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Frances’ journey with fibromyalgia: Medical cannabis for chronic pain associated with fibromylagia
Published: September 2025
Disclaimer: This is an anonymised patient case study, written with patient consent. The decision-making in this case study was undertaken by a doctor. The information in this document does not constitute medical advice or treatment recommendations. The use of cannabis based medications is the responsibility of a qualified medical professional who may initiate treatment after reviewing a patient's medical history. Most medical cannabis products are unapproved medicines and are regulated by the Therapeutic Goods Administration (TGA) Special Access Scheme (SAS), for which individual responses may vary.
Meet Frances
Frances* (pseudonym) is a 32-year-old woman living with fibromyalgia – one of an estimated 3–5% of Australians affected by this chronic condition, which is characterised by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties.1,2
Frances is seeking treatment for persistent pain, poor sleep and daily fatigue related to fibromyalgia. Despite trialling a range of conventional medications, she has experienced only limited relief. Her ongoing pain and exhaustion significantly affects her ability to work, exercise, and maintain daily life.
Fibromyalgia presents with a variety of symptoms, including widespread pain, sleep disturbance, fatigue, headaches, mood disorders and irritable bowel syndrome (IBS) and is more common in women than in men.1,2,3 These symptoms often overlap with other conditions such as anxiety, depression, and chronic fatigue syndrome.1,3
Many people living with fibromyalgia describe conventional medical treatments as only partly effective, with burdensome side effects.2,3 Current management usually combines lifestyle and self-management strategies with medications such as antidepressants (e.g. duloxetine), anticonvulsants (e.g. pregabalin) and analgesics.2,3 However, many patients, like Frances, continue to struggle with persistent pain and impaired quality of life despite best-practice care.
Frances’s consultation with her doctor
Ongoing pain and fatigue, alongside variable responses to standard pharmacological treatments, led Frances and her healthcare team to consider other strategies.
Use of medical cannabis is increasingly reported by patients with chronic pain conditions, with some users citing improved pain intensity, sleep, and overall wellbeing.4 These trends highlight the potential role of cannabis-based therapies as adjuncts in managing chronic pain conditions such as fibromyalgia.4
This case study explores how Frances’s medical team carefully assessed her presentation, medical history, risk factors, and possible drug interactions before initiating medical cannabis as part of her management plan.
Frances’s doctor collected the following information:
Patient information and presentationPresenting condition: Fibromyalgia
Age: 32 years
Symptoms
- Widespread musculoskeletal pain – particularly dull back ache
- Baseline back ache flares to sharp pain during physical exertion
- Insomnia with frequent night waking leading to daytime fatigue
- Anxiety – rapid heartbeat, clammy hands
Pain assessmentPosition: Diffuse – neck, shoulders, hips but mainly lower back
Type: Chronic with flare-ups after exertion or stress
Severity
- Good days: 4–5/10
- Bad days: 7–8/10
Triggers: Exertion, stress, lack of sleep, cold weather
Personal and family medical historyMedical history
- Fibromyalgia – diagnosed 2 years ago
- Generalised anxiety disorder
Family history
- Grandfather – myocardial infarction
Allergies: None known
Current and past medications and treatmentsCurrent medications
- Amitriptyline – for nerve pain
- Tramadol
- Multivitamin
Past treatments
- Sertraline for anxiety (ceased 3 years ago)
- Morphine and fentanyl during recent hospital admission
- Buprenorphine patches (ceased 1 year ago)
Non-pharmacological treatments- Stretches and regular exercises using cross trainer at home
- Sleeps supported with full body pillows
- Meditation and breathing exercises
Specialist and other healthcare involvement- Rheumatologist
- Ongoing GP management – last seen 6 weeks ago
- Psychologist
Lifestyle factorsSmoking: Never
Alcohol: Nil
Driving: THC liability verbalised
Workplace drug testing: N/A
Exercise: Stretches and regular exercises using cross trainer at home
Support network: Lives with partner and child, parents are supportive
Previous use of cannabis- Black market cannabis flower intermittently since age 15 years – ceased 1 year prior, nil side effects noted
- Preferred treatment form: oils
Frances' risk assessment & treatment plan
Risk assessmentAnxiety
- Given Frances’ history of generalised anxiety disorder, her doctor noted the importance of monitoring mood closely.
