Use of medicinal cannabis in the treatment of pain in fibromyalgia
case report
Keywords:
Medicinal cannabis, canabidiol, fibromyalgia, chronic painAbstract
Pain affects millions of people worldwide, impacting the quality of life, both physically and in psychological, emotional, and spiritual factors. Fibromyalgia is a chronic syndrome that is manifested by extreme sensitivity in the so-called "tender points" and still without much option for pharmacological treatment. Thus, the use of cannabidiol has become an option for the treatment of chronic pain. The objective of this paper is to report the case of a female patient with chronic musculoskeletal pain, who was treated with several pain medications and antidepressants. After applying the Generalized Pain Index (GDI) and the Symptom Severity Scale (SSS), the patient started treatment with cannabidiol. Information from the patient's form was used to construct the study. The results of the treatment with cannabidiol showed a positive effect both on pain intensity and other symptoms of fibromyalgia, since these compounds act similarly to endogenous endocannabinoids, in the central and peripheral nervous system, acting on CB1 and CB2 receptors. Therefore, the use of cannabis in pain treatment has been a promising option for this disease, besides reducing other symptoms associated with fibromyalgia.
References
De Santana, J. M.; Perissinotti, D. M. N.; Oliveira Junior, J. O. De, Correia, L. M.f.; Oliveira, C. M. De, Fonseca, P. R. B. da. Revised definition of pain after four decades. BrJP [Internet], 3, 3:197–8, 2020.
Niv, D. & Kreitler, S. Pain And Quality Of Life. Pain Practice, 1, 2, 150–161, 2001.
Kanematsu, J. Dos S.; Atanazio, B.; Cunha, B. F.; Caetano, L. P.; Arada, D. M. Y. Impacto da dor na qualidade de vida do paciente com dor crônica. Rev Med (São Paulo), 101, 3:e-192586, 2022.
Aguiar, D. P.; Souza, C. P. De Q.; Barbosa, W. J. M.; Santos- -Júnior, F. U.; Oliveira, A. S.de. Prevalência de dor crônica no Brasil: revisão sistemática. BrJP. São Paulo, 4, 3:257- 67, 2021
Coluzzi, F.; Fornasari, D.; Pergolizzi, J.; Romualdi, P. From Acute To Chronic Pain: Tapentadol In The Progressive Stages Of This Disease Entity. European Review for medical and Pharmacological Sciences, 21, 1672-1683, 2017.
Rahman, S.; Archana, A.; Dutta, D.; Kumar, V.; Kim, J.; Jan, A. T.; Minakshi, R. The onus of cannabinoids in interrupting the molecular odyssey of breast cancer: A critical perspective on UPRER and beyond. Saudi Pharmaceutical Journal, 27, 437–445, 2019.
Silva, R. G.; Remtula, S. P.; Gonçalves, T. C. Canabinoides na dor crónica: uma revisão baseada na evidência. Rev Port Med Geral Fam, 37:133-44, 2021.
Zeraatkar, D.; Cooper, M. A.; Agarwal, A.; Vernooij, R. W. M.; Leung, G.; Loniewski, K.; Dookie, J. E.; Ahmed, M. M.; Hong, B. Y.; Hong, C.; Hong, P.; Couban, R.; Agoritsas, T.; Busse, J. W. Long-term and serious harms of medical cannabis and cannabinoids for chronic pain: a systematic review of non-randomised studies. BMJ Open,12:e054282, 2022.
Johal, H.; Devji, T.; Chang, Y.; Simone, J.; Vannabouathong, C.; Bhandari, M. Cannabinoids In Chronic Non- -Cancer Pain: A Systematic Review and Meta-Analysis. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders, 13: 1–13, 2020.
Khurshid, H.; Qureshi, I. A.; Jahan, N.; Went, T. R.; Sultan, W.; Sapkota, A.; Alfonso, M. A Systematic Review Of Fibromyalgia And Recent Advancements in Treatment: Is Medicinal Cannabis a New Hope? Cureus, 13, 8: e17332, 2021.
Sarzi-Puttini, P.; Giorgi, V.; Marotto, D.; Atzeni, F. Fibromyalgia: An Update On Clinical Characteristics, Aetiopathogenesis And Treatment. Nat Rev Rheumatol, 16, 645–660, 2020.
Sagy, I.; Schleider, L. B.; Abu-Shakra, M.; Novack, V. Safety And Efficacy Of Medical Cannabis in Fibromyalgia. J. Clin. Med, 8, 807, 2019.
Couto, N.; Monteiro, D.; Cid, L.; Bento, T. Effect Of Different Types Of Exercise In Adult Subjects With Fibromyalgia: A Systematic Review And Meta-Analysis Of Randomized Clinical Trials. Scientific Reports, 12:10391, 2022.
Goldenberg, D. L., Burckhardt, C., & Crofford, L. Management Of Fibromyalgia Syndrome. JAMA, 292, 19, 2388–2395, 2004.
