Private Prescription Medication – Alternative Pharmacological Therapy
There are two alternative medications that give some symptom relief in fibromyalgia patients; low-dose naltrexone (LDN) and medicinal cannabis. In the UK, both are available on private prescription for fibromyalgia patients. However, the process required to obtain and fill your private prescription is not as straightforward as just visiting your GP. Private prescriptions for LDN are available through Dickson Chemist in Glasgow if you are UK based, or through the LDN Research Trust for international readers. In the UK, prescriptions for cannabis medicines are only available from a specialist consultant in the area of their expertise. This can be, for example, a pain specialist, neurologist, oncologist or psychiatrist, among many others. Certainly, your GP can help advise you as to whether it may be an appropriate treatment and can refer you to a specialist for a consultation.
LDN Private Prescription and Fibromyalgia
Naltrexone is an opioid receptor antagonist treatment for alcohol and opioid dependence. The naltrexone competes with and blocks opioids from binding to the receptor and prevents the opioids having any effect in the body. Therefore, LDN is not suitable for fibromyalgia patients taking opioid drugs for pain relief. The hypothesis about the way it works is that LDN causes a short-term blockade of opioid receptors, resulting in a rebound of endorphin function which may reduce pain in fibromyalgia. 23.
A number of small studies have shown that LDN appears to significantly reduce pain and other symptoms, such as stress and sleep problems associated with fibromyalgia. 24. However, due to the size and scope of these trials, further research is required to sufficiently prove the effectiveness of LDN for fibromyalgia. Patients are prescribed LDN as an off-label medication (licensed medication approved for other conditions) in doses of between 1 and 4.5mg of LDN daily. In terms of adverse side-effects, larger scale studies have provided good evidence that LDN is safe and well tolerated in fibromyalgia patients. 21.
Medicinal Cannabis – NHS or Private Prescription
Cannabis-based medicines can contain CBD, THC and CBN cannabinoids. Read more about cannabinoids here. Medicinal cannabis is unlicenced for any conditions in the UK. This means doctors will only consider it after all existing licensed options and off label medication have been exhausted. Fibromyalgia is one of the conditions appropriate for medical cannabis but only when there is a proven, unmet clinical need. In other words, all other options were tried and failed.
Private health care providers and medical cannabis clinics appear to be more willing to prescribe cannabis-based medicines than NHS doctors. However, they are only able to prescribe medicinal cannabis if standard medications have not improved your condition and there is clear evidence of efficacy. The cost for the private consultation, follow-up treatment and the cannabis medication can amount to over £1000 a month.
Medicinal Cannabis and Fibromyalgia Research
Scientific research into the efficacy of cannabis as a medicine for fibromyalgia and chronic pain has increased since 2018 following the legalisation of medicinal cannabis in the UK. Evidence shows that clinical endocannabinoid deficiency may in part be the cause of fibromyalgia symptoms; and consequently treatment with phytocannabinoids frequently improved symptoms. 25. However, the number of studies examining the efficacy of cannabis in treating fibromyalgia are scarce, so it is difficult to draw definitive conclusions. But, emerging data do suggest a positive effect of cannabis in fibromyalgia.
For example, one recent study found that the mean pain level reduction was 77% and mean sleep quality improvement was 78% in fibromyalgia patients using medicinal cannabis. 26. Another study reported that 51% of fibromyalgia patients taking medicinal cannabis either “reduced the dose or the number of medications” that they took to treat fibromyalgia-related symptoms; with 47% ceasing their use of prescription medications altogether. 27. Further, targeted research should determine effective dosage and which patients are more likely to benefit from this treatment. Risks associated with cannabis use include psychiatric, cognitive, and developmental problems, as well as the risks of addiction. 28.Additional risks can also occur when using cannabis and CBD with prescription medications. Read more about taking CBD with prescription medications here. CBD does not require a prescription, so it is discussed below in the Dietary Supplements section.
