Chronic Fatigue Syndrome, (CFS), also known as myalgic encephalomyelitis (ME), is a poorly understood condition that can be brought on in several ways. Many patients, frustrated with the lack of conventional (or successful) therapeutic options, turn to medical cannabis and other experimental approaches.
There are no clinical or preclinical research studies exploring cannabis for the treatment of CFS/ME. There are also no clinical studies pending on this subject, according to the US National Library of Medicine. This may be secondary to the legal status of cannabis in the USA and internationally and challenges associated with conducting a study as a result.
Many patients with CFS/ME try many different kinds of treatments, with little result. It’s from this frustration that some find their way to medical cannabis. It does seem as if cannabis holds some hope for patients with CFS, but there is a long way to go before clinical work can begin.
The Endocannabinoid System
The endocannabinoid system (ECS) is a network of receptors and naturally produced chemical transitions within our bodies. It is responsible for managing stress response, from both internal and external sources.
While the ECS is a relatively new discovery in medicine, scientists believe it is responsible for regulating many crucial physiological processes, including stress, appetite, pain, inflammation, memory, and mood. The primary goal of a healthy and fully functioning endocannabinoid system is to keep the mind and body in a state of constant balance, called homeostasis.
The relationship between the endocannabinoid system and CFS/ME is not clear. Experts are still debating what causes CFS/ME, and what biological pathways it follows. With the underlying mechanism of the condition up in the air, it’s hard to draw many conclusions.
What we currently know about the CFS/ME and endocannabinoids comes down to the many theories behind the disease. Immune system defects top the list, as do abnormalities in the functioning of the central nervous system.
Other theories revolve around dysfunction in stress response and an imbalance in the gut flora. Many of these scientific speculations revolve around physiological processes managed at least partly by the endocannabinoids system, including the immune system, stress response, and the central venous system. It’s no wonder the endocannabinoid system is a popular target for the treatment of CFS/ME.
The sheer number and variety of theories for CFS/ME imply that nobody is certain about a root cause. Right now, all we can do is make guesses based on the available evidence.
CFS & Cannabis
Without any available research on cannabis for the treatment of CFS/ME, the best information comes from cannabis’s many applications for the related symptoms of the condition. This means looking at how cannabis may benefit related mood and autoimmune disorders, and for the treatment of pain. Each is an area already targeted by conventional approaches in the battle against CFS/ME, so it’s worth exploring how medical marijuana may be useful in each of these areas as well.
Depression is commonly associated with CFS/ME. The current opinion on the benefits and risks of cannabis for helping this mood disorder are mixed and poorly understood. Patients’ surveys consistently report depression as a primary reason for medical cannabis use, yet there is also evidence that heavy use of cannabis in adolescence may increase the risk of depression later in life.
As one of the three possible systems affected by CFS/ME, the immune system is an important therapeutic target. An autoimmune disorder, which occurs when an overactive immune system damages the body instead of protecting it, is a broad term that covers dozens of different ailments, including rheumatoid arthritis, inflammatory bowel disease (IBS), and multiple sclerosis (MS). Cannabis is a known immune‐modulating agent. It does so through several mechanisms, including reducing pro‐inflammatory cytokine expression and increasing anti‐inflammatory cytokines. Several clinical trials have found cannabis effective for treating specific autoimmune disorders, including those mentioned above.
CFS/ME is often associated with varying degrees of chronic pain, the condition for which medical marijuana use is the most highly established. According to “The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research,” a 2017 report by the National Academies of Sciences, Engineering, and Medicine, “In adults with chronic pain, patients who were treated with cannabis or cannabinoids are more likely to experience a clinically significant reduction in pain symptoms.”
Given that cannabis shows potential for many of the associated conditions of CFS/ME, it seems likely there may be some therapeutic value for patients with a CFS/ME diagnosis. Still, there is so much research still needed into CFS/ME and cannabis separately, as well as together.
Any patient wishing to try cannabis for the treatment of CFS/ME should first speak with a knowledgeable physician. Cannabinoids, and especially CBD, are thought to follow the same pathways as many conventional hepatic drugs (meaning drugs affecting the liver), so there may be a risk of possible interaction with other prescription drugs that are broken down by the liver. Working cannabis into a integrative approach to treatment for CFS/ME requires much skill and care.
