CBD oil and fibromyalgia
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- Research overview
- The studies
- What the experts say
- Bottom line
Fibromyalgia is a disorder characterized by widespread pain, exhaustion, poor sleep quality, and cognitive difficulties that sufferers often experience as brain fog. It is a contentious condition, with medical experts often disagreeing about what constitutes a diagnosis of fibromyalgia, and some debating its existence at all.
Problematically, the FDA-approved drugs traditionally used to treat fibromyalgia have limited efficacy, with commonly used first-line medications such as duloxetine and pregabalin offering little respite from prevailing symptoms such as pain. Fibromyalgia patients often also complain of side effects associated with these medications.
Fibromyalgia is a disorder characterized by widespread pain, exhaustion, poor sleep quality, and cognitive difficulties that sufferers often experience as brain fog. Photo by: Gina Coleman/Weedmaps
For the estimated 2% to 4% of the global population who suffer from this condition, the majority of whom are women, there is an increasing interest in alternative therapies that may provide relief from the symptoms. Cannabidiol (CBD) oil is currently attracting attention as an alternative form of treatment.
There is still no research specifically investigating CBD oil as a treatment for fibromyalgia. However, in 2018 research was published in the “Journal of Clinical Rheumatology” suggesting medicinal cannabis may represent an effective treatment for the illness.
CBD may alleviate certain symptoms associated with fibromyalgia, such as pain, sleep disruptions, anxiety, and depression. Photo by: Gina Coleman/Weedmaps
There is also a solid body of evidence that indicates CBD may alleviate certain symptoms associated with fibromyalgia, such as pain, sleep disruptions, anxiety, and depression.
The brain is one of the key areas affected by fibromyalgia, with brain inflammation contributing to pain and brain fog. Recent research suggests that microglia in the brain and spinal cord play a role in fibromyalgia. When certain cells become activated, they can contribute to inflammation by amplifying pain signaling and transmission.
CB2 receptors within the body can modulate microglial cell function. One 2016 study in the Swiss journal “Cellular and Molecular Life Sciences” suggested that therapeutic strategies aimed at CB2 receptors could provide a promising treatment for inflammation. The therapeutic effects of CBD on inflammation have been documented in a range of studies, such as one published in 2015 in the journal “Bioorganic and Medicinal Chemistry.”
In addition, CBD has seems to offer neuroprotective properties and stimulate cell repair in the brain. This could improve brain function in fibromyalgia patients. CBD oil may also diminish anxiety and depressive behaviors by boosting anandamide signaling, according to results of a double-blind, randomized clinical trial published in 2012 in “Translational Psychiatry”. Anandamide is a neurotransmitter that facilitates homeostasis and balanced mood.
There is a solid body of evidence that indicates CBD may provide alleviation for certain symptoms associated with fibromyalgia. Photo by: Gina Coleman/Weedmaps
In addition to helping to ease inflammation in the body, CBD oil may reduce neuropathic pain, which arises from damaged or malfunctioning nerves. Some fibromyalgia sufferers experience neuropathic pain as one of their symptoms.
Fibromyalgia sufferers also often experience difficulty with sleep. In a March 2019 study, published in “Epilepsy Research,” a single, large dose of CBD induced sleepiness among 30% of participants who suffered from treatment-resistant epilepsy. In another clinical trial with healthy volunteers, however, a single large dose of CBD did not create any change in sleep or wake cycles. CBD oil may help fibromyalgia sufferers with sleep, though further research is needed.
Chronic pain is also often accompanied by other conditions: anxiety or depression are present in almost 80% of the chronic pain population. The co-existence of pain and depression is particularly true for fibromyalgia patients. CBD can help alleviate anxiety in this population. In one 2017 human study, 300 milligrams of CBD taken orally caused a measurable drop in anxiety and cortisol levels.
