Association of herbal cannabis use with negative psychosocial parameters in patients with fibromyalgia

Abstract

Objective. Patients with chronic pain, including fibromyalgia (FM), may seek treatments outside of mainstream medicine. Medicinal cannabinoids are popularly advocated for pain relief but with limited evidence for efficacy in FM. The extent of use of cannabinoids in FM is unknown. Methods. We have documented the self-reported prevalence of cannabinoid use in 457 patients with the diagnosis of FM and referred to a tertiary care pain center. We validated the diagnosis of FM and examined the associations of cannabinoid use in these patients. Results. Cannabinoids were being used by 13% of all patients, of whom 80% used herbal cannabis (marijuana), 24% used prescription cannabinoids, and 3% used both herbal cannabis and prescription cannabinoids. One-third of all men used cannabinoids. Current unstable mental illness (36% versus 23%; P ‫؍‬ 0.002), opioid drug-seeking behavior (17% versus 4%; P ‫؍‬ 0.002), and male sex (26% versus 7%; P ‫؍‬ 0.0002) were all associated with herbal cannabis use. There was a trend for cannabinoid users to be unemployed and receiving disability payments. The diagnosis of FM was validated in 302 patients, with 155 assigned another primary diagnosis. When the FM group was analyzed separately, significant associations were lost, but trends remained. Conclusion. Cannabinoids were used by 13% of patients referred with a diagnosis of FM. The association of herbal cannabis use with negative psychosocial parameters raises questions regarding the motive for this self-medication practice. Although cannabinoids may offer some therapeutic effect, caution regarding any recommendation should be exercised pending clarification of general health and psychosocial problems, especially for those self-medicating.

Predictors of Suicidal Ideation in Chronic Pain Patients

“…A recent study conducted by Ste-Marie et al 49 with fibromyalgia patients showed no significant differences in SI or SA between users and nonusers of prescribed and nonprescribed cannabis. It is worth noting that patients were not only asked about their intake of drugs and/or alcohol in general (eg, frequency) but also if they used specifically 1 or both of these substances as a way of alleviating their pain.…”

Suicidality in Fibromyalgia: A Systematic Review of the Literature

“…Santis and colleagues ( 81 ) similarly found that, even within cocaine users, there exists a spectrum of cocaine abuse in which some are more likely than others to self-harm and attempt suicide, namely individuals who use cocaine base paste as compared to cocaine hydrochloride. Finally, due to the cross-sectional nature of studies presented here, it is highly possible that SB, and the emotional pain associated with it, in fact lead to increased drug dependence, as form of self-medication ( 77 ). Nonetheless, cocaine and other drug abuse may be extremely dangerous among FM patients, given its high mortality rate regardless of an FM diagnosis ( 82 ).…”

Patterns of Shared Genetic Risk Between Chronic Pain, Psychopathologies, and Neuroticism

“…All three disorders, as defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013), have a higher prevalence in chronic-pain patients. Cannabis use disorder is more common among people with chronic pain and comorbid depression (Edlund et al, 2013), anxiety (Degenhardt et al, 2015), or other mental-health problems (Ste-Marie et al, 2012). Chronic pain has a bidirectional relationship with both cigarette smoking (Ditre et al, 2011; Sanders et al, 2012; Schürks & Diener, 2008; Shiri et al, 2010) and alcohol use disorder (Cheng et al, 2000; Chopra & Tiwari, 2012; Demyttenaere et al, 2007; Ekholm et al, 2009; Lerch et al, 2003; Macfarlane & Beasley, 2015).…”