In a survey, 80% of patients with fibromyalgia who used cannabis reported subjective improvement in pain.

Fibromyalgia can be challenging to manage – guidelines recommend a symptom-­driven approach addressing pain, sleep, fatigue and functioning. Interest is growing in defining a role for cannabinoids, which reduce neuronal excitability and might alleviate pain, inflammation, depression and addiction. Mayo Clinic researchers surveyed more than 5000 adult patients with fibromyalgia about their experiences with cannabis use for symptom management; whether this use was recommended by their doctors was not addressed.

Half of the 1336 respondents reported using cannabis after their fibromyalgia diagnosis. Cannabis users tended to be younger and were more likely to be disabled and to have comorbid chronic obstructive pulmonary disease, anxiety and depression than were nonusers. The main cannabis compounds used were marijuana (mostly tetrahydrocannabinol [THC]; 34% of users), cannabidiol (CBD; 25%) and equal parts THC/CBD (34%). Common routes of administration were smoking, oral and topical. Dosing varied, with 23% of cannabis users reporting consistent daily dosing. Cannabis users reported reduction in pain (82% of users), improvement in sleep (77%) and improvement in stress, anxiety and mood (69%). Undesirable effects included worsening concentration in 14%, dizziness in 12% and fatigue in 10%. 

Comment: Although many questions remain regarding efficacy, dosing and long-term safety of cannabis for fibro­myalgia, these uncertain risks appear to be acceptable for many patients. Assuming that this survey is reasonably representative of patients with fibromyalgia, we should make sure to inquire about use of cannabis when we are providing care for them.

Marie Claire O’Dwyer, MB BCh BAO, MPH, Clinical Assistant Professor in Family Medicine, University of Michigan Medical School, Ann Arbor, USA.

Singla A, et al. A cross-sectional survey study of cannabis use for fibromyalgia symptom management. Mayo Clin Proc 2024; 99: 542-550.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine.