Cannabidiol for Fibromyalgia

Introduction

Recent research advancements in the regime of natural plants and herbs being an effective treatment for many of the disorders in humans have brought out some very fascinating results. This has shown that many of the natural herbs and plants that were considered to be harmful to the human body previously are very beneficial for certain disorders. Most of these disorders were considered to be uncurable previously, but certain advancements in scientific research have enabled us to discover their treatment in the natural herbs.

Similar is the case for Cannabis sativa, more commonly known as marijuana or ‘weed’. Cannabis has been used as a recreational drug by people for centuries. Contrary to the conventional use of the cannabis plant to make marijuana for smoking, advancements in the field of medical research have found that some of the natural chemicals found in this plant such as cannabidiol (CBD) are very useful for certain medical disorders. The plant extracts, also known as the cannabinoids, have found immense medical importance that has been proven through immaculate medical research, which can be found online. The cannabinoids include cannabigerol, cannabidiol, cannabichromene, and tetrahydrocannabinol (THC) along with some other chemicals found in the extract from Cannabis sativa plant. Cannabidiol (CBD) differs from other chemicals found in cannabis, as it has a different mechanism of action and a different effect on the body as compared to other chemicals such as the tetrahydrocannabinol (THC).

The main substance behind the ‘high’ that the person gets after consuming marijuana is THC, which messes with the neuronal circuits to give hallucinations and euphoric feelings to the person who consumes marijuana. The chemicals having such types of results in the body are called ‘psychoactive’ substances. The top example of a psychoactive substance found in marijuana is tetrahydrocannabinol (THC). CBD is emerging largely as a full body treatment nowadays. The effects of CBD are not only limited to treating localized pain and anxiety, but it also has found a vast range of uses in other medically related conditions such as inflammation, cancer, and nervous conditions such as Alzheimer’s disease, Parkinsonism, and multiple sclerosis. Owing to the neuroprotective and anti-psychotic effects of cannabidiol, this compound has found itself being used for many pharmaceutical purposes.

The main advantage of using CBD is that it is not psychoactive as is the case of THC. THC leads to a deranged state of mind for the user, where the user experiences euphoric thoughts without having control over his or her thoughts. The difference between CBD and THC lies in the site of action of both chemicals in the central nervous system. CBD has a largely opposite effect as compared to that of THC in the areas of the brain such as the striatum, hippocampus, and prefrontal cortex. This fact has been established after years of research that CBD is finally safe for medical use, as is the case for ‘medical marijuana’’. Many studies conducted by laboratories around the world, along with controlled clinical trials, have confirmed that CBD can be adopted as a well-tolerated, safe, and effective drug for antipsychotic purposes. 

The THC has an impairing effect on the body, while all the effects of CBD are non-impairing. But, CBD in cannabis has some effects on the body where it serves to release overall stress on the body. These effects are different from the euphoric or ‘high’ sensations induced in our bodies due to THC, and serve to alleviate the stress and anxiety. This makes CBD as the best alternate to marijuana to seek an escape from pain and anxiety. Contrary to THC, CBD is not psychoactive; it does not get a person high but grants an equal amount of cure against anxiety and nervousness.

The Mechanism of Action of Cannabidiol

Cannabidiol (CBD) acts by interacting with the endocannabinoid system of the body. For those who do not know about this system: it is just another neurotransmitter system in our bodies just like the acetylcholine system or adrenaline system. The neurotransmitter system of our bodies acts to pass on the nerve impulses on synaptic terminals. The nerve impulse gets passed on through the secretion of certain molecules at the synaptic junctions. These molecules are known as neurotransmitters. There are various types of neurotransmitters in the body. Each type of neurotransmitter molecule has a different effect on the body. Some of the neurotransmitters are long-acting while others have a significantly short course of action.

