Fibromyalgia

Benefits of Cannabis:
Medical cannabis has been shown to be very effective in the treatment of fibromyalgia.

Risks of Cannabis:
High dose THC use can make coexisting anxiety and depression symptoms worse.

Flower mixing is preferred for the inhalation route of administration as it allows composing the balance of cannabinoids and terpenes in ratios likely to be effective. CBD flower can be combined with THC flower to obtain a 1:1 ratio of CBD:THC. This can be used on an as-needed basis to control symptoms. CBG flower may be added as it will be beneficial. Myrcene and β-caryophyllene terpenes are beneficial. Use as needed.

Inhaled cannabis can be used, especially for intermittent symptoms to achieve an immediate response. The chronic symptoms will be better addressed using tinctures. CBD and THC should be used, the addition of CBG may help to decrease inflammation/pain symptoms. A 1:1 CBD:THC ratio is often most effective.

• CBD Tincture: Start at 16 mg dose of a whole plant extract, use every 12 hours. The CBD will help with inflammation, depression, anxiety, and pain symptoms.
• THC Tincture: Use an “indica” THC tincture to fully leverage the entourage effect. Start at a 5 mg THC dose administered with CBD/CBG tinctures. The THC will help relieve some pain symptoms, improve fatigue, muscle tension, and help to decrease inflammation.
• CBG Tincture: CBG will decrease inflammation and may help with some fibromyalgia symptoms. Start at 8 mg CBG tincture administered with the CBD tincture.

After 7 days of therapy, adjustment of dose may be considered. Tincture doses are modified based on response. The THC tincture should be titrated up first to about a 15 mg dose as tolerated. Subsequent increases will also include CBD, and CBG if using.

• Adjustment of dose should be considered based on the patient's response every week or two. If side effects are experienced, the last dose administered which was well tolerated should be used.