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Potential for Cannabinoids in the Treatment of Fibromyalgia

Potential for Cannabinoids in the Treatment of Fibromyalgia

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An essay for the 2011 Undergraduate Awards Competition by Michael Kucharczyk. Originally submitted for GM2004 - Clinical Medicine I at University College Cork, with lecturer See message below in the category of Medical Sciences
An essay for the 2011 Undergraduate Awards Competition by Michael Kucharczyk. Originally submitted for GM2004 - Clinical Medicine I at University College Cork, with lecturer See message below in the category of Medical Sciences

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Published by: Undergraduate Awards on Aug 29, 2012
Copyright:Attribution Non-commercial

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07/01/2014

 
 
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My general practice placement experience exposed me to many  patients with chronic pain, specifically those with fibromyalgia. Most of these patients were unhappy with the level and quality of medical carethey were receiving, and as a consequence many had a negative view of the health care profession. Motivated by these experiences, I researched various alternate therapeutic options. Nabilone, a syntheticcannabinoid, came to my attention as a novel treatment for  fibromyalgia. This essay discusses the existing treatment guidelines for  fibromyalgia as well as the potential role for cannabinoids in thetreatment of this syndrome. I believe that there is a very promising role for nabilone, and possibly cannabinoids developed in the future, for thetreatment of fibromyalgia syndrome.
 1 |Page 
 
Potential for Cannabinoid use in the Treatment of Fibromyalgia2 |Page 
Introduction
Fibromyalgia Syndrome (FMS) is a widespread chronic pain syndrome, with prevalence inEurope scaling from previous estimates of 2% to current evaluations of 4.7%. Women specifically aremore susceptible, with reports stating they are four to seven times more likely to have the syndrome.(Wolfe & Cathey, 1983; Wolfe & Cathey, 1985; Wolfe, Ross, Anderson, Russell, & Herbert, 1995; Branco,et al., 2009) FMS patients typically present with signs of both hyperalgesia and allodynia
 –
featuresfamiliar to that of a chronic neuropathic pain patient. (Staud & Rodriguez, 2006) A diagnosis of FMSshould only be established in the absence of a more likely pathology and if the patient describes ahistory of diffuse pain and tenderness. The tenderness is assessed with 4kg of applied pressure at 11 of 18 potential specific tender sites. However, there is no confirmatory test. (Wolfe, et al., 1990) As to theetiology of FMS, there is are prevalent theories that widespread CNS sensitization is being mediated byautonomic dysregulation (Sarzi-Puttini, Atzeni, Diana, Doria, & Furlan, 2006; Nilsen, et al., 2007;Martinez-Lavin & Hermosillo, 2000) as well as dopaminergic (Wood, et al., 2007); glutametergic(Sarchielli, Di Filippo, Nardi, & Calabresi, 2007); and serotonergic (Seidel, Weinreich, Stratz, & Muller,2007) synapses. At this point in time though, a definitive etiology of FMS is nonexistent. (Abeles,Pillinger, Solitar, & Abeles, 2007)
 
Endocannabinoids (eCBs) are endogenously produced agonists of the cannabinoid receptors(CBRs)
 –
CB
1
R and CB
2
R. CB
1
Rs are primarily found in the brain; notably the basal ganglia, limbic system,and the cerebellum; in addition to the reproductive systems of both genders. These receptors arepostulated to be responsible for the cannabis related euphoria. (Pertwee, 2000) The CB
2
Rs
 
are found inimmunocompetent cells, especially in the spleen, and are thus supposedly involved with the anti-inflammatory effects of cannabinoids. (Pugh, Mason, Combs, & Welch, 1997) Nabilone, a synthetic
 
Potential for Cannabinoid use in the Treatment of Fibromyalgia3 |Page cannabinoid marketed as Cesamet, has been licensed since 1985 as an anti-emetic effective at treatingnausea related to platinum based chemotherapy.
It is more active than Δ
-9-tetrahydrocannabinol(THC), also known as Dronabinol, as an agonist for both CB
1
R and CB
2
R. (Pertwee, 2000) Nabilone orother cannabinoids may be helpful in the treatment of FMS
by modulating the patient’s source of pain,
perception of pain, and disturbed sleep patterns.
Current Treatment of Fibromyalgia
To be put bluntly, there is no gold standardfor FMS treatment. Instead there are a variety of approaches taken by different physicians andsuggestions issued by different authorities. The FDAhas actually only licensed a single agent for thespecifically for FMS treatment
 –
pregabalin. (FDA,2007) The remaining treatment options come fromsuggestions in the literature
or a physician’s
independent investigations. The European LeagueAgainst Rheumatism (EULAR) guidelines were basedon a meta-analysis of studies that used the VisualAnalog Scale (VAS) and/or the Fibromyalgia ImpactQuestionnaire (FIQ). (Carville, et al., 2008). From thisassessment they produced ten recommendations for the management of FMS
 –
see the Table 1, left,extracted from the EULAR guidelines.
Table 1: EULAR recommendations for the Treatment of Fibromyalgia

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