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Ehlers-Danlos syndrome is a group of connective tissue-affecting genetic disorders that impacts about 1 in 5,000 individuals worldwide. Studies have shown cannabis can help in managing the severe pain associated with the syndrome.
Overview of Ehlers-Danlos Syndrome
Ehlers-Danlos syndrome is a group of genetic disorders that affects connective tissues, including the skin, joints, and blood vessels. Connective tissue is responsible for providing the strength and elasticity to the body’s underlying structures. In all types of Ehlers-Danlos syndrome, the effect of the disorder on connective tissue causes joints to have an unusually large range of movement and often causes skin to become overly stretchy and fragile.
Loose joints caused by Ehlers-Danlos syndrome are unstable and thus highly susceptible to dislocation. They can lead to severe, chronic pain and early-onset arthritis. Overly stretchy and fragile skin will also bruise easily and the syndrome causes wounds to split open easily and leave scars that widen over time. Damaged skin typically doesn’t heal well and stitches will often tear out. Extra folds of skin are also a characteristic often associated with the syndrome.
Some forms of Ehlers-Danlos that affect the vascular system can cause blood vessels to rupture and lead to internal bleeding and be life-threatening. A kyphoscoliosis form of Ehlers-Danlos syndrome can cause a severe curvature of the spine that adversely affects breathing.
Patients with Ehlers-Danlos syndrome commonly experience severe pain, making daily tasks difficult. The intense muscle pain, abdominal pain, neuropathic pain, migraines and fatigue caused by Ehlers-Danlos have been found to be significantly associated with psychiatric disorders and anxiety and mood disorders6. The pain related to loose joints from Ehlers-Danlos syndrome has been associated with a high prevalence of psychosocial factors8. Fatigue and headaches are also common symptoms of the syndrome3.
Ehlers-Danlos syndrome is caused by genetic mutations and is therefore most commonly inherited. The genes that become mutated and cause Ehlers-Danlos syndrome are responsible for making proteins that are used to assemble collagen. According to Mayo Clinic, if a person has the most common varieties of Ehlers-Danlos syndrome, there’s a 50% chance they will pass on the gene to each child. New gene mutations can cause Ehlers-Danlos syndrome in individuals with no family history of the disorder.
There is no cure for Ehlers-Danlos syndrome, so treatment focus in on managing symptoms. Pain medications are commonly required. For vascular Ehlers-Danlos syndrome, blood pressure medication may be used to reduce the stress on blood vessels. Physical therapy is sometimes required to strengthen muscles around loose joints.
Findings: Effects of Cannabis on Ehlers-Danlos Syndrome
Cannabis helps patients with Ehlers-Danlos syndrome manage the severe pain commonly associated with the disorder. The studies supporting cannabis’ effectiveness as a pain reliever are vast. Cannabis has been shown to significantly lower pain levels, even demonstrating effectiveness at managing pain that has proven refractory to other treatments2,7,9.
One study that looked at effective pain control methods for patients with Ehlers-Danlos syndrome, and yet didn’t include cannabis, found that opioids were among the most useful1. Opiates are commonly used to treat the pain associated with Ehlers-Danlos syndrome, the drugs sometimes have problematic side effects, including sedation, appetite loss, nausea, constipation and respiratory depression.
Studies have found that cannabinoids, compared to opioids, are effective at relieving pain in lower doses and with fewer side effects5. After a year of regular use, patients with chronic pain were found to be at no greater risk of serious adverse effects than non-cannabis users10.
States That Have Approved Medical Marijuana for Ehlers-Danlos Syndrome
Currently, only the state of New Hampshire has approved medical marijuana specifically for the treatment of Ehlers-Danlos syndrome. However, in Washington D.C., any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment. In addition, a number of other states will consider allowing medical marijuana to be used for the treatment of Ehlers-Danlos syndrome with the recommendation from a physician. These states include: California (any debilitating illness where the medical use of marijuana has been recommended by a physician), Connecticut (other medical conditions may be approved by the Department of Consumer Protection), Massachusetts (other conditions as determined in writing by a qualifying patient’s physician), Nevada (other conditions subject to approval), Oregon (other conditions subject to approval), Rhode Island (other conditions subject to approval), and Washington (any “terminal or debilitating condition”).