- While CBD may reduce anxiety, THC can in some cases exacerbate it.5
- Regular reviews to monitor mood and anxiety symptoms
- A “start low, go slow” dosing approach6
Driving
- Inform Frances of the Therapeutic Goods Administration (TGA) guidance that patients must not drive while being treated with medical cannabis that contains THC, noting that measurable concentrations of THC can remain detectable in saliva for many hours after administration.7
Drug interactions
- CBD may inhibit CYP2C19, CYP2D6 and CYP3A4, which metabolise tramadol and amitriptyline.8
- Careful titration and monitoring for side effects such as drowsiness were advised
Treatment planAfter reviewing Frances’s presentation and history, her doctor developed a personalised treatment plan for fibromyalgia symptom relief.
Treatment goals
- Reduce baseline pain (particularly back pain)
- Manage pain flares
- Reduce anxiety
- Reduce insomnia
Initial products prescribed
- Full spectrum balanced oil (THC 10 mg/mL, CBD 10 mg/mL)
- Start 0.1 mL twice daily
- Increase by 0.1 mL every to two days until symptom control is reached
- Maximum daily dose 3.0 mL
- Full spectrum indica-dominant oil (THC 20 mg/mL, CBD 1 mg/mL)
- Start 0.1 mL nocte
- After two days increase by 0.1 mL
- Increase by 0.2 mL every 2 days until symptom control is reached
- Maximum daily dose 1 mL
Risk management plan
- Symptom diary – to record pain scores, doses, sleep quality, and side effects
- Pre-treatment Depression Anxiety Stress Scales (DASS) assessment – repeated at follow-ups
- Close monitoring for sedation, dizziness, or gastrointestinal upset
Follow-up plan
- 4- and 8-week reviews, with monitoring of pain, sleep, mood, and functional status
Treatment outcomes
At 8 weeks:
- Frances was using 0.3 mL balanced oil in the mornings (already the maximum dose) and reported limited benefit, indicating that this formula was not strong enough to address her symptoms
- The full spectrum indica-dominant oil has assisted with sleep - Frances is currently using 0.2 mL at night
Actions
- Replace the 10:10 balanced oil with a 25:25 balanced oil (THC 25 mg/mL, CBD 25 mg/mL)
- Continue with the indica dominant oil nocte
- Keep up the symptom diary
What the research says
Exploring the science in Frances’ case, what is the relationship between medical cannabis, the endocannabinoid system, and fibromyalgia?
The endocannabinoid system (ECS) – comprising CB1 and CB2 receptors, endocannabinoids, and enzymes – plays a key role in modulating pain, sleep, mood, and immune responses.9
Research suggests that fibromyalgia may be linked to a concept called endocannabinoid deficiency, which may lead to heightened pain sensitivity, poor sleep, and mood disturbances.10,11
- CB1 receptors in the brain and spinal cord regulate pain perception, sleep, and mood9
- CB2 receptors in immune cells modulate inflammation and pain signalling9
It has been proposed that cannabinoids such as CBD and THC may help restore ECS balance and reduce fibromyalgia symptoms, preferably using a gentle approach with standardised whole-cannabis extracts.10
Clinical evidence for medical cannabis remains limited but is growing:
- Small randomised controlled trials and a large observational study report that medical cannabis can reduce symptom severity and improve quality of life in patients with fibromyalgia.11
- A randomised clinical trial with nabilone, a synthetic cannabinoid, has shown improvements in sleep in patients with fibromyalgia compared to the standard amitriptyline therapy.12
Key Takeaways
- Fibromyalgia is a complex, multifactorial condition that imposes a substantial burden on quality of life and conventional treatments often provide incomplete relief.1,2
- Emerging evidence suggests a role for the endocannabinoid system in fibromyalgia pathophysiology.10 While clinical trials remain limited, cannabinoids, particularly CBD and low-dose THC, may help reduce pain, improve sleep, and enhance wellbeing in select patients.4,10
- Frances’s case illustrates how a careful, individualised, and evidence-informed approach – including risk assessment, slow titration and structured follow-up – can support safe and effective access to medical cannabis.
Disclaimer: Medical cannabis products may be associated with adverse events. For more information please contact medinfo@saged.com.au. Medical cannabis products are not suitable for use during pregnancy or breastfeeding, for anyone with a history with psychotic disorders, or for those with unstable cardiovascular disease. Treatment for patients under 18 years is recommended under the guidance of a paediatrician. Patients should not drive or operate machinery while being treated with some forms of medical cannabis.
