Could fibromyalgia be caused by an endocannabinoid deficiency?

The story below about a possible link between fibromyalgia and a deficiency in the body’s endocannabinoid system first appeared on NationalPainReport.com. It is being republished here with permission from the editor.

Some emerging research indicates fibromyalgia, migraines and irritable bowel syndrome may be tied to a deficiency in the body's endocannabinoid system. This could explain why cannabis benefits so many fibromyalgia sufferers.

Visit nearly any online fibromyalgia support group, and you’ll almost always read a few testimonials from patients who say cannabis is the only thing that’s ever relieved their pain.

In 2014, a survey of more than 1,300 fibromyalgia patients by the National Pain Foundation and National Pain Report found medical marijuana is more effective than Lyrica, Cymbalta or Savella, the three drugs approved by the Food and Drug Administration to treat the disorder. (If you’re curious about the effectiveness of Lyrica, Cymbalta and Savella, then you might be interested in my post, “Why your fibro meds aren’t working.”)

There’s growing anecdotal evidence that marijuana relieves fibromyalgia pain, but actual research is still scant. Cannabis remains a schedule I controlled substance in the United States, making it difficult for researchers to study the plant’s pain-relieving properties. To date, there have been less than a handful of small studies using cannabis or its derivatives to treat fibromyalgia. Most of those have shown it to be beneficial, especially for pain relief.

But why does cannabis seem to work so well? Dr. Ethan Russo, medical director of PHYTECS, believes fibromyalgia’s multifaceted symptoms may be caused by a deficiency in the body’s endocannabinoid system (ECS), a condition he calls Clinical Endocannabinoid Deficiency (CED). Maybe the reason cannabis is so effective is because it’s simply supplementing what the body needs – similar to how people take a supplement to treat vitamin D or B12 deficiency.

Russo explores the evidence behind his hypothesis in a soon-to-be published review entitled, “Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel and other Treatment-Resistant Syndromes.” While his idea is still theoretical, there is some early research indicating he may be onto something.

The ECS is made up of cannabinoid receptors within the brain, spinal cord, nerves, gut, organs and other locations in the body. It helps the body maintain homeostasis and is involved in a number of physiological processes, including pain sensation, mood, memory and appetite, among others. The body naturally makes endocannabinoids – the same kinds of endocannabinoids found in cannabis – that feed the ECS and keep it functioning.

Fibromyalgia causes symptoms throughout the body, with the primary ones being pain, fatigue, cognitive and sleep difficulties. Certain conditions, like irritable bowel syndrome (IBS) and migraine, are extremely common among those with fibromyalgia – so much so that Russo believes they may all be connected to an ECS deficiency.

His theory makes sense. The ECS plays a role in so many of the body’s major systems, so if it was indeed malfunctioning, that would account for why fibro sufferers have such varied symptoms. Supplementing the ECS with cannabinoids from the cannabis plant would, in theory, relieve symptoms because the deficiency is being treated.

Russo first posited that fibromyalgia, IBS and migraine may be caused by an ECS deficiency back in 2001. (Click here to read his first review on the subject.) His latest review gives an update on new research that supports ECS deficiency as a possible culprit for fibromyalgia, IBS and migraine.

“Additional studies have provided a firmer foundation for the theory,” he writes in the review, “while clinical data have also produced evidence for decreased pain, improved sleep and other benefits to cannabinoid treatment and adjunctive lifestyle approaches affecting the endocannabinoid system.”

CED is based on the premise that many brain disorders have been linked to neurotransmitter deficiencies. For example, dopamine has been implicated in Parkinson’s disease, and serotonin and norepinephrine have been associated with depression.

“If endocannabinoid function were decreased, it follows that a lowered pain threshold would be operative, along with derangements of digestion, mood and sleep among the almost universal physiological systems sub-served by the ECS,” Russo writes.

That’s a mouthful, but essentially it means if the ECS isn’t properly working, then it could account for the pain, sleep, digestive and other issues so common among fibromyalgia patients. Adding cannabinoids to the body through the use of cannabis may help to bring the ECS back into balance.

