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Catherine is a 68 year old lady with a 10 year history of chronic widespread pain which was diagnosed as fibromyalgia 5 years ago following several investigations. Since then, she has been prescribed various antidepressants including escitalopram 10mg daily and amitriptyline 10mg nocte. She was using bromazepam to help her sleep and codeine 60-90mg 4-6hourly to control pain. Side effects with this medication included daytime sedation, fatigue, constipation, nausea, abdominal pain and dry mouth.

Despite this medication, the patient was still experiencing widespread pain especially in the thighs and neck, daily headaches of varying severity, erratic sleep, with patient waking up almost every hour to empty her bladder, frequent bouts of diarrhoea, depressed mood, anxiety and fatigue.

The patient had slowly tailed down the medication and was only on bromazepam and codeine before she was switched to Pedanios. She is now on a stable dose of her new medication where she is vaporizing 0.2g of Pedanios 22/1 every 4-6hours during the day and Pedanios 20/1 in the afternoon and at night. The temperatures used on the vaporizer vary from 180-190degrees Celsius depending on the requirements and on the severity of the symptoms.

The patient’s symptoms of widespread pain, irritable bowel and irritable bladder, anxiety, depression and insomnia are much better controlled now than when she was on her previous medication. The only side effects experienced were a dry mouth with higher vaporizer temperatures. Pedanios 20/1 caused some sedation when used during the day at high temperatures so it was used in the afternoon and evening. Pain relief was very much superior (3/10) to that obtained from codeine (6/10).

Even though symptoms are much better controlled using cannabinoids than previous medications, using oral drops or gel capsules as a mode of delivery may be more convenient for the patient and provide better relief of symptoms with less frequent dosing.