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Fibromyalgia Syndrome

This book provides a comprehensive overview of fibromyalgia syndrome that focuses on integrating concepts relevant to the pathogenesis, epidemiology and treatment of the condition. Details of how to manage sleep disorders, assess related disabilities, use pharmacological and complementary treatments are provided. Relevant aspects of neuromodulation, genetics, and neuromodulation are also covered. Therefore, enabling the reader to develop a deep understanding of the underlying triggers of and tools for assessing and treating fibromyalgia.

Fibromyalgia Syndrome features a wealth of information on the basic science and contains guidance on how to make clinical decisions when treating patients with this condition, and is a valuable resource for any medical professional or trainee seeking a dedicated up-to-date resource on the topic.


  • Fibromyalgia
  • Chronic Pain
  • Central sensitization
  • Functional disorders
  • Neuromodulation

Editors and Affiliations

Tel Aviv Sourasky Medical Center & Tel Aviv University School of Medicine, Tel Aviv, Israel

Ariel University, Ariel, Israel

About the editors

Professor Jacob Ablin is specialist in general internal medicine, and Rheumatology. He heads an Internal Medicine ward at the Tel Aviv Sourasky Medical Center, Tel Aviv, Israel and is a professor of internal medicine at the Sackler School of Medicine at the Tel Aviv University. His main clinical and research interests are pathogenesis, genetics and epidemiology of the fibromyalgia syndrome.

Prof. Yehuda Shoenfeld is the founder and head of the Zabludowicz Center for Autoimmune Diseases, at the Sheba Medical Center which is affiliated to the Sackler Faculty of Medicine in Tel-Aviv University, in Israel. Dr. Shoenfeld is currently the president of Ariel university in Israel. Dr. Shoenfeld is the Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases at the Tel-Aviv University. His clinical and scientific works focus on autoimmune and rheumatic diseases.

Commonly asked questions about cannabis-based products

The term cannabis-based products covers several types of products that may be prescribed to treat various medical conditions.

On this page, you can find the following information:

What are cannabis-based products?

Cannabis-based product is the preferred term for any product containing cannabis or a cannabinoid. Cannabinoids are chemical compounds found in the plant Cannabis sativa, also known as marijuana. They can also be human-made (synthetic). There are more than 100 identified cannabinoids. Cannabidiol (CBD) and tetrahydrocannabinol (THC) are the most studied of the cannabinoids and the most commonly included ingredients in cannabis-based products. They may be present as individual ingredients or together in a combination. ​

  • This is a non-psychoactive cannabinoid, which means that it does not affect your mind or mental processes and does not give you a ‘high’ like THC does.
  • This is a psychoactive cannabinoid.
  • THC binds to cannabinoid receptors in your brain and causes most of the psychological effects such as elated mood (feeling ‘high’), fast heart rate, dizziness and slow reaction times.
  • Potency or strength depends on a number of factors such as the plant age, plant genetics, harvesting and processing.

What is medicinal cannabis and is it different to recreational cannabis?

Medicinal cannabis is used for medicinal purposes to relieve the symptoms of a medical condition. It can be a dried cannabis product or a product in a pharmaceutical dosage form (eg, tablets or capsules) containing 1 or more cannabis-based ingredients and no other prescription medicines or controlled drugs. You must have a prescription from a prescriber registered to practice in Aotearoa New Zealand before you can be supplied any medicinal cannabis product.

Recreational cannabis is the use of cannabis for the purpose of getting ‘high’ without any medical reason for using it.

In what forms is medicinal cannabis available?

Medicinal cannabis is usually available as:

  • oral drops, lozenges or capsules
  • a mouth spray
  • a form that can be inhaled via a medical vapouriser device (non-combustion)
  • gel or patches that are applied to your skin.

A product does not classify as a medicinal cannabis product if it is in a form intended for smoking, a food or a sterile dosage form (eg, eye drops).

Do medicinal cannabis products in Aotearoa New Zealand meet a quality standard?

