Fibromyalgia is a chronic, debilitating condition where patients experience widespread pain, fatigue, mood changes, sleep and memory problems, known as “fibro-fog”. Fibromyalgia sufferers experience a high sensitivity to pain and may also suffer from migraines and IBS (irritable bowel syndrome). The exact cause of fibromyalgia is unknown but it is thought to be caused by abnormal signalling in the pain pathways in the brain. Research by Dr Ethan Russo shows that most of this abnormal signalling occurs in the endocannabinoid system and that explains why patients with fibromyalgia respond so well to cannabis-based medicines. Dr Russo also claims that migraines and IBS, which are commonly associated with fibromyalgia, may also be caused by endocannabinoid deficiency and also respond very well to cannabinoid medicines.

In many cases, the condition seems to be triggered off by a stressful life event, such as a viral infection, surgery, physical trauma or severe psychological stress. In other cases, symptoms develop gradually and get worse over time. It is commoner in women and typically develops between ages 30-50 although it can affect persons of any age. Fibromyalgia is now officially recognized as a medical condition and affects approximately 1 in 20 persons. Early diagnosis is important so that patients can be advised on how to manage their condition in the right way. There is still no cure for fibromyalgia but there is a lot that can be done to help persons suffering from this condition to lead a normal life.

The management of fibromyalgia needs to be based on a combination of lifestyle changes, each of which will help the affected person cope better with the symptoms of the condition. Self-management a priority when dealing with such chronic conditions and there is no person that can manage your condition better than yourself:

1) Diet is extremely important. It has been shown that certain foods can worsen the pain in fibromyalgia sufferers. One should try to avoid processed foods, refined sugars, artificial sweeteners, caffeine, fast food, gluten and lactose-containing products. The best diet for chronic pain is based on small frequent meals, consuming fresh, organic green, leafy vegetables, wild fish, free-range chicken, organic fruit and gluten-free cereals and snacks. One should drink plenty of water which can be flavoured with fresh fruit but no artificial sweeteners or sugars.

2) Exercise is the most underused therapy that can help with fibromyalgia. Patients with chronic pain are often stiff and do not move much. This causes their pain to increase, resulting in more stiffness. Gentle, regular exercises can make a big difference for patients with fibromyalgia. Not all patients are capable of enduring a 30-minute walk. However, there are many other options which can help, such as yoga and hydrotherapy, or just swimming in a pool. For patients who haven’t exercised in a long time, a physiotherapist would help to get that person moving slowly and back on track. Although there may be no significant immediate improvement with exercise, patients who exercise regularly find that their pain levels are much more tolerable.

3) Stress has been shown to worsen symptoms of fibromyalgia and by controlling stress levels, one can manage this condition better. Time management is important when living with a chronic condition. One needs to pace activities and find time to rest and relax, both mentally and physically. Mindfulness meditation has been shown to help acceptance of fibromyalgia symptoms and to reduce pain levels. It also helps to reduce stress and anxiety and improve symptoms of depression and insomnia, which are often associated with this condition.

4) Correcting vitamin deficiencies may sometimes make a big difference in some patients. It has been shown that many patients with fibromyalgia have Vitamin D deficiency. It has also been found that up 80% of us may be Magnesium deficient. Omega 3 fatty acids and the Vitamin B’s are important for nerve conduction and pain signalling. Because of the link between the gut and the brain, some functional medicine specialists are now emphasizing the importance of probiotics to optimize gut bacteria and improve overall health in these patients.

5) Unfortunately, most medications for fibromyalgia have significant side effects and many patients prefer not to take any medication rather than having to experience the side effects of medication as well as poorly-controlled pain. The ideal medication for fibromyalgia would be one that can adequately control the pain while producing little or no side effects. Cannabis-based medicines have been shown to be the best alternative in such cases as research shows they are the most effective for pain relief with much less side effects when compared to opiates, anti-epileptics or anti-depressants which are sometimes prescribed for this condition. The right combination and ratio of cannabinoids and terpenes can provide almost complete relief of symptoms in severely affected patients who may also be suffering from concurrent symptoms such as anxiety, insomnia and depression.

The Consultation

A 1-hour slot is allocated for patients presenting for the first time with a fibromyalgia. The patient will be asked about the symptoms experienced and if a diagnosis has already been established. The doctor will ask about medications tried in the past and about any therapy sessions that the patient may have attended. The patient’s history is explored, focusing on possible triggers and aggravating factors. Throughout the meeting, the patient’s symptoms and concerns are addressed, ensuring that everything is understood clearly.

After the interview, the doctor may need to examine the patient to understand better the severity of the pain, the areas most badly affected and whether there are any signs that warrant further investigation. At this point, the doctor would be able to provide the most probable diagnosis and discuss the necessary steps needed to manage the symptoms. Further investigations may be necessary in some cases and the doctor will advise on how to have these carried out at Mater Dei Hospital or in a private hospital.

The doctor would then compile a medical report with a treatment plan for the patient. This often includes some lifestyle changes which can help reduce the pain and optimize the response to treatment. Nutritional supplements are recommended when necessary and various medication options are discussed.  The patient is then called back after 2 weeks for a 15-minute follow-up to discuss any progress and get the first prescription. During this meeting, any supplements and equipment can be purchased if necessary and a follow-up appointment is given for a month’s time. The doctor will give the patient a mobile number and email to contact should they have any problems administering the medicine.