Several states have approved medical marijuana specifically to treat “chronic pain,” which is a symptom commonly associated with Ehlers-Danlos syndrome. These states include: Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Maryland, Michigan, Montana, New Mexico, Ohio, Oregon, Pennsylvania, Rhode Island and Vermont. The states of Nevada, New Hampshire, North Dakota, Montana, Ohio, Vermont, and West Virginia allow medical marijuana to treat “severe pain.” The states of Arkansas, Minnesota, Ohio, Pennsylvania, Washington, and West Virginia have approved cannabis for the treatment of “intractable pain.”
Recent Studies on Cannabis’ Effect on Ehlers-Danlos Syndrome
- Arthur, K., Caldwell, K., Forehand, S., and Davis, K. (2015, October 24). Pain control methods in use and perceived effectiveness by patients with Ehlers-Danlos syndrome: a descriptive study. Disability and Rehabilitation, 1-12, Epub ahead of print. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26497567.
- Boychuck, D.G., Goddard, G., Mauro, G., and Orellana, M.F. (2015 Winter). The effectiveness of cannabinoids in the management of chronic nonmalignant neuropathic pain: a systematic review. Journal of Oral & Facial Pain and Headache, 29(1), 7-14. Retrieved from http://goo.gl/n2nMnn.
- Castori, M., Morlino, S., Celletti, C., Ghibellini, G., Bruschini, M., Grammatico, P., Blundo, C., and Camerota, F. (2013, December). Re-writing the natural history of pain and related symptoms in the joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type. American Journal of Medical Genetics. Part A, 161A(12), 2989-3004. Retrieved from http://onlinelibrary.wiley.com/wol1/doi/10.1002/ajmg.a.36315/full.
- Ehlers-Danlos syndrome. (2015, August 20). Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/ehlers-danlos-syndrome/basics/definition/con-20033656.
- Elikkottil, J., Gupta, P., and Gupta, K. (2009, November-December). The analgesic potential of cannabinoids. Journal of Opioid Management, 5(6), 341-57. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3728280/.
- Herschenfeld, S.A., Wasim, S., McNiven, V., Parikh, M., Majewski, P., Faghfoury, H., and So, J. (2015, October 3). Psychiatric disorders in Ehlers-Danlos syndrome are frequent, diverse and strongly associated with pain. Rheumatology International. Epub ahead of print. Retrieved from http://link.springer.com/article/10.1007/s00296-015-3375-1.
- Lynch, M.E., and Campbell, F. (2011, November). Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials. British Journal of Clinical Pharmacology, 72(5), 735-744. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3243008/.
- Scheper, M.C., de Vries, J.E., Verbunt, J., & Engelbert, R.H. (2015). Chronic pain in hypermobility syndrome and Ehlers–Danlos syndrome (hypermobility type): it is a challenge. Journal of Pain Research, 8, 591–601. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548768/.
- Wallace, M.S., Marcotte, T.D., Umlauf, A., Gouaux, B., and Atkinson, J.H. (2015, July). Efficacy of Inhaled Cannabis on Painful Diabetic Neuropathy. Journal of Pain, 16(7), 616-27. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5152762/.
- Ware, M.A., Wang, T., Shapiro, S., and Collet, J.P. (2015, September 15). Cannabis for the Management of Pain: Assessment of Safety Study (COMPASS). The Journal of Pain. Retrieved from http://www.jpain.org/article/S1526-5900(15)00837-8/fulltext.
- Ware, M.A., Gamsa, A., Persson, J., and Fitzcharles, M.A. (2002, Summer). Cannabis for chronic pain: case series and implications for clinicians. Pain Research & Management, 7(2), 95-9. Retrieved from http://downloads.hindawi.com/journals/prm/2002/380509.pdf.
- What is Ehlers-Danlos syndrome? (2015, November 2). Genetics Home Reference. Retrieved from http://ghr.nlm.nih.gov/condition/ehlers-danlos-syndrome.