Similar to these neurotransmitter systems in the body, the endocannabinoid system (ECB system) is also a neurotransmitter release system. The receptors in the ECB system are known as the cannabinoid receptors. The endocannabinoid system is composed of neurotransmitters known as endocannabinoids. Endocannabinoids are one of the most widely known, potent, and versatile signaling molecules known up to now. The receptors in the endocannabinoid system are called the cannabinoid receptors. When these cannabinoids such as cannabidiol bind to these receptors, they affect the rates of metabolism and other factors such as transcription and translation of specific protein factors in the cells. These protein factors are then responsible to exert certain effects, which mainly include the inhibition of certain inflammatory cytokines such as interleukin factors. These mediators of inflammation cause several diseases in the central nervous system such as fibromyalgia and multiple sclerosis. These factors are also beneficial in the sense that they inhibit certain autoimmune responses in the body. These autoimmune responses are responsible for damaging the beneficial tissues in the body such as myelin sheath, causing nervous disorders such as multiple sclerosis. These receptors are present on the cells throughout the entirety of our central nervous system along with the brain and spinal cord, and they are specifically called CB1 and CB2 receptors. Such receptors are found predominantly in the brain in the hippocampus and cerebellum. Due to their specific location in these areas of the brain, the endocannabinoid system can affect certain behaviors and processes of the body such as immune responses of the immunocytes such as T cells, communication between cells such as signaling and chemotaxis, bodily processes such as appetite, metabolism, and digestion, and cognitive behaviors including memory, and more. Because these receptors directly affect the function of the cell they are on, the psychic effects experienced after consuming cannabinoids such as CBD and THC have a rapid onset. The psychoactive cannabinoids such as THC result in euphoria, enhancement of sensory perception, increased heart rate, decreased pain stimuli, and difficulties in concentrating on specific tasks. These effects are due to the relative abundance of CB1 and CB2 receptors in the hippocampus. The effects may also include short term impairment of memory. These effects are largely due to the psychoactive agents found in cannabis such as tetrahydrocannabinol (THC).

On the other hand, the effects of CBD are largely different than that of THC. This is because of the non-psychoactive nature of cannabidiol. 

Fibromyalgia – An Introduction

Fibromyalgia is a disorder of the central nervous system that is characterized by musculoskeletal pain in the whole body, including voluntary muscles. The skeletal pain in fibromyalgia is the major cause of the fatigue experienced by the patients in this disease. Just like other central nervous system disorders, fibromyalgia is gradually progressive- its symptoms gradually accumulate and worsen over time. The onset of the disease is not so notable in the patients. In most of the cases, the disease starts after an intense physical trauma to the upper part of the body. However, the disease may also be a manifestation of other factors such as invasive surgery or a widespread infection throughout the body that affects the central nervous system. The disorder may also arise as a result of major psychological stress, and the mechanism behind why the disease has an onset after such stress is still unknown to the physicians. The symptoms of the disease may not appear until the disease has significantly progressed, and then appear when the disease has gone beyond the reversal point.

Apart from the musculoskeletal pain experienced in fibromyalgia, the patient may also notice abnormalities in the basic body processes such as sleep, memory, and mood issues. This is because the disease adversely affects the regions of the brain that control these basic body processes. However, the most notable symptom of fibromyalgia is probably the pain that runs throughout the body. Apart from the fact that fibromyalgia causes its pain impulses, the researchers, through coordinated clinical studies, also have discovered that this disorder affects the other nerve impulses that are traveling through the nerves. Particularly, this disorder amplifies certain pain stimuli traveling through the spinal tracts up to the brain, by affecting how the pain is perceived by the central nervous system.

Fibromyalgia is often found to be co-existing with certain other disorders such as gastrointestinal disorders, urinary impairments such as irritable bladder syndrome, intestinal cystitis, and temporomandibular joint disorders. In these cases where it coexists with these diseases, the negative effects of these diseases most commonly pain is increased to a great extent. This not only degrades the lifestyle of the patients surviving with these disabilities but also is exhaustive for the caregivers.

Many clinical studies have been conducted to find out the exact mechanism of fibromyalgia through which it is responsible for altering the nerve impulses in humans. The researchers, through these studies, believe that certain stimuli such as severely repeated nerve stimulation, along with damaging and intense stimuli such as electrical trauma to the nerve connections in the central nervous system cause the brains of people with fibromyalgia to change. The damage to the nerve connections does not stop here but also affects the way the nerve impulses are transferred through certain synaptic junctions and bridges in the central nervous system. Due to the fact that this disorder affects the passage of nerve impulse through nerves, it can cause certain stimuli to be exponentially amplified, while may also be responsible for completely fading out other stimuli. Particularly, this effect is most notable in cases of pain stimuli. This disorder causes an abnormal increase in levels of certain neurotransmitters in the brain that are responsible for the regulated conduction of pain impulses. Also, the central nervous system becomes habituated to these abnormal stimuli of pain and become more sensitive throughout the disorder, meaning they can overreact to pain signals. This is responsible for the increased sensations of pain that a person experiences in fibromyalgia.