CFS/ME was not a condition investigated in “The Health Effects of Cannabis And Cannabinoids” report mentioned above. At this writing, CFS/ME is also absent from any known medical condition listings for US states where cannabis is legal at the state level.
That said, patients with CFS/ME likely have symptoms or associated conditions that do qualify. These may include anxiety, depression, fibromyalgia, or chronic pain. Speak with your physician to find out if any of these associated medical conditions qualify for a cannabis recommendation in your area.
In Canada, physicians must follow predetermined federal and provincial guidelines for the prescription of medical cannabis, but they do not have to adhere to a list of approved conditions (as they do in the US). If a physician in Canada determines cannabis is an appropriate treatment for CFS/ME, given the patient’s symptoms and medical history, he or she can prescribe it.
Medical use of cannabis is rapidly evolving. There are over 30 countries around the world where medical cannabis use is now permitted. Each country has their own set of approved conditions, and means of access.
In Israel, which has had limited access for over a decade (and now much broader access), there are only a handful of conditions approved for treatment with cannabis. Israeli patients with CFS would need to seek treatment through a comorbidity, and likely only for pain. As per one English source, cannabis is only approved for patients with clear neuropathy of a clear organic origin who have been treated for at least a year in a pain clinic after exhausting acceptable treatment options.”
Germany has a much more liberal approach, similar to that seen in Canada. In Germany, physicians must follow broad guidelines but do not have to refer to a list of approved conditions before prescribing cannabis. At least in theory and with a supportive physician, patients could potentially receive medical cannabis for CFS (and not just for the treatment of a comorbidity).
If you feel you may qualify for medical cannabis, contact a provider in your area to learn more about this possible treatment.
Chronic fatigue syndrome (CFS), systemic exertion intolerance disease (SEID), and myalgic encephalomyelitis (ME) are all different names for the same disorder. It’s often referred to as CFS, or CFS/ME.
CFS is a chronic illness, characterized by extreme tiredness or fatigue that can’t be explained by any recent activity or other medical condition. Chronic fatigue syndrome is not the same thing as feeling fatigued or tired much of the time—people with CFS feel disproportionately exhausted after any physical or mental effort.
CFS can last for months, or even years. Only a fraction of people who develop CFS return to full strength and health.
CFS affects both men and women, and both adults and children. It’s estimated that between 1 and 8 adults Americans out of every 1,000 are affected by CFS, but the number could be higher because many cases go undiagnosed.
CFS affects twice as many women as it does men, and people aged between 25 and 45 are most likely to develop it. People of all racial, ethnic, and economic backgrounds can develop CFS, although it’s more common among African-Americans and Latinos, and among people in lower socioeconomic groups. It’s thought that the US economy spends $9 billion to $25 billion every year due to CFS.
The main symptom of CFS is lasting fatigue. Unlike normal tiredness, you don’t feel any better after you’ve rested, although you do feel worse if you push yourself to do more despite your fatigue. The tiredness of CFS is severe enough to cut down your normal activity levels by 50% or more, and lasts for several months.
Other symptoms of CFS include:
- Difficulty concentrating and focusing on work or at school
- Problems with your short-term memory
- Sore throat
- Enlarged lymph nodes (swollen glands) in the neck and under the arms
- Muscle pain and joint pain that isn’t accompanied by redness or swelling
- Headaches that bring a different type of pain, come in a new pattern, or are more severe than previously
- Sleep that doesn’t make you feel more refreshed, rested, or recharged when you wake up
- Extreme exhaustion after exercising, focusing hard, or doing any strenuous activity
- Anxiety and depression
Many people with CFS also experience other symptoms, like an intolerance of alcohol, hay fever or other allergies, and recurring sinus problems. You might often show symptoms of depression, but that’s usually because of the impact of CFS, not a symptom of CFS.
When should you see a doctor?
In today’s busy world, it’s relatively common to feel tired and fatigued much of the time, which makes it difficult to know when to go to the doctor.
In general, if you feel ongoing tiredness for several months, you don’t feel any better after you’ve slept or rested, and your tiredness seems to be out of proportion to your recent physical and/or mental effort, you should visit your doctor to investigate what’s causing your fatigue.
