Written by Dr. Zora DeGrandpre
Updated January 5, 2021
People suffering from fibromyalgia are finding that cannabis products containing CBD work for treating their symptoms, often with less negative side effects than prescription medications.
Before we look at the research into CBD for fibromyalgia, let's take a step back and understand what fibromyalgia is.
What is fibromyalgia?
Fibromyalgia is a chronic disease characterized by symptoms of chronic pain, insomnia, migraines, fatigue, joint pain, mood issues and symptoms of an irritable bowel. While we don’t know the cause(s) of fibromyalgia, it appears to be a sort of hypersensitivity condition where both painful and non-painful stimuli are perceived as pain.
People with fibromyalgia suffer from an increased sensitivity to pain.
This is thought to be caused by an abnormal functioning of pain signals in the central nervous system.
Commonly used treatments for fibromyalgia are pain relievers like NSAIDs and opioids, acupuncture, muscle relaxants, and sleep aids. Exercise therapy, relaxation techniques and stress-reduction techniques can also be helpful. Recently, the European League Against Rheumatism (EULAR) recommended against using NSAIDs.
Some patients are instead opting for CBD products to treat their fibromyalgia.
They are finding that CBD derived from hemp is safer and has fewer side effects than the prescription medications they were previously using.
How does CBD work for fibromyalgia?
While there are many theories about the underlying causes of fibromyalgia, one possibility is that fibromyalgia is one of the conditions caused by an endocannabinoid deficiency or dysregulation of the endocannabinoid system (ECS). Other theories are based in genetics, a history of physical or emotional abuse, hormonal disruptions and other conditions like anxiety and depression that may alter the perception of pain1, 2.
The ECS is a naturally occurring regulatory pathway which plays a role in controlling major systems like the nervous system and the immune system. Overall, a healthy ECS controls sleep, appetite, memory, reproduction, mood and the perception of pain. An endocannabinoid deficiency/dysregulation occurs when a person has a poorly functioning endocannabinoid system, resulting from having abnormal levels of endocannabinoids.
If a person's body doesn't produce sufficient amounts or types of endocannabinoids, they may be more sensitive to pain.
Without a sufficient supply or type of endocannabinoids, the endocannabinoid system cannot properly do its job of maintaining balance in the body — and thus it is believed that people with fibromyalgia experience more pain than what is usual.
CBD can potentially help support the endocannabinoid system: one way CBD may do this is by slowing down the body's natural process of breaking down endocannabinoids3.
What are the effects of using CBD for fibromyalgia?
People using hemp-derived CBD for fibromyalgia are reporting the following benefits:
- Improved mood
- Pain relief
- Improved sleep
- Less inflammation
- Reduction or cessation of prescription medication and henceforth a decrease in negative side effects
What are the side effects of using CBD for fibromyalgia?
Generally, CBD has few side effects and is well tolerated. However, it can be sedating for some people, especially if it is used in high doses.
Some people have reported fatigue, upset stomach and diarrhea to be additional side effects.
Always start with a low dose of CBD and slowly work your way up.
It's a good idea to take CBD the first few times in the comfort of your home, when you do not have to drive, in case you do experience some negative side effects.
How should I use CBD for fibromyalgia (What dosage should I use)?
People with fibromyalgia symptoms are finding the best delivery methods to be capsules or sublingual tinctures because of the speed of the effects from these methods—sublingual dosing is a bit faster. Vaping can be used, but you should know that there are potentially risks inhaling these compounds. We just don’t know.
Most CBD products come as either broad-spectrum (which contain no THC) or full-spectrum products, which contain ≤0.3% THC. CBD is non-intoxicating (non-psychoactive) while THC can be psychoactive. If you are concerned about either the legality or the intoxicating nature of a CBD product, it is best to stick with the broad-spectrum CBD products.
If you are completely new to using CBD, it's always best to start with a low dose of broad-spectrum CBD product and increase the dose very slowly. 5 – 10 mg of CBD is usually the lowest dose—but if you use edibles like gummies, you can cut them in ¼’ s or ½ ‘s to start with.
Increase the CBD dosage as needed until you reach the desired effect.
Always speak with a doctor before using CBD, especially if you already take other medications. CBD can cause drug interactions.
What are terpenes and are terpenes useful for helping with fibromyalgia?