Another major point of concern in fibromyalgia disorder is the prevalence of insomnia in this disease. The symptoms of fibromyalgia are exhaustive, and they significantly degrade the sleep quality of the patient suffering from this disorder. The major culprit for insomnia in fibromyalgia is pain. Pain significantly degrades the sleep quality of the patient. Moreover, insomnia in this disorder can aggravate the symptoms, causing dangerous progression that may gradually lead towards causing permanent disabilities in the patient, or this may even lead to other disorders such as Alzheimer’s disease, Parkinson’s disease, and other diseases that cause neurodegradation in the patient.

The Treatment – An Abstract

Traditionally, this disorder has been treated by using first-line medications such as administering duloxetine to the patients for their symptomatic treatment. However, these FDA approved drugs have very limited efficacy in the patients of fibromyalgia or sometimes have no effect at all in the severely degraded cases of this disease. Physicians have relied on using traditional analgesics for the management of pain in this condition for a long time. But, using traditional analgesics for pain management in fibromyalgia also has a very limited effect, as traditional analgesics are unable to affect the vital circuits of the central nervous system that are involved in the perception and localization of the pain stimuli. Some studies have also suggested that the brain is affected by dangerous inflammation in this disorder, and the inflammation often affects the vital areas of the brain controlling the cognitive behavior of the patients. The microglia in the brain and spinal cord, under stimulation from the various inflammatory cytokines, along with other inflammatory immunocytes are the main reason behind the impairment of certain central nervous system areas in fibromyalgia due to inflammation.

Recent researches have shown the benefits of administering CBD to the fibromyalgia patients for their symptomatic treatment and to stop the progression of this disorder. CBD can help prevent the disease in various ways. One of them is through the anti-inflammatory properties of CBD. CBD has been shown to prevent certain areas of the brain and spinal cord from being attacked by the inflammatory cells. This prevents the nerve damage in these areas, thereby preventing the musculoskeletal symptoms. Moreover, the neuroprotective properties of certain cannabinoids which they exert through binding to the cannabinoid receptors in the ECB system also prevent autoimmune attacks against the nervous tissue. In this regard, several research papers have been published in journals all around the world. 

An Israeli research institute gathered data by administering CBD to the patients suffering from fibromyalgia. The whole research was a review of patients suffering from fibromyalgia. The patients were administered CBD in measured doses by the physicians. The response of the patients to the treatment was assessed through comparative measurement of the symptoms, as compared to a control group who were placed on placebo. The clinical data were gathered comprehensively from the major hospitals in Israel. The study also focused on the effectiveness of cannabinoids obtained from medical Cannabis to stop the progression of this disease in addition to providing symptomatic treatment to the patients. All the patients were accurately diagnosed with fibromyalgia. 

The results of the study were largely suggestive of CBD being used for the symptomatic treatment of the patients. After the administration of medical Cannabis in those patients, almost all of them reported a drastic improvement in their symptoms. The pain was alleviated, and the fatigue was reduced to an insignificant level. The improvement in the symptoms of the patients treated with medical Cannabis and CBD was so marked that most of the patients decided to adopt this drug as their main drug to combat the symptoms, as well as for the treatment of fibromyalgia. Most of them gave up the previous prescriptions. The patients who continued their previous prescriptions reduced the dose by a large margin, and also changed the type of medication they had taken before taking up CBD as their main drug to treat fibromyalgia. The patients told the effects of the treatment, and their responses were largely in the favour of CBD being used for this purpose. 

The research also studied the potential side effects of using CBD and medical Cannabis for the treatment of the aforementioned disease. The major benefit of using CBD for fibromyalgia was that the CBD treatment had very less or no side effects at all. The minor side effects that were observed included dryness of mouth, redness of the eyes, and an increased appetite. These side effects started appearing from the initial phase of CBD being used as a treatment drug for fibromyalgia. Even then, the side effects were mostly reported to be transient. They lasted only for a few weeks after appearing in the initial phase of the treatment and were mainly seen in cases where the medical Cannabis was administered through smoking it. Many patients adapted to feeling hungry by eating before the use of MC.

