CBD for Fibromyalgia
David Ozeri, MD, is a board-certified rheumatologist. He is based in Tel Aviv, Israel, where he does research at Sheba Medical Center. Previously, he practiced at New York-Presbyterian Hospital.
CBD oil is getting a lot of popular attention as a potential treatment for fibromyalgia. So far, we don’t have a lot of research on it, but we do have some — and it’s promising.
Still, a lot of people don’t really understand what CBD oil is or how it works, and it tends to be wrapped up in the controversy over medical marijuana. That can make people hesitant to try it. There’s also a lot of confusion over whether it’s legal—but there are also some positive changes on that subject.
What Is CBD Oil?
CBD stands for “cannabidiol,” which comes from the cannabis plant. Yes, the cannabis plant is where we get marijuana. However, CBD oil doesn’t have any psychoactive properties, which means it doesn’t get you high.
The substance responsible for the high associated with marijuana comes from a different substance, which is called THC (tetrahydrocannabinol.) Growers who want to maximize the plant’s high use breeds and techniques that focus on higher THC levels. Meanwhile, cannabis that’s grown for hemp is generally richer in CBD than THC, and that’s where CBD is derived from.
CBD that’s extracted from cannabis is being used for a lot of medical purposes, and you can find a lot of impressive-sounding claims online. Are they true? From a scientific standpoint, the answers are more like “possibly” and “some of them appear to be” than a firm “yes,” and it depends on which claims you’re looking at.
People are using CBD oil for a lot of different medical purposes, including:
- Chronic pain and inflammation
- Pain from glaucoma
- Epilepsy, especially in children
- Social anxiety disorder
- Bipolar disorder
- Multiple sclerosis
- Parkinson’s disease
- Movement problems from Huntington’s disease
- Assistance with smoking cessation
- Stopping the growth of cancerous tumors
As of mid-2018, CBD oil is not FDA-approved for any conditions. Research in the United States is in the early stages, though, since for decades, legal restrictions made it extremely difficult to study the medical benefits of marijuana or any of its components. We may see applications submitted to the agency as research continues to move forward.
CBD oil is used in various ways. You can smoke it, swallow capsules, use it under the tongue, in spray or drop form, and topically.
Research for Fibromyalgia
General CBD research is in its infancy, so research on CBD for fibromyalgia could be considered embryonic. We just don’t have much to go on right now. A 2016 survey of the literature concluded that there’s not enough evidence to recommend any cannabis-based treatments for fibromyalgia or other rheumatic conditions.
However, this topic is likely to get a lot of future attention, for several reasons.
First, we have a pain epidemic in the U.S., and fibromyalgia is a major contributor to that. Current treatments just aren’t good enough for most of us, so there’s an enormous financial incentive to find something that’s better at relieving our pain and other symptoms.
We also have an opioid addiction and overdose epidemic. Studies have demonstrated that when a state legalizes marijuana, the number of opioid prescriptions drops . That’s good news for doctors looking for safer pain treatments, law enforcement agencies struggling to control the tide of illegal opioid use, and lawmakers looking for solutions to the opioid problem.
CBD oil is believed to be effective against pain and inflammation, and, in its pure form, it’s generally regarded as safe.
Finally, while anecdotal evidence certainly isn’t scientific proof of anything, we have an abundance of it from people with fibromyalgia who say CBD helps them, and you can bet that when patients who have hard-to-treat conditions tell their doctors something works, it piques their interest.
As for the scientific motivations behind further study, consider that CBD is believed to help relieve:
When it comes to fibromyalgia symptoms, those three are significant.
A 2017 paper published in Expert Opinion on Therapeutic Targets suggested CBD as a possible way to diminish the activity of brain cells called glia, which leads to central sensitization. That’s a major feature of fibromyalgia and other central sensitivity syndromes such as chronic fatigue syndrome, irritable bowel syndrome, and migraine.
Fibromyalgia also involves something called endocannabinoid deficiency. That’s the system that deals with your body’s natural endocannabinoids as well as cannabis products that you may take in. That makes cannabis products a promising treatment.
A 2016 review published in Cannabis and Cannabinoid Research found evidence that CBD is effective in migraine and irritable bowel syndrome, which are related to fibromyalgia. It also stated that some cannabis-based treatments appeared effective for fibromyalgia. The authors stated that CBD is often preferable to patients due to the high and other effects associated with THC.
Some have suggested that CBD can fight inflammation. Fibromyalgia isn’t currently classified as an inflammatory condition, but research suggests that at least some cases may involve inflammation of a body-wide web of connective tissue called the fascia. If that’s accurate, it could be one more reason CBD should be considered.