What the experts say
Dr. George Habib is the co-author of a 2018 retrospective review study in the “Journal of Clinical Rheumatology” investigating medical cannabis as a treatment for fibromyalgia, and he believes it offers fibromyalgia patients hope. ”In general, the impression (from the study) was that this type of medication is more effective than pregabalin and duloxetine,” Habib said.
While there is a still a need for larger randomized trials, Habib, a rheumatologist in Netanya, Israel, believes that the research is promising and that it is worth trying medicinal cannabis for fibromyalgia soon after diagnosis, rather than considering it as an option when opioids fail.
Habib does point out that the patients in the study consumed oil containing both CBD and THC extracts. “A small fraction of our patients used oil, and mostly containing THC, so only a very small number of patients used pure CBD oil,” he said.
Dr. Ginevra Liptan, director of The Frida Center for Fibromyalgia and author of “The FibroManual: A Complete Fibromyalgia Treatment Guide For You. And Your Doctor,” reported that many of her patients have experienced relief from symptoms such as muscle tension, pain, anxiety, and insomnia as a result of combining CBD oil with their mainstream medications. Like Habib, however, she emphasizes that CBD oil appears to be more effective when teamed with THC.
Early studies and anecdotal evidence from patients are promising and indicate that CBD oil may reduce pain and inflammation, support healthy sleep, and improve mood. Photo by: Gina Coleman/Weedmaps
“CBD oil on its own, without any other medications or treatments, typically does not give strong analgesic effects,” Liptan explained. “Successful pain relief without any additional prescription medications usually requires products that contain some amount of THC in addition to the CBD.”
She, therefore, endorses the use of full-spectrum CBD oils for fibromyalgia. “I see much greater benefit from full-spectrum CBD oils, which contain other cannabinoids and sometimes trace amounts of THC, compared to the CBD isolates, which do not have the synergistic effects of the whole plant extract.”
Liptan also notes that the extent to which patients experience relief varies from patient to patient. Some notice only a mild improvement in their pain, while others notice significant pain relief. While cautious not to depict CBD oil as a panacea, Liptan emphasizes that CBD oil represents a safe form of pain relief for fibromyalgia and that it is definitely worth consideration as a treatment.
There is still a lack of conclusive clinical evidence that CBD oil is an effective treatment for fibromyalgia. However, early studies and anecdotal evidence from patients are promising and indicate that CBD oil, particularly full-spectrum CBD, may reduce pain and inflammation, support healthy sleep, and improve mood.
CBD oil and fibromyalgia Copy article link to clipboard. Link copied to clipboard. Contents Research overview The studies What the experts say Bottom line
Fibromyalgia and Cannabinoids
Fibromyalgia – this often means severe pain, exhaustion, sleep disorders and psychological suffering. The symptoms of chronic pain syndrome are varied and vary from patient to patient. Many of those affected have great difficulty in coping with their everyday life and their level of suffering is very high. As some studies have shown, the medical use of cannabis can have a beneficial effect on the disease.
Fibromyalgia – What is it?
Fibromyalgia syndrome (FMS) is characterised by muscle and connective tissue pain, which is particularly evident at certain pain points (tender points). Thus, the term fibromyalgia also means “fibre-muscle pain”. The pain can occur all over the body, but is usually felt near the joints. FMS belongs to the category of rheumatic diseases. In Germany, 2 percent of the population is affected by the chronic pain syndrome, and women are six to seven times more likely to suffer from it than men. 
The cause of the disease is unknown, but doctors assume that a genetic predisposition to the disease plays a role. In addition, traumas such as abuse in childhood, current psychological stress or chronic psychological stress such as stress can promote the development of the disease.
Typical symptoms are chronic, diffuse pain that occurs in different regions of the body and at extremely sensitive tender points. These are particularly sensitive points at the transition from muscles to tendons. In the past, doctors also used these tender points as criteria for diagnosing fibromyalgia, but this is now outdated.