“It’s a key in a lock in your body that exists for a reason,” explains Dr. Jahan Marcu, chief scientist with Americans for Safe Access. “We send in cannabinoids to activate this system that’s supposed to be working. It’s a sort of care and feeding of the ECS so it can do its job.”

The best evidence for CED comes from an Italian migraine study, which found reduced levels of an endocannabinoid known as anandamide in patients with chronic migraines versus healthy controls.

“Reduced [anandamide] levels in the cerebrospinal fluid of chronic migraine patients support the hypothesis of the failure of this endogenous cannabinoid system in chronic migraine,” read the study.

Unfortunately, the Italian study will probably never be repeated in the United States because it required risky and invasive lumbar punctures.

In the gut, the ECS modulates the movement of food along the digestive tract, the release of digestive juices to break down food and inflammation.

Cannabis has long been used to treat digestive issues and was one of the first effective treatments for diarrhea caused by cholera in the 19th century.

“Unfortunately while many patient surveys have touted the benefit of cannabinoid treatment of IBS symptoms, and abundant anecdotal support is evident on the Internet, little actual clinical work has been accomplished,” Russo writes.

A few studies using marijuana for fibromyalgia have had positive results. Overall, marijuana has been found to decrease pain and anxiety, and improve sleep and general well-being.

“There is actually some evidence that the levels of at least one endocannabinoid (anandamide) increase in the circulation of patients with fibromyalgia,” says Prof. Roger G. Pertwee from the University of Aberdeen in Scotland. “There is also considerable evidence that anandamide is often released in a manner that reduces unwanted symptoms such as pain and spasticity in certain disorders. … It is generally accepted that THC, the main psychoactive constituent of cannabis, can relieve pain, including neuropathic pain for example, by directly activating cannabinoid receptors. … Some non-psychoactive constituents of cannabis have also been found to relieve signs of pain, at least in animal models.”

For anecdotal evidence, Russo cites the National Pain Foundation/National Pain Report survey in his review, saying, “The results of the survey strongly favor cannabis over the poorly effective prescription medicines. These results certainly support an urgent need for more definitive randomized controlled trials of a well-formulated and standardized cannabis-based medicine in fibromyalgia inasmuch as existing medicines with regulatory approval seem to fall quite short of the mark.”

More research needs to be done to either prove or disprove CED’s existence.

“What we really need is randomized controlled trials to look at this more carefully, and that’s the only kind of evidence that the [Food and Drug Administration] and most doctors are going to find acceptable in the end,” Russo says.

MRI and PET scans are not yet able to detect endocannabinoid levels in living patients, but as technology advances, that may become a possibility. The ability to actually test endocannabinoid levels in fibromyalgia patients and compare those against healthy controls would help to confirm Russo’s theory.

“We’re on the edge of having that capability,” Russo says. “It’s in my plans to look at this type of thing in the future.”

If you enjoyed this post, then you might also like:

“What you need to know about CBD oil and fibromyalgia”

What you need to know about using CBD oil to treat fibromyalgia pain. Is it legal? Find out here. |FedUpwithFatigue.com

“How to use medical marijuana without getting high”

By using CBD-rich cannabis products, you can reap some of the medicinal benefits of marijuana without the high. | FedUpwithFatigue.com


  1. Mary Emilio says

    I am so fed up right now and so sick. I have chronic pain and fatigue. I have been waiting for medical marijuana to come to WVa . Well I have waited from the day WVa was to pass medical marijuana and this is sept. 2018 and from what I read 2 more years.
    I can’t even use cbd because medical marijuana is suppose to be legal but I am being told I can’t use anything till doctors and dispenseries are set up. 2 more yrs. I am on Fentanyl but want off . I am loosing my hair and the medicine isn’t working like it did because I’ve been on it since 2004. I have so many other things wrong and seem to do nothing but go to doctors.
    I pay someone to clean my house. Ect. I have no life.
    Also WVa is really strict because of people abusing fentanyl severly. That should not affect me but…..
    Well enough

