By Karen Lee Richards
Finding effective fibromyalgia treatments for the pain, inflammation, and other life-altering fibromyalgia symptoms can be extremely challenging. To date, three drugs have received FDA-approval for the treatment of fibromyalgia. Unfortunately, each of them only seems to be effective for a small percentage of patients, and all of them can have significant negative side effects. Some, like Cymbalta, can also cause terrible withdrawal symptoms when patients try to stop taking them.
However, the increasing number of states legalizing marijuana and the federal legalization of hemp-based CBD oil have people in the fibromyalgia community excited about the new options available to them.
What Patients are Saying About CBD for Fibromyalgia
As the use of CBD oil becomes more common, anecdotal evidence of its beneficial effects for fibromyalgia is growing. Some patients report mild to moderate symptom relief, while others have experienced a remarkable turnaround.
Dr. Ginevra Liptan, author of The FibroManual: A Complete Fibromyalgia Treatment Guide for You and Your Doctor, not only treats fibromyalgia patients, she herself has fibromyalgia. In her article The Science of CBD for Fibromyalgia, she shares her experience with using CBD:
I have found CBD acts as a strong muscle relaxant and that gives some mild pain relief. When used topically in combination with other herbs such as arnica, I find it helps joint and muscle pain. Some of my patients report it gives them significant pain relief, others report only mild benefits and some report no benefit at all.
Dr. Liptan goes on to say that CBD has also lowered her anxiety, helped with insomnia and calmed feelings of hypervigilance from an overactive fight-or-flight response. Although CBD is not a “cure-all,” she feels it is much safer than most other pain-relieving options and is “definitely worth consideration.”
Some fibromyalgia patients have reported an even more dramatic result. For example, a member of Cort Johnson's HealthRising forum community, sharing her experience after just three weeks of using CBD oil said, “This Oil has changed my life, no exaggeration! My pain has gone from a 8-10 most of the time, to a 2-4. I am sleeping better, mood is greatly improved, and my family can't believe how much better I am. I have had fibro for 25+ years, and nothing has come close to helping me like this oil.”
CBD Oil and Fibromyalgia Symptoms
There has been some research done on the effectiveness of cannabis for fibromyalgia, but thus far, there have been no studies on the specific use of CBD oil for fibromyalgia. There are, however, several applicable studies on the use of CBD for many of the symptoms of fibromyalgia.
1. Pain and Inflammation
The number one symptom most identified with fibromyalgia is pain, and CBD is probably best known for its ability to reduce pain and inflammation.
One of the most interesting new theories related to CBD for fibromyalgia comes from a 2016 article in the journal Cannabis and Cannabinoid Research suggesting that part of the problem with fibromyalgia, as well as overlapping conditions like migraines and irritable bowel syndrome (IBS), may be a deficiency of endocannabinoids –– neurotransmitters that bind to cannabinoid receptors. The body naturally produces endocannabinoids like anandamide, which has already been found to be lacking in migraineurs.
Since the endocannabinoid system helps regulate several functions in the body, including parts of the nervous system, the immune system, endorphins, metabolism and hormones, it makes sense that a deficiency of endocannabinoids could result in the pain and other symptoms of fibromyalgia. One reason CBD oil seems to be so effective with many fibromyalgia patients may be because it helps increase the endocannabinoids that are lacking.
Additional studies supporting the effectiveness of CBD for pain relief include:
- A 2012 study published in the Journal of Experimental Medicine found that the use of CBD can reduce pain and inflammation. They also noted that CBD apparently does not cause analgesic tolerance, requiring ever-increasing dosages, as usually happens with pain medications.
- A 2017 paper published in Expert Opinion on Therapeutic Targets listed CBD oil as a possible option for reducing the activity of glia — the brain cells thought to be involved in sensitization of the central nervous system and a feature of fibromyalgia as well as other central sensitivity syndromes like ME/CFS, migraines, IBS and Lyme disease.
- One report assessed the results of several systematic reviews, which covered dozens of studies on CBD for pain. Their research suggests adult, chronic pain patients who used of cannabis or cannabinoids in were more apt to experience a substantial reduction in pain.
2. Sleep problems
People with fibromyalgia typically have significant sleep issues, such as difficulty falling asleep, waking frequently, never getting into a really deep sleep, and waking up feeling like they hadn't slept at all.
We know there are CBD receptors in the part of the brain responsible for maintaining sleep/wake cycles. A study done on animal models has shown that activating those receptors with CBD can induce sleep, which would lend support to the endocannabinoid deficiency theory.
Other human trials demonstrating the beneficial effects of CBD for improving both the quantity and quality of sleep include:
- An early clinical trial gave 160 mg of CBD to people suffering from insomnia. After just a few days, the participants reported sleeping longer and waking less frequently during the night.
- CBD was shown to improve complex REM sleep disorders in Parkinson's disease patients in a 2014 study published in the Journal of Clinical Pharmacy and Therapeutics.
- A 1993 study done with healthy volunteers confirmed the sedative effects of CBD.
Most fibromyalgia patients report having moderate to extreme fatigue. While CBD might not be able to restore energy to pre-fibromyalgia levels, it can often provide a significant energy boost.You may be wondering how CBD can help with sleep, yet also help improve energy. One very interesting quality of CBD is that it is biphasic, meaning that at different concentrations, it can have very different - sometimes even opposite - effects. At low concentrations, CBD tends to promote wakefulness and energy, while at higher concentrations, it can promote better quality sleep.
