial benefits, and personal experiences. Initially, I was hesitant to use medical cannabis because of legal and professional concerns, but I noted the changing legal environment in Minnesota regarding cannabis use. In Part II, I explored the legal implications, financial benefits, and personal experiences. I mentioned being protected under state laws for medical cannabis as a teacher in the state of Minnesota, but acknowledged the possibility of employer drug testing. Financially, medical certification has offered tax benefits compared to recreational purchases. Through trial and error, I found effective delivery methods for symptom relief, offering me hope in managing my fibromyalgia symptoms. I am eager to continue sharing my experiences in Part III to help others navigate similar challenges. For more context, revisit parts I and II of this series.
Part III: The Research
Scouring the "Inter-webs", I discovered many articles that distilled the findings of numerous studies exploring the use of medical marijuana for fibromyalgia symptoms. In these studies, 3 significant themes emerged that are important to me and I believe important for my readers to know. Those themes are using medical marijuana for: 1) improvement in quality of life, 2) efficacy in pain management, and 3) the safe use of medical marijuana. I invite you to continue reading to investigate these themes and implications for fibromyalgia relief.
Quality of Life - Sleep
Many studies are all over the place with this, but one point of improvement seems to be in quality of sleep. At least two literature reviews that informed this post note that an improvement in sleep was a factor in the successful use of cannabis for fibromyalgia treatment . The findings in one study suggest that using THC-rich, low-CBD cannabis was not only low cost but had a higher efficacy in managing symptom relief, including sleep. Another study suggested that in using medical cannabis over a sustained period of time, patients experienced significant improvements in quality of life . While research on cannabis for fibromyalgia treatment may vary, the available evidence points towards improved quality of life, including sleep and pain management, as a significant benefit.
Efficacy in Pain Management
To be perfectly honest, much of the evidence for the efficacy in pain management is anecdotal and the researched "evidence" is mostly inconclusive. In terms of treating fibromyalgia pain, the same results apply. Jane Leonard of Medical News Today explained, "Some studies and anecdotal evidence suggest that marijuana or its extracts may help with the symptoms of pain, including the pain that occurs with fibromyalgia". This is hopeful and other studies concur in their findings that there is a place for medical cannabis as a treatment for fibromyalgia pain when other treatments have failed. I would certainly say so in my own case where medical marijuana is the only treatment that has helped me with pain management as well as improved my sleep and, because of that, my daily functioning.
Improvement in daily functioning seems to be a trend in many studies, particularly the promising results in pain management.
Another study funded by the NIH suggests, "There is evidence for the use of low-dose medical marijuana in refractory neuropathic pain [i.e., damage or dysfunction of the nervous system] in conjunction with traditional analgesics". However, the same study also suggests that there is not enough evidence to support generalized use of medical cannabis for chronic, non-cancer pain - pain experienced by patients with fibromyalgia - and advise caution to clinicians when prescribing it. As mentioned in part one of this series, the scarcity of substantial evidence stems directly from the federal classification of the cannabis plant. Until cannabis is removed from the Schedule I class of drugs, studies will continue to face obstacles.
Safe Use - The Law
Cannabis has been used for centuries as a medicinal plant and we know it also for its recreational and clandestine use. Although it was outlawed for recreational use in 1937 under the "Marihuana [sic] Tax Act", this act also protected cannabis for medicinal use. However, it was eventually outlawed in 1970 under the Controlled Substances Act. This U.S. policy regulated certain "narcotics" on a schedule from a 1-5. Marijuana was placed under schedule 1 which claimed that: "Substances in this category are considered to have a high potential for abuse and no accepted medical use in the United States". It has only been since 1996, in the state of California, that medical marijuana was legalized and since 2014 that the Federal Justice Department was prohibited from interfering with state medical marijuana implementation.
As of today, marijuana is still listed as a schedule 1 substance, yet 38 states have enacted laws permitting medical use of cannabis, and 24 states have legalized marijuana for recreational use. Though this may change in the near future, the federal law remains in place and again until cannabis is removed from the Schedule I class of drugs, research aiming to establish its safety and effectiveness will continue to encounter challenges.
Safe Use - Comparison to Opioids
Dr. Grinspoon, a medical researcher at Harvard Health, reminds us that, "There is truly no free lunch with medication, including medical cannabis". What does he mean by that? He means that with every medication, there are risks. When it comes to psychoactive drugs like cannabis, just like other "narcotics" there are risks. Those risks are subjective and can vary by individual. They include but are not limited to: worsening psychotic disorders, memory and cognitive disfunction, cardiac and lung effects, addiction, or cannabis use disorder, (particularly for young people), in high doses worsening of anxiety and panic attacks (think "paranoia"), and impaired driving or operation of heavy machinery.
Just a note: as adults, it is more difficult to develop cannabis use disorder, However according to Dr. David Gorelick of the University of Maryland School of Medicine, "Cannabis use disorder ... [is] primarily a disease of young adults ... and there is evidence that the younger the age at which you start cannabis use, the faster you’ll develop cannabis use disorder and the more severe the disorder will be.” With that said, medical marijuana is primarily prescribed to adults. Though, in the state of Minnesota, a parent or guardian can register a minor for medical use, more often states allow for medical marijuana to be prescribed only to adults 18 and older.