Frances’ journey with fibromyalgia: Medical cannabis for chronic pain associated with fibromylagia
Published: September 2025
Disclaimer: This is an anonymised patient case study, written with patient consent. The decision-making in this case study was undertaken by a doctor. The information in this document does not constitute medical advice or treatment recommendations. The use of cannabis based medications is the responsibility of a qualified medical professional who may initiate treatment after reviewing a patient's medical history. Most medical cannabis products are unapproved medicines and are regulated by the Therapeutic Goods Administration (TGA) Special Access Scheme (SAS), for which individual responses may vary.
Meet Frances
Frances* (pseudonym) is a 32-year-old woman living with fibromyalgia – one of an estimated 3–5% of Australians affected by this chronic condition, which is characterised by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties.1,2
Frances is seeking treatment for persistent pain, poor sleep and daily fatigue related to fibromyalgia. Despite trialling a range of conventional medications, she has experienced only limited relief. Her ongoing pain and exhaustion significantly affects her ability to work, exercise, and maintain daily life.
Fibromyalgia presents with a variety of symptoms, including widespread pain, sleep disturbance, fatigue, headaches, mood disorders and irritable bowel syndrome (IBS) and is more common in women than in men.1,2,3 These symptoms often overlap with other conditions such as anxiety, depression, and chronic fatigue syndrome.1,3
Many people living with fibromyalgia describe conventional medical treatments as only partly effective, with burdensome side effects.2,3 Current management usually combines lifestyle and self-management strategies with medications such as antidepressants (e.g. duloxetine), anticonvulsants (e.g. pregabalin) and analgesics.2,3 However, many patients, like Frances, continue to struggle with persistent pain and impaired quality of life despite best-practice care.
Frances’s consultation with her doctor
Ongoing pain and fatigue, alongside variable responses to standard pharmacological treatments, led Frances and her healthcare team to consider other strategies.
Use of medical cannabis is increasingly reported by patients with chronic pain conditions, with some users citing improved pain intensity, sleep, and overall wellbeing.4 These trends highlight the potential role of cannabis-based therapies as adjuncts in managing chronic pain conditions such as fibromyalgia.4
This case study explores how Frances’s medical team carefully assessed her presentation, medical history, risk factors, and possible drug interactions before initiating medical cannabis as part of her management plan.
Frances’s doctor collected the following information:
Presenting condition: Fibromyalgia
Age: 32 years
Symptoms
- Widespread musculoskeletal pain – particularly dull back ache
- Baseline back ache flares to sharp pain during physical exertion
- Insomnia with frequent night waking leading to daytime fatigue
- Anxiety – rapid heartbeat, clammy hands
Position: Diffuse – neck, shoulders, hips but mainly lower back
Type: Chronic with flare-ups after exertion or stress
Severity
- Good days: 4–5/10
- Bad days: 7–8/10
Triggers: Exertion, stress, lack of sleep, cold weather
Medical history
- Fibromyalgia – diagnosed 2 years ago
- Generalised anxiety disorder
Family history
- Grandfather – myocardial infarction
Allergies: None known
Current medications
- Amitriptyline – for nerve pain
- Tramadol
- Multivitamin
Past treatments
- Sertraline for anxiety (ceased 3 years ago)
- Morphine and fentanyl during recent hospital admission
- Buprenorphine patches (ceased 1 year ago)
- Stretches and regular exercises using cross trainer at home
- Sleeps supported with full body pillows
- Meditation and breathing exercises
- Rheumatologist
- Ongoing GP management – last seen 6 weeks ago
- Psychologist
Smoking: Never
Alcohol: Nil
Driving: THC liability verbalised
Workplace drug testing: N/A
Exercise: Stretches and regular exercises using cross trainer at home
Support network: Lives with partner and child, parents are supportive
- Black market cannabis flower intermittently since age 15 years – ceased 1 year prior, nil side effects noted
- Preferred treatment form: oils
Frances' risk assessment & treatment plan
Anxiety
- Given Frances’ history of generalised anxiety disorder, her doctor noted the importance of monitoring mood closely.