Several studies, including a 2014 study, published in the journal Current Neuropharmacology, reported on the potential of CBD to promote wakefulness. Exactly how it works is still being studied, but some experts believe CBD helps to strengthen the cells that are involved in making you sluggish and sleepy, as well as improving focus and mental clarity.
4. Depression and Anxiety
Depression and anxiety are two symptoms that often accompany fibromyalgia. For those who prefer not to take antidepressant and anti-anxiety drugs, or who experience negative side effects from those medications, CBD may offer an effective natural alternative.
Several studies have confirmed the antidepressant and anti-anxiety properties of CBD. Here are a few:
- A review published in the September 2015 issue of Neurotherapeutics looked at 49 preclinical, human experimental, clinical, and epidemiological studies. They found evidence that supports the use of CBD oil to ease anxiety.
- Both a 2014 review and a 2018 review of multiple studies found that CBD may act as an antidepressant in animal models of depression.
5. Cognitive Function
Fibromyalgia patients frequently complain of problems with cognitive functioning, sometimes referred to as “fibro fog.” Although the chronic use of cannabis - which contains high levels of THC - has been associated with impaired cognitive function, a 2013 study showed that the use of CBD oil - which contains little to no THC - can actually help improve cognition.
A 2018 study further supported the cognitive benefits of CBD oil by suggesting prolonged use of CBD oil may have promising therapeutic effects for cognition, even among regular cannabis users.
What Form of CBD Oil Is Best for Fibromyalgia?
The most common preparations of CBD oil are oral, sublingual, vaporized and topical. When it comes to choosing which form of delivery to use, bioavailability — referring to how much CBD actually gets absorbed into the bloodstream — is an important issue. Following are the approximate absorption rates for these primary forms of delivery:
- Oral: 4% to 20%
- Sublingual: 12% to 35%
- Vaporized: 34% to 60%
- Topical: 45%
Although absorption rates are important to consider, they don't tell the whole story. There are other considerations to keep in mind when deciding which CBD product may be best for you.
Oral consumption refers to CBD that is swallowed, whether as an oil, in capsule form or in food. When taken orally, CBD has to first pass through your digestive system before circulating through your liver. This process means it will take awhile for the CBD to reach your bloodstream and then only a small portion of it will actually get there. However, on the positive side, what doesn't reach your bloodstream is stored in fatty cells and can be released over a period of days. Therefore, if oral CBD is consumed consistently and on a regular basis, it can provide a steady, long-lasting effect. This can be particularly helpful for chronic illnesses like fibromyalgia.
Sublingual consumption refers to CBD that is administered under the tongue, in the form of oils, tinctures, sprays or lozenges. This method bypasses the digestive system and is absorbed directly into the bloodstream. When using CBD sublingually, you should hold it under your tongue for at least a minute or two before swallowing to allow it to be absorbed by the mucous membranes. Sublingual delivery gets the CBD into your bloodstream much faster than oral consumption, but the effects won't last quite as long since it's not being stored in the fatty cells. . [Try Dr. Formulated CBD+ Stress Relief Liquid Drops by Garden of Life]
Vaporized consumption refers to CBD that is inhaled through the use of a vaporizer pen. This method, also referred to as “vaping,” has the highest bioavailability rate and is the fastest way to get the CBD into your bloodstream. The effects can be felt in as little as 15 minutes, but they do tend to wear off after just two or three hours. However, if you're in pain and looking for fast relief, vaporizers can be an excellent option. (Note: If you decide to use a vaporizer, be sure to either choose a pre-loaded vaporizer pen or purchase CBD oil that is especially designed to be used in vaporizers. Using regular CBD oil in a vaporizer pen can damage your lungs.)
Topical administration refers to CBD that is applied directly to the skin in the form of creams, lotions, balms or salves. While topical application doesn't really get a lot of CBD into the bloodstream, it does absorb into the skin and interact with the nearby cannabinoid receptors. This can be an effective method of delivery for localized pain relief. It can, however, take from one to 48 hours to be effective, depending on the dose and frequency of use. Many users find that regular topical application provides the best and longest lasting relief for localized pain. However, for the body-wide pain and aching often experienced by people with fibromyalgia, topical CBD may not be the most practical choice.
How Much CBD Should I Use?
There is no single or simple answer to how much CBD oil is right for you. Since people with fibromyalgia are usually hypersensitive to many things, including foods, medications and supplements, the best rule of thumb to follow is always to “start low and go slow.” Begin with the smallest dose possible for whichever delivery method you choose. If you're able to tolerate that without significant side effects, gradually increase the dose until you find a dose that provides the symptom relief you're looking for without negative side efffects.
This article was first published on ProHealth.com on July 14, 2019 and was updated on December 8, 2020.
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Karen Lee Richards is ProHealth’s Editor-in-Chief. A fibromyalgia patient herself, she co-founded the nonprofit organization now known as the National Fibromyalgia Association (NFA) in 1997 and served as its vice-president for eight years. She was also the executive editor of Fibromyalgia AWARE magazine. After leaving the NFA, Karen served as the Guide to Fibromyalgia and Chronic Fatigue Syndrome for the New York Times website About.com, then worked for eight years as the Chronic Pain Health Guide for The HealthCentral Network before coming to ProHealth. To learn more about Karen, see "Meet Karen Lee Richards."