Bethan Finighan

The notion that fibromyalgia is misunderstood is nothing new. As an invisible condition, millions of people living with chronic fibromyalgia pain continue to fight for access to effective treatment. As a result, countless patients are forced to go private, with many then finding solace in medical cannabis. Yet, despite this, a staggering proportion of the British public remains unaware of the medicinal properties of cannabis. It holds the potential to provide much-needed relief from pain and anxiety, as well as improvements to sleep and quality of life; a medical cannabis prescription may help to transform symptom management for those living with fibromyalgia in the UK. Fibromyalgia: an overview Fibromyalgia is a chronic condition thought to affect between 1.8 million and 2.9 million people in the UK and typically, but not exclusively, affects women. Those living with fibromyalgia experience chronic pain and stiffness, typically in muscles and tissues such as the tendons and ligaments. Patients can also experience extreme tiredness and fatigue, sleeping problems, anxiety, and cognitive dysfunction – or ‘brain fog’. As a poorly understood and under-researched condition, there is currently no known cause or cure for fibromyalgia. It affects individuals differently, so patients require unique treatment that aims to improve symptoms and quality of life. Some patients find that symptoms can be improved by exercise, physiotherapy, or cognitive behavioural therapy (CBT). Others may require more regular painkillers, antidepressants, or even certain antiepileptic medications that have proven to benefit symptoms. There is also an abundance of testimonial evidence hailing cannabis-based medicines and cannabidiol (CBD) as a godsend for reducing pain and inflammation, improving moods and sleep, and helping to combat fibromyalgia fatigue. Now, a growing number of studies are supporting these claims. Can I get a UK medical cannabis prescription for fibromyalgia? In 2018, UK law was changed to permit doctors on the General Medical Council’s specialist register to prescribe cannabis-based medicines for many qualifying health conditions. Medical cannabis can therefore be considered for the treatment of chronic pain conditions if traditional therapies are ineffective at managing symptoms – including fibromyalgia. Fibromyalgia and medical cannabis: the evidence Most of the existing evidence for using cannabinoids to manage fibromyalgia symptoms comes from preclinical research. Here, scientists have noted that the endocannabinoid system (ECS) – a complex cell-signalling network that regulates a myriad of biological processes – may play a role in the onset of fibromyalgia symptoms. Large-scale clinical trials of cannabis-based medicines for fibromyalgia are yet to be conducted, but numerous surveys and small studies suggest that patients may benefit from using cannabis to manage pain and stiffness, promote relaxation, and improve quality of life. Recent data from a study conducted by the UK Medical Cannabis Registry suggests that medical cannabis can significantly improve fibromyalgia symptoms and quality of life. The research, conducted on 306 fibromyalgia patients with UK medical cannabis prescriptions from Sapphire Medical Clinics, showed a 17% reduction in opioid use by patients, as well as self-reported improvements in pain severity, anxiety, and sleep quality. Studies conducted in smaller patient cohorts have also yielded positive results. In a 2011 study of 28 fibromyalgia patients, 43% of participants reported strong pain relief with cannabis use. Another 43% reported mild pain relief, and only 7% said they saw no difference in their symptoms. Similarly, a 2018 study of 20 fibromyalgia patients found that participants receiving two treatments containing high levels of THC experienced an increase in their pain threshold compared to those who received the placebo. It is, however, imperative that larger studies are conducted, using a more rigorous methodology. A 2020 critical review of studies of cannabis for fibromyalgia, published in the Journal of Cannabis Research, concluded that existing “studies superficially suggest that medical cannabis is a safe and effective treatment for fibromyalgia pain, serious methodological limitations prevent a definitive conclusion regarding the use of cannabinoids for pain management in fibromyalgia patients at this time.” But this robust evidence may come sooner than we think. Flora Growth, a US cannabis manufacturer, hopes to conduct a large UK trial in conjunction with a clinical research group based at the University of Manchester, subject to approval from the NHS Ethics Committee. The trial aims to explore the use of cannabis-based products in patients living with fibromyalgia and chronic pain and should start recruiting patients this year, according to Cannabis Health News. How does medical cannabis help with fibromyalgia? The specific mechanisms underlying the therapeutic effects of cannabis in people with fibromyalgia aren’t fully known, but as one recent paper suggests, it may have something to do with our endogenous cannabinoids – better known as endocannabinoids. The authors present evidence for alterations in the ECS in patients with fibromyalgia. They also highlight that modulation of the ECS in reliable animal model studies, via cannabinoid-induced inhibition of the FAAH enzyme, has shown to reduce pain and anxiety behaviours. The authors conclude that cannabinoids, cannabis, and cannabis-based medicines show therapeutic promise in patients with fibromyalgia, but further investigation is required. What are the risks? As with any medication, adverse effects are not uncommon with medical cannabis. Mild side effects have been noted in the majority of studies, though most are typically resolved with persistent use. The most common side effects include dizziness, fatigue, dry mouth, appetite changes, and nausea. Though in comparison to existing medications used to manage fibromyalgia, medical cannabis appears to have a better safety profile. Opioids, for instance, have an incredibly high potential for abuse and severe withdrawal symptoms. The cannabis plant – when cultivated correctly, in the absence of toxic chemicals – is not inherently harmful and cannot cause an overdose. Whilst cannabis can be abused, most people do not become addicted. Common antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), also come with a risk of tolerance and dependence. They can also cause significant sleep disturbances, whereas cannabis has been shown to improve sleep quality. I think I’m eligible – what next? As it stands, NHS medical cannabis prescriptions are currently reserved for patients with the following conditions: Rare, severe forms of epilepsy Vomiting or nausea caused by chemotherapy Muscle stiffness and spasms caused by multiple sclerosis (MS) Instead, any eligible patients with fibromyalgia or other qualifying chronic pain conditions may be eligible for a private prescription through one of the UK clinics. You can either apply to a clinic directly or through your GP. In the initial consultation, a doctor will look at the patient’s medical history and what medications they have tried in the past to assess the patient on an individual basis. Costs will vary between clinics; consultations typically range between £50 and £200 and the average prescription is around £150-£250 per month. For patients involved in schemes such as Project Twenty21, prescriptions are capped at £150 per product per month in exchange for participating in ongoing clinical studies. For more information on the process, take a look at our guide to getting a medical cannabis prescription in the UK.