Fibromyalgia: Evaluation of Pain Relief Therapies Interview with:
Departamento de Fisioterapia – UFVJM 

Dr. Oliveira  What is the background for this study?

Response: Fibromyalgia is a chronic health condition of unknown etiology characterized by generalized body pain, fatigue, sleep disturbance, impaired cognition, and anxiety. It causes disability, lowers quality of life and is responsible for with high direct and indirect costs. Many therapeutic options are available and delivered to these patients and it is important to patients and clinicians to understand the average effects sizes of these interventions in order to make their choices.

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Stimulation of Nerves in Ear May Provide Pain Relief for Fibromyalgia Patients Interview with:
Anna Woodbury, MD, C.Ac
Associate Professor | Anesthesiology
Associate Program Director | Emory Pain Fellowship
Emory University School of Medicine  What is the background for this study?  What are the main findings?

Response: I have long been interested in non-pharmacologic and minimally invasive therapies for my pain patients.  Unfortunately, there are not a lot of non-pharmacologic options available, particularly for those suffering from fibromyalgia, a poorly understood condition that leads to widespread pain among a constellation of disturbing symptoms.  I observed that many fibromyalgia patients are stigmatized and often dismissed without suitable treatments, and I wanted to find a way to better help them.  

Working in the VA, I learned that gulf war syndrome and fibromyalgia seemed to overlap in terms of their clinical manifestations, and I was presented with an interesting option for pain treatment – the “Military Field Stimulator,” a stimulator that goes on the ear to treat pain using percutaneous electrical nerve field stimulation (PENFS).  I tried it on a few of my difficult to treat pain patients with positive results.  However, the stimulator had not yet been rigorously tested in a clinical trial.  We therefore conducted a small trial to examine the clinical effects of the ear stimulator in veterans with fibromyalgia and examined brain changes that may result from use of the stimulator us a special kind of MRI known as resting state functional connectivity MRI.  

All veterans in the study received standard therapy, including medication management, physical therapy, etc., but some were randomized to standard therapy alone, while others received standard therapy in addition to PENFS.  We found that there was pain relief in both groups immediately following a 4 week treatment period, but the PENFS group seemed to have longer term pain relief (12 weeks), and the changes in the brain differed between the groups.  Further, pain interference measures (the level pain interferes with activity, mood, stress, and sleep) were significantly improved in the PENFS group at some of the timepoints.

Can CBD and Cannabis Provide Pain Relief in Fibromyalgia? Interview with:
Amnon A. Berger, MD, PhD
MD/PhD Program 2006-2017
The Hebrew University Hadassah Medical School
Jerusalem, Israel
Resident Physician (CA-1/PGY-2) and Loring Scholar
Department of Anesthesiology, Critical Care and Pain Medicine
Beth Israel Deaconess Medical Center, Boston, MA

Dr. Berger  What is the background for this study?  What are the main findings?

Response: Fibromyalgia is a common disorder of chronic widespread pain. It has been estimated to affect 2-4% of the general population, though that number is likely an underestimate of the actual incidence. Outside of chronic pain, it also contributes to morbidity and disability because it affects sleep, causes cognitive impairment and psychiatric perturbations. Fibromyalgia is difficult to diagnose and even more difficult to treat.

Because the underlying causes – the etiology and pathophysiology at the base of this condition – are still largely unknown, it is harder to tailor specific treatments. There is evidence to support several modes of treatment, but truly high-level evidence exists only for physical exercise. Effective treatment depends on long term commitment and a multimodal approach by a multidisciplinary team.

Recently, with the rise of use in cannabis and CBD, both for medical and recreational use, evidence has emerged to support its use in fibromyalgia. While most of the evidence is not clear cut and not high enough evidence to support cannabis use, the evidence is overall positive and cannabis derivatives may be an effective choice as part of a multimodal treatment plan.