Are cannabinoids a new treatment option for pain in patients with fibromyalgia?

College of Medicine and Center for Musculoskeletal Pain Research, University of Florida, Gainesville, FL 32610-0221, USA.
Nature Clinical Practice Rheumatology (Impact Factor: 5.85). 07/2008; 4(7):348-9. DOI: 10.1038/ncprheum0826
Source: PubMed


Preliminary studies suggest that the synthetic cannabinoid nabilone might be an effective therapy in patients with fibromyalgia. Skrabek et al. performed a double-blind, randomized, placebo-controlled clinical trial to analyze the effects of nabilone on pain and quality of life in patients with fibromyalgia. After 4 weeks of treatment (0.5 mg once daily in week 1, 0.5 mg twice daily in week 2, 0.5 mg in the morning and 1 mg in the evening in week 3, and 1 mg twice daily in week 4), patients who received nabilone (n = 15) experienced significant improvements in clinical pain, measured on a visual analog scale (P <0.02), Fibromyalgia Impact Questionnaire score (P <0.02) and the 10-point anxiety scale of the Fibromyalgia Impact Questionnaire (P <0.02). After a 4-week wash-out period at the end of the trial, all benefits were lost in the nabilone cohort, which returned to their baseline levels of pain and quality of life. Patients who received placebo (n = 18) experienced no change throughout the study. Although nabilone was not associated with serious adverse effects, some patients did experience drowsiness, dry mouth, vertigo and ataxia as a result of treatment.

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    ABSTRACT: Chronic widespread pain (CWP) is a complex condition characterized by central hyperexcitability and altered descending control of nociception. However, nociceptive input from deep tissues is suggested to be an important drive. N-Acylethanolamines (NAEs) are endogenous lipid mediators involved in regulation of inflammation and pain. Previously we have reported elevated levels of the two NAEs, the peroxisome proliferator-activated receptor type-α ligand N-palmitoylethanolamine (PEA) and N-stearoylethanolamine (SEA) in chronic neck-/shoulder pain (CNSP). In the present study, the levels of PEA and SEA in women with CWP (n=18), CNSP (n=34) and healthy controls (CON; n=24) were investigated. All subjects went through clinical examination, pressure pain threshold measurements and induction of experimental pain in the tibialis anterior muscle. Microdialysis dialysate of the trapezius was collected before and after subjects performed a repetetive low-force exercise and analysed by mass spectrometry. The levels of PEA and SEA in CNSP were significantly higher at post-exercise compared to CWP and at both pre- and post-exercise compared to CON. Levels of both NAEs decreased significantly pre- to post- exercise in CWP. Intercorrelations existed between aspects of pain intensity and sensitivity and the level of the two NAEs in CWP and CNSP. This is the first study demonstrating that CNSP and CWP differ in levels of NAEs in response to a low-force exercise which induces pain. Increases in pain intensity as a consequence of low-force exercise was associated with low levels PEA and SEA in CNSP and CWP. These results indicate that PEA and SEA have antinociceptive roles in humans.
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    ABSTRACT: Fibromyalgia is a syndrome characterized by the presence of chronic widespread pain, representing sensitization of the central nervous system. The pthophysiology of fibromyalgia is a complex and remains in evolution, encompassing diverse issues such as disturbed patterns of sleep, alter processing and decreased conditioned pain modulation at the spinal level, as well as increased connectivity between various pain - processing areas of the brain. This evolution is continuously uncovering potential novel therapeutic targets. Treatment of fibromyalgia is a multi - faceted endeavor, inevitably combining pharmacological as well as non - pharmacological approaches. 2δ ligands and selective nor-epinephrine - serotonin reuptake inhibitors are the current mainstays of pharmacological treatment. Novel re-uptake inhibitors targeting both nor -epinephrine and dopamine are potential additions to this armamentarium as are substance P antagonists, Opiod antagonism is another intriguing possibility. Canabinoid agonists hold promise in the treatment of fibromyalgia although current evidence is incomplete. Sodium Oxybate is a unique sleep - promoting medication while drugs those promot arousals such as modafilnil are also under investigation. In the current review, current and emerging therapeutic options for the syndrome of fibromyalgia are covered.
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    ABSTRACT: Objectives: The aim of this review is to provide practicing clinicians with detailed information on the quality of life (QoL) of patients with fibromyalgia, and the medical and non-medical management effects on quality of life in fibromyalgia. Methods: A systematic English language search of the medical literature from January 1980 to January 2013 using PubMed was conducted using the search terms “fibromyalgia” AND “quality of life.” The literature search revealed 1,086 publications; 259 were clinical trials on human patients, 230 were reviews and 20 were case reports. Three authors reached a consensus on selecting the studies based on specific inclusion and exclusion criteria. A total of 95 research studies were included in this review. Results: Overall quality of life is severely impaired in patients with fibromyalgia. Comorbidities have a further negative impact on QoL. Substantial pain reductions resulting in improvement of QoL were observed with medications and non-medication interventions such as exercise, acupuncture, cognitive behavioral therapy, neurofeedback and multidisciplinary approach. Conclusion: Fibromyalgia and its comorbidities including pain have a considerable negative impact on the quality of life of fibromyalgia patients. Substantial or moderate pain reduction seems to improve quality of life. A multidisciplinary approach appears to be most beneficial in management of this multifaceted illness, but more studies are needed to develop specific interventions necessary to alleviate pain and sufferings in these patients.
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