Treatment of the root cause of refractory pain

Fibromyalgia is an intractable condition defined by chronic widespread pain and weakness. But a recent study published in Clinical and Experimental Rheumatology showed that cannabis can be used effectively to remedy these problems, at least in some patients.

Overall, cannabis research is fraught with methodological difficulties, thanks to anachronistic regulations that consider marijuana to be more dangerous than fentanyl or oxycontin. But this study by Italian scientists stands out, producing research that is applicable to people who are trying to use medicinal cannabis to treat fibromyalgia.


The researchers recruited just over a hundred patients at the Luigi Sacco University Hospital in Milan, Italy. Sixty-six of them were interviewed during six months of treatment. The average participant was 52 years old and more than 90% of the patients were women (women make up the vast majority of people with fibromyalgia).

The study focused on the treatment of refractory patients, that is, people who take medications stably, but have found no relief. Just under half of their patients were taking two other medications, while almost a third were taking at least three. These medications were severe central sedatives, including opioids, anticonvulsants, nerve blockers, and antidepressants.

Given the intensity of the drugs people were already taking, it was surprising to find that half of the patients (47%) received enough cannabis relief to reduce or discontinue their pain reliever use.

One-third to one-half of the patients experienced significant benefits with respect to sleep, anxiety, depression, and pain symptoms. Most of the patients were overweight or obese, and cannabis appeared to be more effective for heavier patients. Some participants were excluded, including those who already used cannabis and people with other pain or rheumatic diseases.

The authors conclude: “Therefore, complementary treatment [Medical cannabis treatment] may be considered, especially in the [fibromyalgia] subpopulation suffering from significant sleep disorders and mild anxiety-depressive symptoms.”


Dosing cannabis is complicated, which is why the Italian researchers used a strategy commonly applied by patients. They used two pharmaceutical grade flowers, let’s call them: rich in THC and balanced. The balanced flower had slightly more CBD than THC.

Both were converted into olive oil tinctures with a dropper to dose. Participants were advised to take two doses per day, one balanced dose in the morning and the THC-rich formulation in the evening. THC can promote sleep and appears to be a more effective pain reliever than CBD, so it would be unwise to discourage its use entirely. But the intoxicating effects of THC are negative for many people who would go to work and live a normal life. This study gave fibromyalgia sufferers the opportunity to use different formulations tailored to their own circadian rhythms and sensitivities.

There was no established dosing regimen: medical research so far has not been established in a single dose, and it is unrealistic to suspect that an ideal dose exists, given the variety of conditions that cannabis can help treat.

Instead, the researchers recommended that participants try 10-30 drops in each morning and afternoon dose. Slowly titrating based on their own comfort, they could take up to 120 drops per day. This could mean starting with just 4 mg of THC and 2 mg of CBD, divided into two doses. The highest doses would have been close to 27 mg of THC and 8 mg of CBD, with most of the THC taken at night.


More than a third of the participants experienced clinically significant improvements in sleep symptoms and fibromyalgia. Half of the patients reported moderate benefits in anxiety and depression once cannabis was added to their treatment regimen.

This is a common theme: the evidence is in conflict over whether cannabis can treat depression or insomnia separately. But when these problems are secondary to a condition like chronic pain or fibromyalgia, cannabinoids are quite effective. It is as if they were treating the underlying problem, rather than just the symptoms.

Dr. Ethan Russo hypothesizes that fibromyalgia, along with migraine, may be an expression of a clinical syndrome of endocannabinoid deficiency. This theory proposes that certain diseases manifest when the endocannabinoid system is too weak to adequately regulate the many physiological systems under its control. If endocannabinoid deficiency causes certain diseases, then taking vegetable cannabinoids like CBD and THC will address the root of the disease, rather than simply mitigating some symptoms.

The fact that almost half of the patients were able to reduce the use of other drugs, with 21% discontinuing their other medications altogether, “probably reflects their subjective satisfaction with the efficacy and side effects of MCT [medical treatment cannabis], ”said the Italian study.


Among the participants, 60 were women and only 6 were men. Therefore, it was not possible to determine if sex had any impact on treatment. Interestingly, the researchers found that the heaviest participants were the most likely to experience benefits. This could be related to lower obesity rates among cannabis users, which is constantly observed when studying how cannabis affects public health.

There are also other possible explanations. CBD and THC are oily molecules that like to hang out in fat tissue. The authors speculate that people with more fat can better absorb cannabinoids, leading to a better treatment result.

The benefits of cannabis in anxiety and depression are also particularly remarkable: 80% of people with fibromyalgia suffer from anxiety or depression.


Of the initial 102 participants, about a third dropped out of the study within six months. That’s a reasonably good retention rate for a clinical study like this. But it is important to consider who left and why, as this can skew the results. Eleven participants explicitly discontinued treatment: cannabis did not work, caused moderate side effects, or was too expensive. Ten of the participants continued to use cannabis but dropped out of the study when they moved to another hospital. The remaining 15 dropouts were simply not accounted for.

About one in three people experienced mild or moderate side effects (such as dizziness, drowsiness, nausea, and dry mouth). Few participants reported worse symptoms after starting cannabis therapy, although it may have been making some patients feel fatigued.


The researchers seem to think so, especially compared to conventional alternatives: “The MCT [Medical Cannabis Treatment] has been shown to be a much safer supplement than opioid treatment, which is associated with a high risk / benefit ratio and is not effective. in the treatment of fibromyalgia; Furthermore, MCT has no substantial addictive properties in terms of dose escalation or withdrawal syndrome. Tolerance is the most important concern because, although symptom relief is obtained after only three months, a longer treatment period could lead to decreased effectiveness, although this can be avoided with extremely slow dose titration. ».

Adrian Devitt-Lee, March 15, 2020

Spanish Translation: Alexander Gómez, Anandamida Gardens.