- While CBD may reduce anxiety, THC can in some cases exacerbate it.5
- Regular reviews to monitor mood and anxiety symptoms
- A “start low, go slow” dosing approach6
Driving
- Inform Frances of the Therapeutic Goods Administration (TGA) guidance that patients must not drive while being treated with medical cannabis that contains THC, noting that measurable concentrations of THC can remain detectable in saliva for many hours after administration.7
Drug interactions
- CBD may inhibit CYP2C19, CYP2D6 and CYP3A4, which metabolise tramadol and amitriptyline.8
- Careful titration and monitoring for side effects such as drowsiness were advised
After reviewing Frances’s presentation and history, her doctor developed a personalised treatment plan for fibromyalgia symptom relief.
Treatment goals
- Reduce baseline pain (particularly back pain)
- Manage pain flares
- Reduce anxiety
- Reduce insomnia
Initial products prescribed
- Full spectrum balanced oil (THC 10 mg/mL, CBD 10 mg/mL)
- Start 0.1 mL twice daily
- Increase by 0.1 mL every to two days until symptom control is reached
- Maximum daily dose 3.0 mL
- Full spectrum indica-dominant oil (THC 20 mg/mL, CBD 1 mg/mL)
- Start 0.1 mL nocte
- After two days increase by 0.1 mL
- Increase by 0.2 mL every 2 days until symptom control is reached
- Maximum daily dose 1 mL
Risk management plan
- Symptom diary – to record pain scores, doses, sleep quality, and side effects
- Pre-treatment Depression Anxiety Stress Scales (DASS) assessment – repeated at follow-ups
- Close monitoring for sedation, dizziness, or gastrointestinal upset
Follow-up plan
- 4- and 8-week reviews, with monitoring of pain, sleep, mood, and functional status
Treatment outcomes
At 8 weeks:
- Frances was using 0.3 mL balanced oil in the mornings (already the maximum dose) and reported limited benefit, indicating that this formula was not strong enough to address her symptoms
- The full spectrum indica-dominant oil has assisted with sleep - Frances is currently using 0.2 mL at night
Actions
- Replace the 10:10 balanced oil with a 25:25 balanced oil (THC 25 mg/mL, CBD 25 mg/mL)
- Continue with the indica dominant oil nocte
- Keep up the symptom diary
What the research says
Exploring the science in Frances’ case, what is the relationship between medical cannabis, the endocannabinoid system, and fibromyalgia?
The endocannabinoid system (ECS) – comprising CB1 and CB2 receptors, endocannabinoids, and enzymes – plays a key role in modulating pain, sleep, mood, and immune responses.9
Research suggests that fibromyalgia may be linked to a concept called endocannabinoid deficiency, which may lead to heightened pain sensitivity, poor sleep, and mood disturbances.10,11
- CB1 receptors in the brain and spinal cord regulate pain perception, sleep, and mood9
- CB2 receptors in immune cells modulate inflammation and pain signalling9
It has been proposed that cannabinoids such as CBD and THC may help restore ECS balance and reduce fibromyalgia symptoms, preferably using a gentle approach with standardised whole-cannabis extracts.10
Clinical evidence for medical cannabis remains limited but is growing:
- Small randomised controlled trials and a large observational study report that medical cannabis can reduce symptom severity and improve quality of life in patients with fibromyalgia.11
- A randomised clinical trial with nabilone, a synthetic cannabinoid, has shown improvements in sleep in patients with fibromyalgia compared to the standard amitriptyline therapy.12
Key Takeaways
- Fibromyalgia is a complex, multifactorial condition that imposes a substantial burden on quality of life and conventional treatments often provide incomplete relief.1,2
- Emerging evidence suggests a role for the endocannabinoid system in fibromyalgia pathophysiology.10 While clinical trials remain limited, cannabinoids, particularly CBD and low-dose THC, may help reduce pain, improve sleep, and enhance wellbeing in select patients.4,10
- Frances’s case illustrates how a careful, individualised, and evidence-informed approach – including risk assessment, slow titration and structured follow-up – can support safe and effective access to medical cannabis.
Disclaimer: Medical cannabis products may be associated with adverse events. For more information please contact medinfo@saged.com.au. Medical cannabis products are not suitable for use during pregnancy or breastfeeding, for anyone with a history with psychotic disorders, or for those with unstable cardiovascular disease. Treatment for patients under 18 years is recommended under the guidance of a paediatrician. Patients should not drive or operate machinery while being treated with some forms of medical cannabis.