When CBD is extracted from the hemp plant, another very large class of plant substances—the terpenes—are extracted as well. Terpenes are currently a “hot research” topic because many have beneficial medicinal properties that may work alongside CBD in what is known as the “entourage effect”. The following terpenes are good to look for because they work synergistically with CBD to provide relief from inflammation4.
- β-caryophyllene (beta-caryophyllene)
- α-Pinene (alpha-pinene)
- Myrcene
- Linalool
- Limonene
What does the research have to say about cannabinoids and fibromyalgia?
You should know that many of the clinical studies on CBD and fibromyalgia also used THC. This may be difficult and even illegal in some states that do not allow THC to be sold. If you live in a state where medical or “recreational” cannabis is not legal, your best bet may be to try CBD in a full-spectrum product—according to the 2018 Farm Bill, these products can legally contain ≤0.3% THC.
In a recent review on CBD in fibromyalgia, the authors stated “While the current evidence is still limited, emerging data do suggest a positive effect of cannabis in fibromyalgia. Cannabis use is not without risks, including psychiatric, cognitive, and developmental as well as the risks of addiction. As such, clinical judgment is warranted to weigh these risks and prescribe to patients who are more likely to benefit from this treatment. Further research is required to define appropriate patient selection and treatment regimens5.”
Other studies have provided support for using cannabinoids for fibromyalgia, though often for pain relief, some THC was thought to be important6, 7.
Recently, the Arthritis Foundation—which has an interest in fibromyalgia—released guidelines for the use of CBD in arthritis pain. They state that “We are intrigued by the potential of CBD to help people find pain relief and are on record urging the FDA to expedite the study and regulation of these products. While currently there is limited scientific evidence about CBD’s ability to help ease arthritis symptoms, and no universal quality standards or regulations exist, we have listened to our constituents and consulted with leading experts** to develop these general recommendations for adults who are interested in trying CBD8.” The Arthritis Foundation has also urged the FDA to speed up the approval of CBD products for pain relief.
references
1Littlejohn G, Guymer E. Key Milestones Contributing to the Understanding of the Mechanisms Underlying Fibromyalgia. Biomedicines. 2020 Jul 17;8(7):223. doi: 10.3390/biomedicines8070223. PMID: 32709082; PMCID: PMC7400313. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400313/
2Häuser W, Fitzcharles MA. Facts and myths pertaining to fibromyalgia. Dialogues Clin Neurosci. 2018 Mar;20(1):53-62. doi: 10.31887/DCNS.2018.20.1/whauser. PMID: 29946212; PMCID: PMC6016048. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016048/
3Mlost J, Bryk M, Starowicz K. Cannabidiol for Pain Treatment: Focus on Pharmacology and Mechanism of Action. Int J Mol Sci. 2020 Nov 23;21(22):8870. doi: 10.3390/ijms21228870. PMID: 33238607; PMCID: PMC7700528. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700528/
4Gallily R, Yekhtin Z, Hanuš LO. The Anti-Inflammatory Properties of Terpenoids from Cannabis. Cannabis Cannabinoid Res. 2018 Dec 26;3(1):282-290. doi: 10.1089/can.2018.0014. PMID: 30596146; PMCID: PMC6308289. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6308289/
5Berger AA, Keefe J, Winnick A, Gilbert E, Eskander JP, Yazdi C, Kaye AD, Viswanath O, Urits I. Cannabis and cannabidiol (CBD) for the treatment of fibromyalgia. Best Practice & Research Clinical Anaesthesiology. 2020 Aug 15. https://www.sciencedirect.com/science/article/pii/S1521689620300781
6Giorgi V, Bongiovanni S, Atzeni F, Marotto D, Salaffi F, Sarzi-Puttini P. Adding medical cannabis to standard analgesic treatment for fibromyalgia: a prospective observational study. Clin Exp Rheumatol. 2020 Jan 1;38(123):S53-9. https://journals.lww.com/jclinrheum/fulltext/2018/08000/medical_cannabis_for_the_treatment_of_fibromyalgia.12.aspx
7Chaves C, Bittencourt PC, Pelegrini A. Ingestion of a THC-Rich Cannabis Oil in People with Fibromyalgia: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Pain Medicine. 2020 Oct;21(10):2212-8. https://academic.oup.com/painmedicine/article/21/10/2212/5942556?login=true
8(2019, September 24). Retrieved January 05, 2021, from https://www.arthritis.org/about-us/news-and-updates/cbd