People with fibromyalgia also have other symptoms like sleep disorders, REM sleep disorders and problems falling asleep and sleeping through the night. There are also symptoms like exhaustion and daytime tiredness, and sometimes joint pain and muscle cramps. The patient may experience subjective discomfort in the form of tingling or burning sensations in the hands and feet. Some patients also experience a lack of concentration and forgetfulness.
The illness is often accompanied by a psychological disorder, such as depressive moods. 20 to 30 percent of patients suffer from depression. In addition, the pain syndrome can be accompanied by gastrointestinal complaints, an irritable bladder or restless legs syndrome.
Other fibromyalgia symptoms can also occur:
- Dry mouth
- Excessive sweating
- Tension headache / migraine
- Menstruation complaints
Before they are diagnosed with fibromyalgia syndrome, people usually have many visits to doctors and often suffer from various physical symptoms for several years. But first of all, an inflammatory rheumatic illness has to be ruled out as the cause. The doctor will do a full physical examination. The laboratory blood test shows no abnormalities in fibromyalgia. Imaging diagnostics, such as ultrasound or MRT, do not produce any results either.
In the case of generalised pain that has lasted for more than three months, and when other diseases are ruled out, doctors diagnose fibromyalgia or somatoform pain disorder. By somatoform disorder, doctors mean pain for which no physical cause can be identified and which is often associated with severe psychosocial or emotional stress. The clinical pictures of FMS and somatoform pain disorder are often equated.
Therapy: What helps against fibromyalgia?
Fibromyalgia syndrome is a benign but chronic disease. For many people, dealing with this diagnosis is not easy. Therefore, patient training and patient support groups are an important part of the therapy. Those affected can find information on this through the Fibromyalgia Action UK charity and the American National Fibromyalgia and Chronic Pain Association.
In addition, patients should regularly take part in light sports such as Nordic walking or swimming. Relaxation exercises such as autogenic training or gymnastics are also recommended. Stress reduction and physical activity are an important step in increasing general well-being and quality of life. Physiotherapy or physical therapy with heat can also alleviate the symptoms. Exercising in warm water causes particularly well effects.
Psychotherapy is helpful for many patients. Cognitive behavioural therapy (CBT) in particular is used to treat various chronic pain disorders and sleep disorders.
The use of drugs is difficult because classic painkillers are rarely helpful in fibromyalgia syndrome. Especially those used in rheumatic therapy very often have side effects and should only be used in exceptional cases. If your doctor prescribes medication, these might be antidepressants like amitriptyline or serotonin reuptake inhibitors (SSRIs). Anticonvulsants can also be used. 
Cannabinoids against fibromyalgia symptoms
Recent studies show that cannabinoids might be a useful treatment option for patients with fibromyalgia. For example, researchers from the Clinical Cannabis Research Institute in Israel have analysed data from fibromyalgia patients between 2015 and 2017 in a prospective observational study. The result: 81 percent of the study participants noticed a positive effect from cannabinoid therapy. 
The average pain intensity of the participating patients before treatment was 9 (on the pain scale from 1 to 10). By the end of the observation period, this value had dropped to 5. The most common side effects were mild, especially dizziness, dry mouth, and gastrointestinal problems.
Participants were given cannabis drugs in different compositions. They took cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) in the form of cannabis flowers and/or oil. The CBD and THC content of the medication also varied from person to person.
The authors of the study conclude that “medicinal cannabis can be an effective and safe treatment for fibromyalgia (…)”. Furthermore, the data indicates that “especially for those where standard pharmacological therapies have failed”, medicinal cannabis may be a promising therapeutic option. 
An older study from 2016 already suggested that nabilone might have a better effect on sleep in FMS than amitriptyline. But there were no significant differences between the two drugs for the symptoms of pain and upset. 
Cannabis therapy: Half of the patients can do without other medicines
Also very interesting is a recent study from 2020, in which Israeli scientists interviewed 101 cannabis patients suffering from FMS. They found that treatment with cannabis-based drugs enabled almost half of the patients (47%) in avoiding any other therapy. Slightly more than half (51%) reduced the dose or the number of other drugs used to treat their symptoms. Only one patient discontinued treatment. 
