Medicinal Cannabis: Could It Help with Chronic Fatigue and Chronic Pain?

Hi Friend

This week we will look into medicinal cannabis and how it ban be used/effective.

🧠 How Does Medicinal Cannabis Work?

Our bodies have a natural system called the endocannabinoid system (ECS), which helps regulate:

• Pain perception

• Sleep

• Mood

• Inflammation

• Immune activity

• Energy balance

The ECS uses chemical messengers (endocannabinoids) and receptors (CB1, CB2) found in the brain, nerves, immune cells, and tissues to maintain balance (homeostasis).

👉 Medicinal cannabis contains plant cannabinoids (THC, CBD) that interact with this system:

• THC binds to CB1 receptors in the brain, reducing pain signals, easing nausea, relaxing muscles — but can also cause drowsiness, memory issues, or a “high.”

• CBD works indirectly on these receptors, helping modulate inflammation, anxiety, and excessive nerve activation without causing a high.

The two may work together (sometimes called the entourage effect), enhancing each other’s benefits.

🧠 Why Might It Help These Conditions?

Both CFS/ME and fibromyalgia involve:

• Central sensitisation — the brain and spinal cord become hypersensitive to pain and sensory signals.

• Neuroinflammation — low-level inflammation in the brain and nervous system may amplify fatigue and pain.

• Dysautonomia — problems with the autonomic nervous system (e.g., POTS, temperature regulation, gut motility issues).

• Poor sleep — fragmented sleep, reduced deep (slow wave) and REM sleep.

• Mood disturbances — anxiety, depression, emotional overwhelm (common secondary challenges).

🔬 Fibromyalgia: Evidence

• Some fibromyalgia patients appear to have an underactive endocannabinoid system (“clinical endocannabinoid deficiency hypothesis”).

• A Cochrane review (Goldenberg et al. 2020) found synthetic cannabinoids like nabilone may:

  • Slightly reduce pain

  • Improve sleep quality

  • But side effects (e.g. dizziness, cognitive slowing) are frequent

• Small studies of herbal cannabis report:

  • Reduced pain intensity

  • Improved sleep

  • Variable effects on fatigue itself

• In real-world surveys (e.g. Häuser et al. 2023), many fibromyalgia patients report cannabis helps with pain, sleep, and anxiety — but not directly with energy levels or fatigue.

🔬 Chronic Fatigue Syndrome / ME: Evidence

• No randomised controlled trials to date testing cannabis or CBD in CFS/ME specifically.

• Some patients use medicinal cannabis (especially CBD-dominant preparations) off-label to help with:

  • Sleep disturbance

  • Pain

  • Anxiety

  • Muscle tension

  • Post-exertional malaise flares (indirectly, by improving sleep or reducing pain)

But no robust evidence shows it improves core fatigue, post-exertional malaise, or cognitive dysfunction.

💡 What Might Medicinal Cannabis Help?

⚠️ Risks

• Sedation, dizziness, cognitive slowing

• Tolerance or dependence (mainly with THC)

• Drug interactions

• Driving restrictions (THC is tightly regulated in the UK)

💡 Is It Worth Trying?

➡ Cannabis-based medicines may help with chronic pain where other treatments have failed.
➡ For CFS/ME, evidence is weak — any benefit likely comes through easing related symptoms (pain, insomnia, anxiety).

Always consider:
✔ Licensed prescribing routes
✔ Part of a broader plan (pacing, vagal nerve work, nutrition)
✔ Careful monitoring of side effects

It is best used when combined with pacing, mindfulness, vagal toning and other lifestyle interventions.

📌 My Take

Medicinal cannabis is not a first-line treatment for fatigue or chronic pain, but it may offer symptom relief for some. More research is needed, especially for fatigue.

This Weeks podcast was an amazing episode with a former PIP assessor who explains all about ow people are assessed for benefits and some undercover ways in which they can gather clues, a very interesting watch, subscribe and watch below.

References:

• Stockings E et al. Cannabis and chronic pain: A meta-analysis. JAMA Netw Open. 2021;4(2):e2037758.

• Goldenberg DL et al. Cannabinoids for fibromyalgia. Cochrane Database Syst Rev. 2020;8:CD012496.

• Häuser W et al. Cannabinoids in chronic pain: A systematic review. Pain Reports. 2023;8(1):e1033.

Regards

Dr Ahmed