We don’t have a full picture of the possible side effects of CBD. Some reported side effects include:
- Changes to liver enzymes used to process drugs
- Dry mouth
- Low blood pressure
- Increased tremor in Parkinson’s disease, at high doses
These effects are possible but require more study, according to the World Health Organization:
- Alteration of hormonal levels
- Immune system stimulation at low levels, and immune suppression at higher levels
Addiction and abuse don’t appear to be problems with CBD, and it appears to have a low toxicity level meaning that it takes a lot to overdose.
Is CBD Oil Legal?
You’d think the question, “Is CBD legal?” would be answerable with a simple yes or no. It hasn’t been, and while it’s getting easier to answer that question, it’s still not cut-and-dried (nor is the question of whether or not CBD oil can result in a positive drug test).
You’ve long been able to find a lot of claims by hemp growers and CBD sellers that their product is legal in all 50 states as long as it contains less than 0.3 percent THC. However, a 9th Circuit Court of Appeals ruling disagreed.
Enter the 2018 Farm Bill. This piece of legislation was wildly popular in both the Senate, where it was passed in June of 2018, and the House, where it was passed in December of 2018 and signed into law soon after. It re-classified hemp as a legal agricultural product, which makes CBD products legal at the federal level.
In states where marijuana and/or CBD is legal, there’s no longer a clash between state and federal law. That’s a win for those wanting to take CBD products medicinally.
However, some states have specific laws on the books banning hemp products. So what does the Farm Bill mean for those states?
Technically, federal law overrules state law. That doesn’t mean that those states will stop arresting and trying people on CBD charges, though, especially if they want to challenge the new federal law. If you’re in one of those states, be safe and talk to an expert about any possible trouble you could get into for using CBD products.
The website ProCon.org has information about which states have laws specific to CBD oil. A site called Governing maintains a map of where marijuana is legal in some form.
A Word From Verywell
Certainly, you have a lot to consider when it comes to any treatment, and even more so when it comes to CBD. Consider the pros and cons—including the legal ones—carefully. Be sure to discuss this option with your doctor to make sure you’re safe, and, as with any treatment, watch for side effects.
With legal changes in-store and more research coming, expect things to change rapidly when it comes to CBD oil and other cannabis-based treatments. We’ll likely know a great deal more about the effectiveness and safety of these products a few years from now.
Find out what we know about CBD oil for fibromyalgia, the possible side effects, and whether CBD oil is legal where you live.
How can CBD help with fibromyalgia?
Cannabidiol (CBD) is an oil that derives from cannabis. A growing body of research suggests that CBD may help people with fibromyalgia.
Fibromyalgia is a condition characterized by chronic pain. Studies suggest that CBD may help relieve pain and inflammation, so researchers are looking into its effects on the symptoms of fibromyalgia.
For example, one 2020 review concludes that although current evidence is still limited, the emerging data suggest that cannabis can have a positive effect on fibromyalgia.
Also, although CBD shows promise as a remedy for this condition, research has not yet proven that it is safe and effective, and the Food and Drug Administration (FDA) have not approved CBD for treating fibromyalgia or other forms of pain.
Nonetheless, CBD remains a popular choice. This article will explore why CBD may be able to relieve the pain of fibromyalgia. It will also examine its most effective uses and some potential side effects.
In short, CBD is not the same as cannabis.
CBD is one of more than 100 cannabinoids that come from the cannabis plant. Another compound in cannabis, called tetrahydrocannabinol (THC), is responsible for producing a high.
In most cases, the CBD oil on the market is made from a type of cannabis called hemp, which legally must contain less than 0.3% THC.
Concentrated CBD oil could offer greater benefits with fewer risks than using medical cannabis.
Researchers cannot decisively say why the compound appears to reduce some fibromyalgia symptoms, or why it works for some people and not others, but researchers are currently testing some theories.
The pain relieving effects of CBD are likely down to its effects on the brain. It may interrupt the nerve pathways that send signals of pain between the brain and the rest of the body.
CBD and other cannabinoids attach to specialized receptors in a person’s brain. One of these receptors, called a CB2 receptor, plays a role in managing pain and inflammation.
When CBD enters the body, it may attach to CB2 receptors, or it may cause the body to produce natural cannabinoids (endocannabinoids) that attach to these receptors. This may then result in reduced pain and inflammation.
One 2016 study suggests that a lack of endocannabinoids may be at the root of chronic pain syndromes, including migraine and fibromyalgia.
Using CBD may correct this deficiency, explaining the compound’s success in alleviating chronic pain.
Research is still limited, however, so more studies are needed before researchers can fully understand this process.
For more information and resources on CBD and CBD products, please visit our dedicated hub.
Scientists are now conducting quality research on this treatment method. In the past, research has focused on medical cannabis rather than CBD in particular. New studies are finding benefits linked to this compound.
According to the National Centers for Complementary and Integrative Health, some evidence suggests that cannabis or CBD could have modest benefits for chronic pain.
