Adjunctive Cannabinoid-Based Therapy in a Woman With Chronic Widespread Pain, Osteoarthritis, and Sleep Disturbance: A Case Report

Case Report Author: Jean Talleyrand, MD, Family Physician and Cannabis Medicine Specialist, Treating Physician

Abstract

A 46-year-old woman with osteoarthritis, cervical spondylosis, insomnia, stress, and anxiety was managed with a multimodal plan that included trigger point injections, hip joint injection, cervical radiofrequency ablation, and adjunctive use of cannabis-based products, including a standardized nanoemulsified cannabinoid formulation (PhytoRx). Her symptoms reflected overlapping pain, sleep, and stress disturbances, and she reported that she preferred to minimize conventional prescription medications because of poor tolerability. Over serial follow-up, her pain severity and interference reduced, with improving sleep quality and relaxation, worsening when access to the cannabinoid product was interrupted. Brief Pain Inventory and Pittsburgh Sleep Quality Index scores improved during the treatment period, although several interventions occurred concurrently, limiting attribution to any single therapy. This case suggests that standardized cannabinoid-based products may have a potential adjunctive role within individualized multimodal care for selected patients with overlapping chronic pain and sleep symptoms.

Keywords

Chronic pain; cannabis; cannabinoid-based medicinal product; insomnia; fibromyalgia; osteoarthritis; case report

Introduction

Chronic widespread pain frequently coexists with sleep disturbance, anxiety, depressive symptoms, fatigue, and impaired function. These symptom clusters are characteristic of centralized pain syndromes, including fibromyalgia, but may also occur in patients with peripheral nociceptive drivers such as osteoarthritis or degenerative spine disease.¹⁻³˒⁹ In clinical practice, peripheral and centralized pain mechanisms often overlap, complicating diagnosis, treatment selection, and assessment of therapeutic response.

Current pharmacologic and nonpharmacologic treatments for chronic widespread pain and fibromyalgia provide variable and often incomplete benefit.⁴⁻⁶˒¹⁰˒¹¹ Although several medications are used in clinical practice, including anticonvulsants, antidepressants, muscle relaxants, nonsteroidal anti-inflammatory drugs, and opioid-containing analgesics, many patients experience limited efficacy, adverse effects, or poor treatment acceptability.¹⁰˒¹¹ These challenges are particularly relevant for patients who prefer to minimize conventional prescription medication use or who have previously experienced poor tolerability.

Cannabinoid-based products are increasingly used as adjunctive therapies by patients with chronic pain, insomnia, and stress-related symptoms. Proposed mechanisms include modulation of nociceptive processing, inflammatory signaling, affective responses to pain, and sleep regulation through the endocannabinoid system and related neurobiological pathways.⁷⁻⁹ However, clinical interpretation remains limited by heterogeneity in cannabinoid composition, route of administration, dosing, study design, patient population, and outcome measurement. Product-specific reporting is therefore important, particularly in real-world clinical contexts in which cannabinoid products are often used alongside other interventions.

This case report describes a woman with chronic multisite pain, osteoarthritis, cervical spondylosis, insomnia, anxiety, and psychosocial stress who experienced improvement during multimodal management that included interventional procedures and adjunctive cannabinoid-based therapy. The report is presented in accordance with case-reporting principles intended to improve transparency and clinical interpretability.¹˒²

Case Presentation

A 46-year-old woman presented with more than five years of chronic neck, back, hip, shoulder, and widespread body pain. Her history included breast cancer in remission after right mastectomy for secretory adenocarcinoma diagnosed in adolescence, cervical cancer treated with total abdominal hysterectomy in 2018, and an inguinal hernia awaiting repair. Family history was notable for fibromyalgia in her mother and breast cancer in an aunt and grandmother.

Social stressors included one son incarcerated after a 2022 motor vehicle accident and a younger son who sustained a skull fracture in a separate 2022 motor vehicle accident. She works as an insurance administrator in workers’ compensation and travels frequently.

Clinical findings

Her diagnoses included intermittent tension headaches, bilateral hip pain, chronic low back pain, osteoarthritis of the right shoulder, and insomnia due to pain. She had been prescribed tizanidine, acetaminophen with codeine, gabapentin, and later meloxicam, but reported strong aversion to prescription medications and used them sparingly. She preferred turmeric and cannabis-based products, reporting regular cannabis use for more than 10 years.

She described her pain as a diffuse ache, throbbing, and intermittent burning or shooting affecting the neck, shoulders, lower back, hips, and generalized body regions. Imaging showed degenerative joint disease of the hip, cervical spine degenerative changes with mild-to-moderate C5-C6 foraminal narrowing, and normal lumbar and thoracic MRI findings.

Therapeutic intervention

The multimodal treatment plan included trigger point injections to the neck and shoulder region, right hip joint injection, and referral for cervical nerve radioablation. She also used ginger/turmeric supplements for inflammation and continued cannabis products that she had selected herself.

Her cannabis regimen included a Type I Cannabis concentrate delivered by vape cartridge and used 1 to 2 puffs 4 to 5 times daily as needed, and a Type II Cannabis gummy formulation containing 5 mg THC and 5 mg CBD, used 1 to 2 portions one to two times daily during travel as needed. She was counseled regarding potential adverse effects, including drowsiness and impaired coordination, and agreed to avoid driving or operating heavy machinery while using THC-containing products.

After an elective umbilical hernia repair, she began PhytoRx, a liquid cannabinoid product delivered by pump and intended to be added to a beverage. The product contained 50 mg CBD and 25 mg CBG per pump, was described as nanoemulsified for improved bioavailability, and was used in a flexible dose range of 2 to 4 times per 24 hours. The patient selected this product because of ease of use during travel and preference for a nonintoxicating adjunctive option. Consent documentation included disclosure that the product was not FDA approved, that potential drug-drug interactions existed, and that the clinician had no financial ties to the manufacturer.