The average improvement in sleep and pain was just over 77 percent. Other symptoms improved less, but more than half of the people interviewed said that cannabis therapy made them spend more time outdoors. The authors of the study concluded that medical cannabis was “an effective treatment for fibromyalgia”. Almost a quarter of the patients reported mild adverse effects. However, these did not lead to discontinuation of the treatment.
High THC content particularly effective for fibromyalgia
Cannabis with a high content of tetrahydrocannabinol (THC) shows good results in treating the pain caused by FMS, but cannabidiol (CBD) does not provide any relief for patients. This is the finding of a 2019 fibromyalgia study by the Leiden University Medical Center (LUMC) in the Netherlands .
The study was conducted by LUMC in collaboration with Bedrocan, a producer of medical cannabis flowers. The research was a randomised, placebo-controlled study that investigated the analgesic effect of cannabis flowers through inhalation in 20 fibromyalgia patients with chronic pain. Three different cannabis varieties with known THC/CBD ratios were used. A placebo without THC and CBD was also used.
The two groups that received cannabis flowers with high THC content felt significantly less pain during the tests than the other patients. They were taking a drug with a lot of CBD and little THC or no cannabis at all.
Fibromyalgia patients: Cannabis use against symptoms and complaints
Very positive results were already obtained in 2018 by scientists from Israel who conducted a survey of cannabis users suffering from fibromyalgia. The researchers sent an internet-based questionnaire to three large fibromyalgia Facebook groups in Israel. The results of the survey showed that cannabis use had a beneficial effect on the patients’ symptoms of pain and sleep problems. Few reported adverse effects or feelings of dependence on cannabis.
For 94 percent of the people who took part in the survey, cannabis use brought relief from pain and for 93 percent improved sleep quality. In addition, the respondents reported positive effects on their psychological disorders. For example, 87 percent felt that the symptom of depression improved and 62 percent felt that existing anxiety states were reduced. 
Recent studies show that treatment with cannabis-based drugs can relieve the pain caused by fibromyalgia. However, more research is needed here too. For example, future trials should aim to compare medical cannabis with the standard treatment for fibromyalgia, so that the right place of cannabinoids in the therapy can be determined.
THC in particular seems to have a special role in the treatment of fibromyalgia symptoms. It is therefore worth investigating how THC works in the long-term therapy of the disease. Of particular interest here is the question of whether fibromyalgia patients can reduce other medications with THC. The effect of cannabis therapy on the other symptoms of fibromyalgia, apart from chronic pain, also needs to be researched.
 Sagy, I.; Bar-Lev Schleider, L.; Abu-Shakra, M.; Novack, V. Safety and Efficacy of Medical Cannabis in Fibromyalgia. J. Clin. Med. 2019, 8, 807. doi: 10.3390/jcm8060807.
 Walitt B, Klose P, Fitzcharles MA, Phillips T, Häuser W. Cannabinoids for fibromyalgia. Cochrane Database Syst Rev. 2016;7(7):CD011694. Published 2016 Jul 18. doi:10.1002/14651858.CD011694.pub2
 Habib G, Avisar I. The Consumption of Cannabis by Fibromyalgia Patients in Israel. Pain Res Treat. 2018;2018:7829427. Published 2018 Jul 22. doi:10.1155/2018/7829427
Gesa Riedewald ist seit 2017 als Medical Writer für das Thema Cannabis als Medizin tätig. Sie hat langjährige Erfahrung in den Bereichen Text und Kommunikation, unter anderem bei Leafly und in der Healthcare-Branche. Die fundierte und wissenschaftliche Berichterstattung zum medizinischen Einsatz von Cannabis liegt ihr am Herzen.
Fibromyalgia and Cannabinoids: recent studies show that treatment with cannabis-based drugs can relieve the pain caused by this illness.