For example, a 2020 review concludes that CBD could, in some contexts, have benefits for relieving chronic pain, improving sleep, and reducing inflammation.
Anecdotal data also suggest that using CBD oil may alleviate symptoms of fibromyalgia for some people.
Studies also suggest that CBD can relieve pain, improve sleep, and reduce refractory pain in people with various conditions linked to chronic pain, including fibromyalgia, migraine, and irritable bowel syndrome.
People who use medical cannabis are likely to consume some CBD, but exact quantities are unknown. There is a debate about whether CBD is more effective when a person uses it alone or alongside medical cannabis.
A combination of other chemicals in the plant may intensify the positive effects of CBD and provide additional benefits. For instance, one 2006 study suggests that CBD works best in combination with THC.
More evidence is necessary for researchers to know the true effectiveness and safety of CBD for pain and chronic health conditions.
What do the studies say?
A 2020 review concludes that the emerging data suggest that cannabis can have a positive effect on fibromyalgia. The researchers also say, however, that the current evidence is still limited.
A 2019 randomized study looks at the effects of Bediol, a drug that contains both CBD and THC, in people with fibromyalgia. It suggests that more people who took Bediol reported a 30% decrease in pain scores compared with those who took a placebo.
However, other results in this study were inconclusive, and it is unclear whether the effects were due to THC or CBD.
A 2017 study concludes that CBD might counteract the hypersensitivity of cells surrounding nerves in people with chronic pain, including those with fibromyalgia. However, it also points to the need for more research in this area.
A 2015 review analyzes existing research into cannabinoid usage for chronic pain, though not specifically pain linked to fibromyalgia. Seven of the 11 studies included in the review suggest that CBD relieves pain.
A different 2015 review looks at the results of 28 randomized, clinically controlled trials of medical cannabis as a treatment for pain. Many of the trials focused on pain linked to multiple sclerosis. The review suggests that high quality evidence supports the use of medical cannabis to treat chronic pain in some contexts.
Does synthetic cannabis work?
One 2016 review assesses the effects of a synthetic cannabinoid called Nabilone on fibromyalgia. The researchers say that the participants tolerated it poorly, and that it had no significant benefits, compared with a placebo.
On the other hand, a 2020 review states that “synthetic cannabinoids are one of the most promising classes of drugs in pain medicine.”
Research into the effects of synthetic cannabis is limited, so researchers are still investigating its effectiveness.
Why has finding evidence been difficult?
There is limited evidence from human studies to support the benefits of CBD oil, as the use and research of cannabis are still restricted.
As cannabis is becoming legalized in various regions, research is gaining momentum and starting to show some promising results.
Many studies of CBD have limitations, including the following:
- very small participant numbers
- conflicting results
- a lack of control groups or placebos
- a lack of objective measures, relying instead on self-report measures
Other challenges that researchers face include sourcing high quality CBD or medical cannabis (due to a lack of regulation) and controlling the dosage and potency of CBD products.
Although a small group of studies suggests that CBD is effective for fibromyalgia, the data remain mixed and inconclusive.
A variety of websites offer instructions for using CBD oil, but there is little expert insight into usage or dosage. Some people use the oil topically, while others use it orally.
If possible, people may benefit from talking about dosages with a doctor who is knowledgeable about CBD and fibromyalgia.
As with any drug, it is advisable to start with a low dosage and carefully observe the body’s reaction.
The FDA do not regulate CBD products in the same way they regulate drugs, so companies sometimes mislabel or misrepresent their products. This means that it is especially important to do some research to find quality products.
People generally tolerate CBD well, but some have reported side effects. Some common side effects include:
- dry mouth
People should talk to their doctor before taking CBD. CBD may interact with certain over-the-counter aids, dietary supplements, and prescription medications, especially those that warn against consuming grapefruit .
There are also some concerns that CBD might interfere with the liver’s ability to break down toxins by disrupting an enzyme called cytochrome P450 complex.
Although hemp and hemp-derived products that contain less than 0.3% THC are legal under the Farm Bill, there is still some confusion over the specifics.
Research is ongoing, and the legal status of CBD and other cannabinoids varies by state.
If a person in the United States is thinking of trying CBD, they can check their local laws here.
Fibromyalgia is a chronic condition. Although CBD will not cure it, some people find that it can help them manage their symptoms, and research in this area shows promise.
Is CBD legal? Hemp-derived CBD products with less than 0.3% THC are legal federally but still illegal under some state laws. Cannabis-derived CBD products, on the other hand, are illegal federally but legal under some state laws. Check local legislation, especially when traveling. Also, keep in mind that the Food and Drug Administration (FDA) have not approved nonprescription CBD products, which may be inaccurately labeled.
Last medically reviewed on November 2, 2020
Cannabidiol (CBD) may help relieve chronic pain. Learn more about the evidence behind this, plus the potential benefits and risks, here.