On 1 April 2020, the Ministry of Health’s Medicinal Cannabis Agency began accepting applications from medicinal cannabis product suppliers to assess their products. The purpose of an assessment is to establish whether the product meets the medicinal cannabis minimum quality standard and to improve access to quality products. The minimum quality standards provide prescribers with confidence in the quality and consistency of any medicinal cannabis products they prescribe to their patients.

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For a list of medicinal cannabis products that meet the minimum quality standard, see medicinal cannabis products that meet the minimum quality standard. A range of further medicinal cannabis products will become available over time as suppliers of medicinal cannabis products apply to the Medicinal Cannabis Agency to assess whether their products meet the medicinal cannabis minimum quality standard.

The Medicinal Cannabis Agency does not currently assess products for their safety or efficacy.

Do I need a prescription for medicinal cannabis?

Yes, you need a prescription from any registered prescriber (such as a doctor or nurse practitioner) in Aotearoa New Zealand before you can get any medicinal cannabis product. The prescriber will need to check if the product meets the quality standard by the Medicinal Cannabis Agency. They will ask you about your medical history, including any other medicines you are taking. Your prescriber is best placed to advise you on the risks and benefits of using medicinal cannabis products.

With a prescription, your prescriber or a pharmacy will dispense the product. You cannot buy medicinal cannabis products online or from a third party.

Can I import medicinal cannabis products from overseas?

No, personal imports of medicinal cannabis products are not allowed. You can only get medicinal cannabis products from a registered medical practitioner in Aotearoa or a pharmacy that is importing the medicinal cannabis products on behalf of the medical practitioner.

The current policy on importing cannabis based products is that any medicinal cannabis product is considered to have a therapeutic purpose and will be treated as a prescription medicine when imported. This means that you cannot import medicinal cannabis products for personal use, including in the form of cosmetics, beauty products, jewellery or any other products that contain cannabis.

Do cannabis-based medicinal products work?

The scientific evidence for the effectiveness and safe use of cannabis-based products is not considered strong. In general there is not yet enough information to fully recommend their use. One of the main issues is that there are limited pharmaceutical grade cannabis-based products available for use and there is a lot of variation in the quality of products used. Trialling a cannabis-based product is only a suitable option for people who have ongoing symptoms after trying available conventional treatments. Medicinal cannabis is not considered a first option for any medical condition.

Certain cannabis-based products may provide some moderate improvements in symptoms for people with:

  • Multiple sclerosis-associated spasticity.
  • Seizures associated with refractory epilepsy such as Dravet syndrome or Lennox-Gastaut syndrome.
  • Chronic pain, specifically nerve pain.
  • Nausea (feeling sick) and vomiting (being sick) caused by cancer therapy.

There is a lack of evidence to support the use of cannabis-based products for depressive disorders, post-traumatic stress disorder (PTSD), Parkinson’s disease, anxiety, obsessive-compulsive disorder (OCD), autism, ulcerative colitis, Alzheimer’s disease, glaucoma and Crohn’s disease.

What is the dose of medicinal cannabis?

The recommended dose is difficult to determine due to individual differences in people’s response and the products used. Some people are very sensitive to it whereas others need to use more to produce an effect. Other reasons that make dosing difficult to determine include the following:

  • Products are not equivalent and have different ratios of CBD and THC, which can affect your body in different ways when used in a combination. This means that finding the right dose needs trying first and then adjusting.
  • Individual differences exist and some find that their dosage needs to change when the product brand is changed.
  • Cannabis-based products intended for inhalation are harder to dose. Flower-based products require the use of a medical vapouriser, which helps control the dose received by adjusting the temperature and amount of product used. However, this is not an exact science and it makes dosing harder to determine.

It is best to start a cannabis-based product at a low dose and gradually increase it to reduce the chance of side effects. Your doctor will also provide you with guidance on adjusting your dose.

What are the side effects of cannabis-based products?

Cannabis-based products can cause side effects and these differ between people and products. No studies have not been done to assess the long-term adverse effects of cannabis-based products. Common mild side effects include:

  • nausea (feeling sick)
  • indigestion, stomach upset
  • stomach pain or cramps
  • diarrhoea (runny poo)
  • dizziness
  • confusion
  • tiredness
  • dry mouth.
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Did you know that you can report a side effect to a medicine to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product.