Considering all the risks associated with cannabis and switching our focus to the risks associated with opioids intended for pain relief, cannabis seems to have better outcomes. This risks involved in opioid use include : Addiction! Opioids have a high risk for addiction, along with physical and psychological dependence. Other risks include sedation and drowsiness, dizziness, nausea, vomiting, constipation, respiratory depression, overdose, and death among other problems. As the USA is in the midst of an opioid epidemic finding alternatives to long term pain relief for people with chronic pain conditions should be a priority. For some, medical cannabis is that alternative.
Safe Use - How does it work
The cannabinoids in cannabis interact with the endocannabinoid receptors CB1 & CB2 in the brain. As noted in several studies, including this one, cannabis sativa has been used for centuries as a medicinal plant but it was not until the mid-twentieth century that scientist discovered the many benefits of THC leading to a better understanding of the potential uses and effects of the plant. The CB1 receptors are found throughout the central nervous system while CB2 receptors are bound to the immune system. THC interacts mostly with the CB1 receptors, especially in the brainstem and the spinal cord. This interaction leads to the analgesic effects sought after by fibromyalgia patients and others with chronic pain disorders.
Though there are inconsistent results, using cannabis for pain is an option legally in 37 states, and often used clandestinely everywhere else. In those states where it is legal, doctors will prescribe it just as they would any other medication with one caveat; everybody responds to it differently and distinctive strains of marijuana work differently in the body. But, we can break it down into two types: sativa and indica. Though these are old "industry" terms, they are useful for simplicity and to get a beginner understanding of what these two strains can do.
Sativa is known for what some call a "head - high". It is higher in THC and lower in CBD. It creates an energizing, anxiety-reducing effect that can be used during the day because of its stimulating effect. Because it does contain CBD, it shows promise in relieving the pain and other symptoms of fibromyalgia.
Indica causes what some call a "body - high" and is known for its relaxing effects. It usually has a higher levels of CBD and lower THC. Because of this, the psychoactive "high" effects are not as pronounced. It is also shown to relieve nausea, increase appetite, and reduce pain. Because it is so intensely relaxing it is better used at night for it's sleep benefits.
Safe Use - My Story
As noted in the second post in this series, there are different delivery methods when using cannabis. Although it can be inhaled, ingested, and taken sublingually with relative ease, I prefer sublingual delivery, specifically a cannabis spray. Using this method, I feel I have more control. It works faster than ingesting it and since I am a former smoker, I do not wish to inhale anything into my lungs that could have any potential damaging effects.
The spray I use is a hybrid blend with an even amount of THC and CBD. When using a spray, I always start with one pump under the tongue. Usually, this is enough to ease my anxiety and make me care less about pain. Two pumps not only eases my anxiety but also begins relieving the pain of my fibromyalgia. I have not had a need to try three pumps because two sprays under the tongue have been enough to ease my discomfort. My doctor told me that it would take some experimentation to see what worked for me and like any psychoactive drug to take it slow when increasing my dose to see what level works for me. What that means is that with a sublingual spray, the effect happens within 10-20 minutes and lasts for a good 6-8 hours. I am fortunate that I have had no negative side effects from medical marijuana.
RECAP
In my previous blogs (Parts I and II), I discussed how using medical cannabis has significantly improved my ability to manage the symptoms of fibromyalgia. In Part III, I went deeper into some key research findings about cannabis use for fibromyalgia, focusing on three themes: the positive impact on overall quality of life, pain management effectiveness, and safe usage practices. While there is compelling evidence supporting cannabis's ability to enhance sleep quality and daily functioning for fibromyalgia patients like myself, there remains a need for more comprehensive research to fully understand its efficacy in pain relief. Compared to potent pain medications like opioids, cannabis offers a relatively safer alternative with fewer severe side effects, although responsible use is crucial to mitigate potential risks.
Scientists explain that cannabis works for pain relief by interacting with specific receptors in our bodies. Different strains of cannabis, such as sativa and indica, produce distinct effects. Sativa is known for its stimulating properties and is suitable for daytime use, while indica is more relaxing and better suited for nighttime use, aiding in sleep improvement. It's important for individuals to find the most effective and comfortable way to incorporate cannabis into their treatment plans. Moving forward, ongoing research efforts are necessary to deepen our understanding of cannabis's therapeutic potential, its optimal usage, and safety considerations, especially concerning conditions like fibromyalgia.
Finally, my doctor emphasized the importance of experimenting to find the right dosage for me and to approach dosage increases gradually, especially with psychoactive drugs like cannabis. For me, using a sublingual spray means feeling the effects within 10-20 minutes, which last for a substantial 6-8 hours. Fortunately, I have experienced no negative side effects from medical marijuana, contributing to my overall positive experience with its use for fibromyalgia management. This highlights the importance of personalized treatment approaches and careful monitoring under medical guidance when incorporating cannabis into one's health regimen.
If you enjoyed this post, share it with your friends and colleagues, and consider becoming a subscriber. If you have any tips or suggestions about how to better cope with chronic pain, leave a comment. I would love to hear from you!
Karen Palmen, EdD is a veteran educator in Saint Paul, Mn. She teaches Dance and English at Saint Paul Central High School. She has an active TikTok page that features humorous, political, mental health, and educational content (kickin it with karen). And a a dormant YOUTUBE channel with the same name, featuring fermented foods and other cooking oddities.
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