Symptom management, adherence to therapy, and filling the gaps of medical cannabis therapy: a qualitative study on the importance of nursing consultations for fibromyalgia patients

Background: In agreement with the latest European League Against Rheumatism (EULAR) on patient education for fibromyalgia (FM) treatment, nurses should be involved in the therapeutic plan of FM patients to provide information about the disease and pharmacological and non-pharmacological approaches that can be used to mitigate symptoms, including the use of medical cannabis. This study aims to demonstrate the key role of nursing educational intervention to improve self-care and therapy adherence by FM patients. Design, setting, participants and interventions: All potential subjects, solicited from the Italian Fibromyalgia Syndrome Association (AISF Onlus) address book (n = 1100), were provided with a description of the study as well as a privacy protection form (as an e-mail) subsequent to authorization from the AISF. In this qualitative study, nurse educational intervention (30 min duration) was offered via videoconference to FM patients who were taking and/or had taken medical cannabis as well as patients not in therapy but interested in taking it, who matched the inclusion criteria. Two weeks before the educational intervention, subjects (n = 30) completed the Revised Fibromyalgia Impact Questionnaire (FIQR) and the A-14 Scale on-line. Two weeks following intervention, subjects repeated the FIQR and A-14 Scale in addition to the Clinical Global Impression - Global Improvement (CGI-I) Scale. Results: Historic diagnoses of subjects included terms such as “insane”, “imaginary ill”, and “whiny”; as well, their physical conditions were underestimated by their immediate families. All subjects have problematic employment histories which consistently identified their varied employments as physically too demanding. Over time, increased physician- and societal-awareness, resulted in all subjects being diagnosed with FM; consequently, all subjects reported a strong desire to become well-informed about FM and its treatment. Although medical cannabis (MC) was an available therapy, twenty subjects reported that cannabis had never been proposed despite years of ineffective therapies. Conclusions: The subjects were disappointed and discouraged by the widespread ignorance about their condition and the lack of recognition by the National Health System. Our findings suggest that patients with FM require specialist clinical advice from initial diagnosis through to the end of treatment, and that nurses with in-depth knowledge of fibromyalgia and treatment options are the best professionals to perform this task; furthermore, healthcare professionals should receive a better education about MC-based treatment regimens. Registration: This study protocol conforms to the Declaration of Helsinki and was approved by the Ethics Committee of the University of Milano-Bicocca (Protocol 545 9-7-2020) and registered on Clinicaltrials.gov NCT05247411. Written informed consent for participation in the study and publication of the results was obtained from all respondents.