Best Strains for Fibromyalgia

As you likely know, fibromyalgia is a complex chronic condition that encompassess numerous symptoms, most notably widespread pain that often co-exists with other symptoms including:

• Fatigue

• Sleep disturbances and insomnia

• Joint pain and tenderness

• Anxiety (and sometimes depression)

Given the heterogeneity of the disorder, treatment needs to be highly personalized. What works for some, may not work for you. Consequently, for most patients who find successful outcomes with cannabis, it generally takes a bit of trial-and-error until finding the ideal strain (and preferred intake method or methods).

To find the strain that’s best for you, identify what symptoms you’d like to address first. For example, pain or insomnia. And, work back from there. Likewise, consider when you’ll be medicating. What you use for daytime will likely be different than nighttime.

Moreover, given the variable consistency among strains and patient accessibility to medicine, rather than recommend specific strains, we suggest finding strains or products based on their chemical composition profile.

Daytime:

For daytime relief, most patients desire minimal psychoactivity (i.e. the euphoric effects of cannabis), so they will use strains or products that are high in CBD, with little to no THC.

Nighttime:

For nighttime relief, patients report positive results with both high CBD and high THC strains. Likewise, strains that are rich in the terpene Myrcene (between .5% and 3%) -- which is thought to have sedative properties and work synergistically with THC -- seem to work best.   

Some patients report they find it beneficial to combine an oral form (edibles, tinctures, etc.) with a small amount of cannabis consumed with a vaporizer. Vaporization provides rapid relief (and is easy to self-titrate), while orally consumed medication lasts longer through the night (which is ideal if you easily wake during the night).   

Finding the Right Strain May Require Some Trial-and-Error

Teri Robnett, a fibromyalgia patient who uses cannabis to treat her fibromyalgia reports cannabis took a bit of trial-and-error, but once she got the hang of it, she found it helped much better than pharmaceuticals. “From season to season, even day to day, the severity of symptoms can change because of the weather, stress, or hormones,” Robnett said. “Cannabis allows me to self-titrate. By being able to vary how I consume and types of strains, I can more effectively treat the symptoms.”

Robnett medicates with an edible and vaporizer at night. Because edibles take longer to kick in, she starts by vaporizing with a THC-dominant strain that’s also rich in myrcene. Vaporizing allows the active ingredients to quickly enter the bloodstream and provide immediate relief. Edibles, on the other hand, provide relief that lasts through the night. “The edible takes much longer to affect me than vaporizing, but lasts much longer, and I can sleep through the night,” she said. “Getting a good night’s sleep helps keep my symptoms under control the next day.”

Again, it’s important to consider that every patient is unique, so finding the ideal strain may take a little time. Beyond experimenting with different strains, also consider different forms of administration such as such as topicals, edibles, capsules, or tinctures.

Further Resources

Articles:

• Can Cannabis Treat Fibromyalgia Better Than Prescription Drugs? By Jeremy Kossen on Leafly

Studies:

Research on cannabis and cannabinoids to treat fibromyalgia is limited, but the studies that exist seem to validate patient experience:

National Pain Foundation

(Source: National Pain Report)

The National Pain Foundation conducted a survey in 2014 of over 1,300 patients. Nearly a third (30 percent of respondents) reported having tried medical cannabis.

Of the more than 390 survey participants who had used cannabis, far more patients reported favorable outcomes with cannabis compared to FDA-approved pharmaceuticals:

• 62% reported cannabis as “very effective” in treating their symptoms

• 33% reported that cannabis “helped a little”

• Only 5% said it did not help at all

The Effects of Nabilone (THC) on Sleep in Fibromyalgia: Results of a Randomized Controlled Trial

(Source: PubMed)

METHODS:

Randomized, controlled, double-blind, crossover trial comparing 0.5-1.0 mg nabilone (isolated THC) before bedtime to 10-20 mg amitriptyline (before bedtime) in patients with FM accompanied by chronic insomnia.

Subjects received each drug for 2 wk with a 2-wk washout period. The primary outcome was sleep quality, measured by the Insomnia Severity Index and the Leeds Sleep Evaluation Questionnaire. Secondary outcomes included pain, mood, quality of life, and adverse events (AEs)

RESULTS:

• Thirty-one subjects participated and 29 completed the trial (26 women, average age 49.5 years old). Both amitriptyline and nabilone improved sleep, however, nabilone was superior to amitriptyline

• Nabilone was marginally better in alleviating restfulness, but not on wakefulness.

• The study did not evaluate effects on pain, mood, or quality of life.

ADVERSE EFFECTS:

• Some mild to moderate side effects were reported, including dizziness, nausea, and dry mouth.

CONCLUSIONS:

• The study suggests Nabilone is well-tolerated, while improving sleep. Low-dose nabilone may be an effective alternative to amitriptyline  (administered once daily at bedtime).

• The researchers suggest more study (including longer trials) to assess longevity of effects and long-term safety.