Thyroid Hormone Therapy for Fibromyalgia
All fibromyalgia patients should have a thyroid function test to rule out hypothyroidism and cellular resistance to thyroid hormones. As stated above, hypothyroidism has the same symptoms as fibromyalgia. Nowicki and Lowe advocate that all fibromyalgia patients are given the opportunity to trial thyroid hormone replacement. 15. Furthermore, they suggest that hypothyroid fibromyalgia patients begin treatment with 60 mg of natural desiccated thyroid (NDT) or a synthetic T4/T3 preparation with a 4:1 ratio. The dosage should be increased by 60 mg of NDT at approximately 3- to 4-week intervals until an optimal dosage has been reached.
Controversially (see paragraph below), they also suggest euthyroid (normal thyroid function test) fibromyalgia patients should begin treatment with immediate-release T3, usually with a starting dosage of 50 mcg. Patients should increase the dose at weekly to biweekly intervals by 12.5 mcg. Rather than relying on thyroid function tests, which often don’t give a true representation at the cellular level; they advise that dosage increases should continue until the patient is: symptom-free; no longer meets the ACR criteria for fibromyalgia; fully functional, and has reference-range physiological measures, such as the basal body temperature and basal pulse rate. Studies showed that patients taking thyroid hormone only made a full recovery when the hormone therapy was combined with non-pharmacological, metabolism regulating therapies. 15.
It May be Difficult to Get a Doctor to Prescribe Combination Thyroid Hormones
Unfortunately, few endocrinologists are currently supportive of NDT or combined T3/T4 therapy. As a result, T4 is the standard treatment of choice for hypothyroid patients. Their reason being that there is a lack of relevant scientific research proving the effectiveness of combined hormones. However, there is a wealth of anecdotal evidence from patients who have improved significantly after taking NDT or combined T3/T4. The standard measure of thyroid function is the Thyroid Stimulating Hormone (THS) level, not the actual thyroid hormone levels themselves. A patient is seen as euthyroid (normal thyroid function) if their TSH falls within quite a wide normal range (0.27 – 4.2 mU/L). However, using this measurement alone has fundamental flaws. Despite this, doctors are unlikely to prescribe thyroid hormone to a patient who has THS levels within the normal range. However, you may have more success in getting a private prescription from a consultant.
Next: Exercise for Fibromyalgia – Non-Pharmacological Therapies
References
15. Nowicki, J. and Lowe, J.C., 2020. Fibromyalgia Syndrome. In Textbook of Natural Medicine (pp. 1319-1329). Churchill Livingstone.
21. Ishikawa, H., Takeshima, M., Ishikawa, H., Ayabe, N., Ohta, H. and Mishima, K., 2021. Pregabalin withdrawal in patients without psychiatric disorders taking a regular dose of pregabalin: A case series and literature review. Neuropsychopharmacology Reports.
23. Metyas, S., Chen, C.L., Yeter, K., Solyman, J. and Arkfeld, D.G., 2018. Low dose naltrexone in the treatment of fibromyalgia. Current rheumatology reviews, 14(2), pp.177-180.
24. Patten, D.K., Schultz, B.G. and Berlau, D.J., 2018. The safety and efficacy of low‐dose naltrexone in the management of chronic pain and inflammation in multiple sclerosis, fibromyalgia, Crohn’s disease, and other chronic pain disorders. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 38(3), pp.382-389.
25. Russo, E.B., 2016. Clinical endocannabinoid deficiency reconsidered: current research supports the theory in migraine, fibromyalgia, irritable bowel, and other treatment-resistant syndromes. Cannabis and cannabinoid research, 1(1), pp.154-165.
26. Habib, G., Khazin, F. and Artul, S., 2021. The Effect of Medical Cannabis on Pain Level and Quality of Sleep among Rheumatology Clinic Outpatients. Pain Research and Management, 2021.
27. Habib, G. and Levinger, U., 2020. Characteristics of medical cannabis usage among patients with fibromyalgia. Harefuah, 159(5), pp.343-348.
28. Berger, A.A., Keefe, J., Winnick, A., Gilbert, E., Eskander, J.P., Yazdi, C., Kaye, A.D., Viswanath, O. and Urits, I., 2020. Cannabis and cannabidiol (CBD) for the treatment of fibromyalgia. Best Practice & Research Clinical Anaesthesiology.