Who should not use cannabis-based products?

Cannabis based products may not be appropriate for some people. These include people who:

  • have a personal or strong family history of psychosis
  • have an active mood disorder
  • are pregnant and breastfeeding
  • have heart rhythm problems
  • have had recent heart attacks or strokes
  • have severe liver or kidney problems.

Can I take cannabis-based products with medicines?

Cannabis-based products have several interactions with medicines, herbal products and illicit or recreational products. This is mostly because of the way they are broken down (metabolised) in your body. Some combinations can have serious effects. Your prescriber or pharmacist will be able to check for interactions. If you are taking medicinal cannabis, it is really important to tell your healthcare provider before starting any medicine or herbal product.

What do I need to know before travelling with medicinal cannabis?

Entering Aotearoa New Zealand

If you are travelling, you may bring a medicinal cannabis product into Aotearoa New Zealand if:

  • the product has been prescribed to you by a registered prescriber
  • you have a copy of the prescription or a letter from your prescriber stating that you are being treated with the product
  • you declare the product on your passenger arrival card
  • you carry the product in its original container, and
  • you are bringing no more than a 3 month supply of a CBD product or a 1 month supply of any other medicinal-cannabis product.

Taking medicinal cannabis products overseas

Before you travel overseas, make sure you check how medicinal cannabis products are classified in any places you plan to visit or transit through. In some countries, possession of cannabis is a criminal offence, with no exemption for medicinal cannabis products.

Other terms you may come across

  • Cannabinoids: These are the chemical compounds found in the plant Cannabis sativa. There are more than 100 identified cannabinoids. THC and CBD are the most recognised and studied among these.
  • Cannabis: This term refers to the cannabis plants Cannabis sativa cultivated as the source of THC. Cannabis has a THC content of more than 0.35%.
  • Cannabis-based product: This is the preferred term for any product containing cannabinoid. This includes products derived from natural or synthetic components of the Cannabis sativa plant.
  • Hashish/hash: This refers to the resin derived from the cannabis plant that has a psychoactive effect.
  • Hemp: Cannabis that contains very low amounts of THC in its flowers and leaves (less than 0.35%) is classified as hemp.
  • Marijuana: This is an alternative name for cannabis when it is used as a psychoactive substance. It usually refers to the dried, crushed flowers and leaves.
  • Medicinal cannabis: This refers to the use of all forms of cannabis-based products for medical purposes, that is, to treat a medical condition or symptoms. ‘Medicinal cannabis’ is not a preferred term as the majority of products do not meet the criteria associated with a medicine.
  • Hemp seed: These are the seeds of the Cannabis sativa plant. The seeds do not contain THC or CBD. Other parts of the plant (eg, leaves and flowers) contain THC and CBD that could contaminate the seed if not processed correctly.
  • Hemp seed oil (also known as hemp oil): This is obtained by pressing hemp seeds. Classified as a food, it does not contain THC or CBD. It is not to be confused with CBD oil.
  • Synthetic CBD products: These are CBD products that have been synthetically manufactured rather than coming from the cannabis plant. Currently, no non-cannabis-derived CBD products have been approved by Medsafe.

Learn more


    BPAC, NZ, 2022 Therapeutic Goods Administration, Department of Health, Australia Australian and New Zealand College of Anaesthetists & Faculty of Pain Medicine, 2022 BPAC, NZ Ministry of Health, NZ


Te reo resources

The Māori Pharmacists’ Association Ngā Kaitiaki o Te Puna Rongoā has a free phone line to answer questions whānau have about their medicines. Call 0800 664 688.

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Note: This is a non-urgent service and they will get back to you within 24 hours.
For urgent health advice freephone Healthline 0800 611 116.

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Credits: Health Navigator Pharmacists. Reviewed By: Maya Patel, MPharm PGDipClinPharm, Auckland Last reviewed: 03 Apr 2022 Page last updated: 05 May 2022

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