Pantoja-Ruiz, C.; Restrepo-Jimenez, P.; Castañeda-Cardona, C.; Ferreirós, A.; Rosselli, D. Cannabis And Pain: A Scoping Review. Brazilian Journal of Anesthesiology, 72, 1, 142-151, 2022.
Hryhorowicz, S.; Kaczmarek-Rys, M.; Zielinska, A.; Scott, R. J.; Stomski, R.; Plawaski, A. Endocannabinoid System As A Promising Therapeutic Target In Inflammatory Bowel Disease - A systematic review. Front. Immunol., 12, 790803, 2021.
Plancarte-Sánchez, R.; Mansilla-Olivares, A.; Reyes-Pacheco, V. A. De Los, Meneses-González, F. Therapeutic Applications Based On Cannabinoids Action. Gac Med Mex., 155:283-294, 2019.
chang, Y.; Zhu, M.; Vannabouathong, C.; Mundi, R.; Chou, R. S.; Bhandari, M. Medical Cannabis for Chronic Noncancer Pain: A Systematic Review of Health Care Recommendations. Pain Research and Management, Article ID 8857948, 9 pages, 2021.
Anaya, H. J. M.; Ortiz, M.p. T.; Valencia, D. H. F.; Ribero, O. F. G. Efficacy of cannabinoids in fibromyalgia: a literature review. Colombian Journal anesthesiology, 49:e980, 2021.
Zou, S & Kumar, U. Cannabinoid Receptors and the Endocannabinoid System: Signaling and Function in the Central Nervous System. Int. J. Mol. Sci., 19, 833, 2018.
Habib, G. & Avisar, I. The consumption of cannabis by fibromyalgia patients in Israel. Pain Res Treat, 2018:7829427, 2018.
Weber, J.; Schley, M.; Casutt, M.; Gerber, H. Schuepfer, G.; Rukwied, R.; Schleinzer, W.; Ueberall,M.; Konrad, C. Tetrahydro- cannabinol (Delta 9-THC) Treatment in chronic central neuropathic pain and fibromyalgia patients: Results of a multicenter survey. Anesthesiol Res Pract., 827290, 2009.
Guillouard, M.; Authier, N.; Pereira, B.; Soubrier, M.; Mathieu, S. Cannabis use assessment and its impact on pain in rheumatologic diseases: a systematic review and meta-analysis. Rheumatology, 00:1–8, 2020.
Mlost, J.; Bryk, M.; Starowicz, K. Cannabidiol for Pain Treatment: Focus on Pharmacology and Mechanism of Action. International Journal of Molecular Sciences, n. 21, 23 novembro 2020. 8870.
Anand U.; Pacchetti B.; Anand P; Sodergren M. H. Cannabis-Based Medicines And Pain: A Review Of Potential Synergistic And Entourage Effects. Pain Management, n. 4, abril 2021. 395-403.
Gregorio, D. D.; Mclaughlin R. J.; Posa, L.; Ochoa-Sanchez, R.; Enns, J.; Lopez-Canul, M.; Aboud, M.; Maione, S.; Comai, S.; Gobbi, G. Cannabidiol Modulates Serotonergic Transmission and Prevents Allodynia and Anxiety-Like Behavior in a Model of Neuropathic Pain. PAIN: The Journal Internacional Association for the Study of Pain, 160, Janeiro 2019. 136-150.
Cardoso, G. K. S.; Lopes, W. L.; Hallak, J. E.; Crippa, J. A.; Zuardi, A. W.; Cairasco, N. G.; Panissi, C. R. A. L. Cannabidiol effectively reverses mechanical and thermal allodynia, hyperalgesia, and anxious behaviors in a neuropathic pain model: Possible role of CB1 and TRPV1 receptors. Neuropharmacology, São Paulo, 197, 9 Julho 2021. 108712.
Khurshid, H.; Qureshi, I. A.; Jahan, N.; Went, T. R.; Sultan, W.; Sapkota, A.; Alfonso, M. A Systematic Review of Fibromyalgia and Recent Advancements in Treatment: Is Medicinal Cannabis a New Hope? Cureus, 13, 21 Agosto 2021. e17332.
Skrabek, R. Q.; Galimova, L.; Ethans, K.; Perry, D. Nabilone For The Treatment of Pain in Fibromyalgia. The Journal of Pain, 9, n. 2, Fevereiro 2008. 164-173.
Ware, M. A., Fitzcharles, M. A.; Joseph, L.; Shir, Y. The Effects Of Nabilone on Sleep in Fibromyalgia: Results of a Randomized Controlled Trial. Pain Medicine, 110, Fevereiro 2010. 604-610.
Donk, T. V. D., Niestersa, M.; Kowal, M. A.; Olofsen, E.; Dahan, A.; Velzen, M. V. An Experimental Randomized Study On The Analgesic Effects Of Pharmaceutical-Grade Cannabis In Chronic Pain Patients With Fibromyalgia. PAIN: The Journal International Association for the Study of Pain, 4, n. 160, Abril 2019. 860-869.