Results

Figure 1 demonstrates two components of pain: areas of widespread intermittent chronic pain suggesting a centralized component and acute focal post-surgical pain after a hernia repair.  Before initiation of PhytoRx, the patient’s Brief Pain Inventory (BPI) reflected moderate pain severity and moderate pain interference, while the Pittsburgh Sleep Quality Index (PSQI) indicated poor sleep quality. Following the multimodal treatment sequence, she reported substantial improvement in pain and sleep. Her neck pain improved after trigger point injections and later after cervical radioablation. Hip pain improved after a joint injection. She also reported an improvement in post-surgical pain control, relaxation, and sleep continuity after starting PhytoRx, noting that she did not require any pharmaceutical medication.

 

Brief Pain Inventory and Pittsburgh Sleep Quality Index outcomes

Table 1

Pittsburgh Sleep Quality Components

Table 2

Patient denied acute psychiatric symptoms, excessive grogginess, appetite change, or notable adverse effects attributable to cannabis products. Her self-report suggested improved relaxation, sleep continuity, and day-to-day function, with reduced reliance on prescription medications. When access to the product was interrupted, she again reported increased pain and reduced symptom control.  At a later follow-up, after running out of PhytoRx, she noted worsening compared with her response while using it consistently.  

Discussion

This case describes improvement in pain and sleep outcomes in a patient with chronic multisite pain, degenerative musculoskeletal disease, insomnia, anxiety, depressive symptoms, and substantial psychosocial stress during a multimodal treatment course that included interventional procedures and adjunctive cannabinoid-based therapy. The case is clinically relevant because it illustrates the complexity of overlapping pain, sleep, and stress-related symptoms and highlights the importance of individualized, patient-centered treatment planning.

The patient’s pain phenotype was mixed. Degenerative hip disease, right shoulder osteoarthritis, and cervical spondylosis likely contributed to peripheral nociceptive pain. However, the widespread distribution of symptoms, variable pain quality, insomnia, and psychosocial stress suggested a centralized pain component. Central sensitization and altered pain modulation are well described in fibromyalgia and chronic widespread pain and may contribute to symptom amplification, fatigue, sleep disruption, and impaired function.³˒⁹ This overlap is important because tissue-directed interventions alone may not fully address centralized pain mechanisms.

The patient improved after several interventions, including trigger point injections, hip injection, cervical radiofrequency ablation, perioperative recovery, and cannabinoid-based therapy. Therefore, the relative contribution of the standardized cannabinoid formulation cannot be isolated. Nevertheless, the temporal association between PhytoRx use and patient-reported improvements in relaxation, sleep continuity, postsurgical pain control, and avoidance of additional pharmaceutical medication is clinically notable. Her report of symptom worsening when the product was unavailable further suggests a possible adjunctive role, although this observation remains subjective and vulnerable to expectancy effects, regression to the mean, and confounding.

Cannabinoid-based therapies may be relevant for patients with overlapping pain and sleep symptoms because the endocannabinoid system is involved in nociceptive processing, stress responsivity, and sleep-wake regulation.⁷⁻⁹ Cannabidiol and cannabigerol are nonintoxicating cannabinoids of increasing clinical interest, although high-quality human evidence remains limited. In addition, cannabis and cannabinoid products vary substantially in composition, pharmacokinetics, route of administration, and quality control. These factors limit generalizability and underscore the need for precise product characterization in clinical reports and trials.

The patient’s preference to minimize prescription medication use is also clinically important. Reviews of fibromyalgia pharmacotherapy show that available medications may provide modest benefit for some patients but are limited by tolerability, variable response, and incomplete symptom control.¹⁰˒¹¹ In this context, treatment acceptability may influence adherence, perceived benefit, and functional outcomes. The patient was reluctant to use several prescribed medications but was willing to use cannabinoid-based products that aligned with her preferences, travel schedule, and desire to avoid additional sedating or poorly tolerated medications.

This report has several limitations. It describes a single patient without a control condition. Outcomes were primarily self-reported. Multiple interventions occurred during the same treatment period, preventing causal attribution. The patient used several cannabis formulations over time, limiting dose-response interpretation. The standardized product was provided at no cost by the sponsor, introducing potential bias. The findings should therefore be interpreted as hypothesis-generating rather than evidence of efficacy.

Despite these limitations, the case highlights the need for research designs that reflect real-world symptom complexity. Traditional siloed approaches that separately address pain, sleep, and mood may be inadequate for patients with overlapping centralized and peripheral pain mechanisms. Future studies should evaluate standardized cannabinoid formulations in larger cohorts using validated measures of pain intensity, pain interference, sleep quality, mood, function, adverse effects, medication use, and durability of response. Product composition, dose, route, timing, adherence, and concomitant therapies should be clearly reported.

Conclusion

In this patient with chronic widespread pain, degenerative musculoskeletal disease, and sleep disturbance, multimodal treatment including adjunctive cannabinoid-based therapy was associated with improved pain and sleep outcomes and reduced reliance on preferred-to-avoid pharmaceuticals. Because several treatments were delivered concurrently, the contribution of the cannabinoid product cannot be isolated. The case supports individualized multimodal care for overlapping pain-sleep-mood symptoms and further study of standardized cannabinoid formulations as part of an integrative therapeutic approach..

Patient consent

Verbal and written informed consent was obtained from the patient for publication of this case report and accompanying clinical details.

Conflict of interest and funding

This report was sponsored by PhytoRx. The sponsor provided the product at no cost but had no role in patient management, data analysis, or manuscript interpretation.

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