The Pain Relieving Effects of CBD in Fibromyalgia

Particularly, the most pronounced effect of CBD on the symptomatic treatment of such patients was discovered on the pain-relieving properties of the cannabidiol. Several research papers have studied the pain-relieving effects of CBD in human patients suffering from chronic pain diseases such as multiple sclerosis, fibromyalgia, and other inflammatory disorders such as rheumatoid arthritis. 

The chronic pain conditions such as fibromyalgia can interfere even with the sleep cycle and mess with the body mechanisms as a whole. Sometimes, the pain is so excruciating that the patient is completely immobilized due to the inability to initiate any movement in the skeletal muscles. Effective therapeutic and pharmaceutical options for patients living with chronic pain conditions in this disorder due to malignant conditions are very limited. Even if the patient starts using an analgesic regularly, the body mechanisms become desensitized to the analgesic very soon, and the whole efficacy of the drug goes to waste. One might resort to traditional analgesics to relieve chronic pain, but the results yielded are not always satisfactory. In some cases, the pain is relieved in the fibromyalgia patients after using conventional analgesics but generally appears again due to unknown causes. 

The use of Cannabis for therapeutic and analgesic purposes is not new and dates back to as far as 2900 BC. A common form for administering CBD is SATIVEX, which is an oral mixture consisting of THC and CBD. This drug is one of the very few that are approved for use and is used for treating pain in multiple sclerosis. The drug SATIVEX is approved for use in many countries but is not currently recognized by the FDA as an analgesic. 

The pain-relieving properties of CBD have been experimentally verified many times. A review was conducted in 2018 to examine the potential of CBD for curing pain. This review consisted of 47 studies, in which many different groups of people were studied who were using cannabidiol as an analgesic for chronic pains other than cancer pains. These studies examined various types of pain, including pain due to multiple sclerosis, fibromyalgia, rheumatoid arthritis, and visceral pain. The studies involved administering cannabidiol to people as an analgesic and also involved people who were administered placebos. The conclusion was: cannabinoids reduced the pain by 29.0 percent, as compared to 25.9 percent for the placebo. Moreover, because cannabidiol has no psychotic effects, there was no change observed in the psychological, emotional, or physical functioning of the subjects. As a result of a reduced sense of pain, the subjects also experienced improved quality of sleep as compared to the sleep they were having before taking cannabinoids. 

Pain due to fibromyalgia significantly impacts the quality of life of the victim. In most cases, the pain starts from the upper extremities and continues down into the lower extremities. The pain in the lower extremities is often so disturbing that it affects the sleep cycle of the patients. When the sleep cycle is affected, it leads to increased anxiety and stress in the patient. According to a study published in PubMed, 29 patients with symptomatic peripheral neuropathy were studied for the effects of CBD oil on their chronic pain. 14 people were randomized into the placebo group. The efficacy of topically used CBD oil for treating pain was studied for four weeks. All the participants had a mean age of 68 years. The Neuropathic Pain Scale (NPS) was administered two times a week to assess the average deviation from baseline to the end of the treatment period. After four weeks, it was found that the patients who were using CBD oil experienced a considerable deduction in sharp and excruciating pain due to the peripheral neuropathy as compared to the placebo group. No adverse events of physical, psychological, or emotional nature were reported in the subjects. CBD oil was provided a promising alternative with minimum side effects when compared to other therapies in the treatment regimen. The efficacy of cannabidiol (CBD) oil in the management of neuropathic pain was thereby proved from this study, and CBD was established as an efficient analgesic for those suffering from chronic pain due to malignancies such as cancer and neuropathies.

The National Center for Complementary and Integrative Health (NCCIH) based in the United States is funding new research into cannabinoids to examine their potential in pain management for chronic malignancies, particularly in disorders such as fibromyalgia and multiple sclerosis. According to this, about three million dollars’ worth of research will be conducted to produce nine papers that comprehensively explore the potential of using CBD oils as an analgesic.  