    • Donna Gregory/FedUpwithFatigue.com says

      Hemp CBD oil is still an option for you b/c you can buy that online. Here’s an article on how to choose a good one b/c there are a lot of inferior products being sold these days. https://fedupwithfatigue.com/how-to-choose-hemp-cbd-oil/

    • carlos says
    • jennifer says

      i would not start buying from amazon. one said they tested but when i asked for the actual test results they said that it’s for their eyes only and it would never be released to the public. there’s too many places that rip you off. if you get drug tested there are many CBD only products that will not give a false positive. the place i have been buying from is CBDistillery, but i recently found another that gives a discount for low income, military, and disabled people of 60%. their prices are cheaper than CBDistillery at regular price. it’s lazarusnaturals.com. i’m currently taking 75mg a day and i want to see if it’s as high quality as the former. there’s also a website that shows the best places to buy from and coupon codes to use. https://cbdoilusers.com/cbd-oil-promo-codes/ this is how i found out about lazarus. i can sleep at night when i couldn’t before. i am still dealing with a lot of pain but it’s better. i am planning to increase the amount i take to see how it goes.

    • Amanda P. says

      I am right there with you! I too am unfortunate enough to live in WV. Northern panhandle. And due to the ever increasing overdoses due to illegal substances no doctor in a 50 mile radius will prescribe any pain medication to anyone. My neighbor passed away from his 3rd bout of cancer last summer and they only gave him pain meds in hospice. The bill passed in our state but the corrupt politicians just sit on their hands while everyone else suffers. Its despicable! I have never wished my pain on anyone. But i wouldnt bat an eye of they felt the pain i endure every single moment of every single day. I am sick of this country’s attack on the suffering. And they also take advantage of drug addicts by using them as their scapegoat to look like the high and mighty good samaritans we all know they really aren’t. Its all about power and money and appearances.

  2. I am currently using medical marijuana for fibro, ptsd, chronic fatigue… first of all it is not a cure, at this point
    But, I will say that it with supplements are helping
    With the over all symptoms better than any drugs I was
    On! But it needs to be approved through on the
    Federal level so insurances will pay for prescriptions.
    You work all your life so when you retire you will have
    Good insurance in your old age, then you get sick
    & go through all this crap and all these medications
    & drs…..& finally you find something that helps & you have
    To pay cash out of pocket …. soo sooo frustrating !

  3. Mandy Buffington says

    This is really interesting to me although I only have had this a year almost as if May 2015 my pain levels got high very fast because I ended up in September starting to have neck pain that got diagnosed as a herniated disc so both things interact with each other and I know pcos can too. I just hope there is a way to do this without smoking it as weed smoke bothers my asthma


  1. […] Could fibromyalgia be caused by an endocannabinoid deficiency?  […]

  2. […] (Read more: Could fibromyalgia be caused by an endocannabinoid deficiency?) […]

  3. […] 2.Could fibromyalgia be caused by an endocannabinoid deficiency? (2017, July 6). Retrieved from https://fedupwithfatigue.com/fibromyalgia-endocannabinoid-deficiency/ […]

  4. […] sufferers may have an inhibited, or malfunctioning endocannabinoid system, according to Dr. Ethan Russo. Clinical Endocannabinoid Deficiency, or CED as Russo calls it, would result in, “a lowered pain […]

  5. […] or cannabidiol, has taken center stage in the discourses surrounding the cannabis plant and its derivatives, such as the non-psychoactive hemp-based CBD. […]

  6. […] or cannabidiol, has taken center stage in the discourses surrounding the cannabis plant and its derivatives, such as the non-psychoactive hemp-based CBD. […]

  7. […] (This question is referencing the article Could fibromyalgia be caused by an endocannabinoid deficiency?) […]

  8. […] “Could fibromyalgia be caused by an endocannabinoid deficiency?” […]

  9. […] Could fibromyalgia be caused by an endocannabinoid deficiency? […]

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