There’s no single test that doctors can use to diagnose chronic fatigue syndrome. Instead, they’ll ask you about your symptoms, and carry out tests to rule out other conditions that could be causing you to feel so tired. Usually, your doctor will order blood and urine tests, and examine your medical history. Some of the other common conditions that cause similar symptoms to CFS include:
- Hypothyroidism, which is when your thyroid isn’t active enough and so doesn’t generate the hormones you need to regulate your energy levels and sleep cycle
- Sleep disorders like sleep apnea, insomnia, or restless legs syndrome
- Mental health issues such as anxiety, depression, schizophrenia, or bipolar disorder
- Anemia, a lack of red blood cells, and also a common cause of tiredness
- Heart or lung issues that cause you to feel fatigue more quickly than usual
Many other illnesses and disorders can cause the same symptoms as CFS, but they usually get better fairly quickly on their own. If you continue to feel the same symptoms for a long time, your doctor is more likely to diagnose CFS.
The exact cause of CFS isn’t known, but scientists have theories about triggers and risk factors that make it more likely that you’ll develop chronic fatigue syndrome.
For most people, CFS comes on very suddenly, often just after a flu-like illness or a period of great stress or trauma, but others develop CFS slowly and gradually.
Some known triggers for CFS include:
- A viral infection. Infectious mononucleosis (glandular fever) is a common cause of CFS, as well as Epstein-Barr virus, human herpesvirus 6, and mouse leukemia virus, but no definite cause has been proven yet.
- A bacterial infection, like pneumonia or Lyme disease
Scientists also think that CFS could be connected to auto-immune disorders since many people who get CFS also have a highly activated immune system that could be attacking certain parts of their body.
Another theory is that CFS is linked to a hormonal imbalance. Some people with CFS also have abnormalities in their hypothalamus, which is the part of the brain that controls the hormones, and the pituitary and adrenal glands, which produce the hormones that are released into the body.
There could also be a genetic element to getting CFS. Some people have a history of CFS in their family. Scientists have a theory that the activity of genes in your white blood cells is different when you have CFS, and that’s what causes the symptoms.
It’s important to remember that if you these issues, it doesn’t necessarily mean that you’ll develop CFS. Many people have overactive auto-immune systems, a family history of CFS, and/or hormonal imbalances, but they don’t develop CFS.
Other risk factors for CFS include:
- Age. You can develop CFS at any age, but it’s most common in your 40s and 50s.
- Gender. Women are more likely to develop CFS than men
- Stress and mental health. Having a hard time coping with stress, living in a traumatic situation, or having existing mental health problems.
CFS can be treated, although there’s no single cure. For most people, their symptoms begin to improve after a couple of years, although you might not get back to your previous state of health, and you might also have periods when your symptoms get worse. Children and young people are much more likely to make a full recovery.
Doctors use a combination of medication, therapies, and lifestyle changes to treat CFS. Treatment for CFS focuses on helping to relieve your symptoms so you can enjoy a better quality of life, rather than on curing the disorder.
Some of the treatments for CFS include:
If you have CFS, your doctor will probably prescribe you medications like:
- Antidepressants, since approximately 50-60% of people with CFS also show signs of depression. Antidepressants can help you to sleep better and cope with your symptoms more easily.
- Analgesics and painkillers, like Tylenol, aspirin, and NSAIDs, to reduce muscle pain, joint pain, and headaches that come with CFS.
- Antihistamines and decongestants, to treat allergies and hay fever that affect many people with CFS.
A combination of Cognitive Behavioral Therapy (CBT) and graded exercise therapy can be effective in treating CFS.
CBT involves talking with a trained CBT counselor, who can help you to find ways to work around your CFS and overcome some of the ways that it limits your life. With CBT, you can feel more in control.
Graded exercise therapy
This is generally led by a physical therapist who will help you create an exercise program that begins very, very gently, with just a few minutes of gentle stretches each day, and that gradually increases. This helps to overcome the extreme tiredness you feel after any exercise.
Having CFS changes your life. You’ll need to learn how to conserve your energy for the most essential activities, how to avoid stress, and reduce the amount of physical effort you put out during your daily life.
There are some alternative therapies which are popular among people with CFS. It’s difficult to prove whether any of them work, because CFS symptoms respond very well to placebos. Acupuncture, nutritional supplements like omega-3 fish oils, and natural remedies like melatonin and magnesium are among the options tried by people with CFS.
Generally, the younger you are and the fewer physical symptoms you show, the more likely you are to be able to treat your CFS successfully.