Anti-inflammatory Properties of CBD

One of the potential ways to stop the progression of fibromyalgia in the patients is to stop inflammation in the patients. CBD averts inflammation due to various ways. One of the factors through which CBD can avoid inflammation is the dysfunction of the cytokines (chemical substances in the body which serve to mediate inflammation through promoting it). Endocannabinoids, particularly non-psychoactive agents such as CBD, affect the cytokine structure and biology of various cell systems. Inflammatory cytokines are the important mediators of inflammation. They help the body get rid of necrotic tissue by cordoning off the area through initiating inflammation. After that, the immune cells such as lymphocytes, macrophages, and neutrophils can invade and clear the area of the tissue debris and stop further necrosis in the tissues. However, certain factors cause the inflammatory cells to attack otherwise healthy tissues. This destroys the normal functioning of the immune system and the immune system starts eating up on the body tissue itself, which gives rise to various conditions called autoimmune disorders, such as multiple sclerosis. Studies have indicated that certain areas of the brain, when affected by uncontrolled inflammation, can give rise to fibromyalgia symptoms in the people. 

The main objective of CBD being used to treat fibromyalgia in patients is the property of CBD to avert inflammation in a variety of ways. Antiproliferative effects of endocannabinoids on cancer cells have been studied well, and their effect on stopping the inflammation is large. As inflammation particularly spreads vastly after a tissue injury due to contusion or other contact causes, so the rate of inflammation surrounding the brain injury can be particularly dangerous, as it causes necrotic cell death in the tissue on a large scale. This cell death proves fatal to certain brain areas that are hit directly by the injury. So, in the case, if there is a direct brain injury due to severe trauma, autoimmune response after invasive surgery or major psychological stress, stopping the inflammation gains prime importance, as it reduces the chance of the damage spread. The microglia, or the macrophages that exist in the brain tissue, have a very important role in inflammation. Moreover, there are cells in the brain tissue called astrocytes. The astrocytes serve to nourish the brain tissue under normal circumstances, providing vital nutrients to the neurons thus playing an important role in tissue growth. However, under the event when the brain tissue becomes necrotic, the astrocytes have been found secreting certain cytokines along with other chemicals such as nitric oxide that mediate inflammation. Interestingly, these astrocytes are found to express both the CB1 and CB2 receptors on their surfaces. The effect of the endocannabinoid neurotransmitters on these receptors has been well explained earlier. Various cannabinoids, such as non-psychoactive CBD, can serve to have an inhibitory effect on the activity of the astrocytes spreading inflammation.

The endocannabinoid system of the central nervous system appears to be playing a promising role in averting the inflammation that happens due to various causes. So, indirectly, it has the potential to protect the tissue of the central nervous system from progressing towards degenerative disorders such as fibromyalgia and multiple sclerosis. In particular, several cannabinoids, above all CBD, appear to be the promising molecules to treat such disorders, thereby giving hope to the patients who previously thought that their disease is incurable. 

Ways of Administration of CBD

There are several possible ways of administering CBD to fibromyalgia patients. The most common one is smoking. The CBD is vaporized inside a vape, which is then inhaled to absorb the drug through the lungs. However, this particular method is not advisable for patients who are already suffering from respiratory disorders such as asthma. The chemical may also be administered through edibles when the edibles are cooked in CBD-infused oil. The CBD oils can be applied topically on the skin or maybe administered in physician-determined doses through the oral route.

Although CBD has a large potential in proving itself a potential treatment drug for fibromyalgia patients, more still needs to be known to investigate the side effects it has when used for a long term. So, it is always advisable to consult a physician before using CBD as a treatment drug for any disease.

REFERENCES

1. Crestani, Francesco. "Medical Cannabis For The Treatment Of Fibromyalgia". JCR: Journal Of Clinical Rheumatology, vol 24, no. 5, 2018, p. 281. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/rhu.0000000000000823.
2. Albrecht, Daniel S. et al. "Brain Glial Activation In Fibromyalgia – A Multi-Site Positron Emission Tomography Investigation". Brain, Behavior, And Immunity, vol 75, 2019, pp. 72-83. Elsevier BV, doi:10.1016/j.bbi.2018.09.018. Accessed 21 Sept 2020.
3. "Fibromyalgia - Symptoms And Causes". Mayo Clinic, 2020, https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780#:~:text=Fibromyalgia%20is%20a%20disorder%20characterized,your%20brain%20processes%20pain%20signals.
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