How To Use CBD for Fibromyalgia
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 pain 1 , 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 endocannabinoids 3 .
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 inflammation 4 .
- β-caryophyllene (beta-caryophyllene)
- α-Pinene (alpha-pinene)
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 regimens 5 .”
Other studies have provided support for using cannabinoids for fibromyalgia, though often for pain relief, some THC was thought to be important 6 , 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 CBD 8 . ” The Arthritis Foundation has also urged the FDA to speed up the approval of CBD products for pain relief.
There Are New Guidelines for Treating Chronic Pain with Cannabis, According to an International Task Force
Cannabis, also known as marijuana, has long been used to ease pain from various causes. Yet many health care providers are reluctant to recommend it to chronic pain patients, in part thanks to a lack of information about how best to use it, dosages, and more.
An international task force hopes to change that by offering more prescriptive guidelines for treating chronic pain with medical cannabis.
The task force, led by Arun Bhashkar, MD, from the Imperial College in London, announced its recommendations for administering and dosing medical marijuana at the recent PAINWeek meeting that was held virtually. To reach their recommendations, Dr. Bhashkar and colleagues surveyed “medical cannabis leaders” in nine countries 20 different countries to learn about how medical cannabis is being used.
“There’s a huge knowledge gap and no way clinicians can fall back on a specified dosing regimen,” co-author Alan Bell, MD, of the University of Toronto, told MedPage Today.
After analyzing the responses, the group outlined a consensus of protocols for treating chronic pain patients with cannabis, starting with how the drug ought to be administered.
Type of Cannabis
They concluded that oral oil or capsules are best, but that vaping dried flower is an option for treating an especially painful flare-up.
No one should be taking more than 40 mg of CBD and 40 mg of THC a day, they noted. CBD stands for cannabidiol, a cannabis compound that is not psychoactive. THC stands for tetrahydrocannabinol, the component of cannabis that may get users “high.”
According to the group, the starter dose for most chronic patients should be 5 mg of CBD per day, which may be increased by 10 mg every two to three days as necessary to relieve pain.
Patients who reach the maximum daily dose of CBD and are still in pain may benefit from adding 2.5 mg of THC. THC may be increased by 2.5 mg every 2 to 7 days.
Conservative Protocol for Higher-Risk Patients
The task force also outlined a “conservative” protocol for those who are frail, elderly, and others who are more apt to experience cannabis side effects. That group of patients should start with the same CBD protocol but go more slowly if THC is required — just 1mg of THC, and increasing it by 1 mg once a week if necessary.
Patients who are in need of greater, faster relief may instead scale up more quickly, the task force suggested: They may start with 2.5-5mg of CBD plus THC once or twice a day and increase their dose of both compounds by 2.5-5 mg daily if needed.
Not Sure What’s Causing Your Pain?
Check out PainSpot, our pain locator tool. Answer a few simple questions about what hurts and discover possible conditions that could be causing it. Start your PainSpot quiz.
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How effective is it?
Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.
The effectiveness ratings for CANNABIDIOL (CBD) are as follows:
Likely effective for.
- Seizure disorder (epilepsy). A specific prescription product (Epidiolex, GW Pharmaceuticals) is approved by the US FDA to treat seizures caused by Dravet syndrome, Lennox-Gastaut syndrome, or tuberous sclerosis complex. It is unclear if other forms of CBD are helpful for seizure. For now, stick with the prescription product.
Are there safety concerns?
When taken by mouth: CBD is possibly safe to take in appropriate doses. Doses of up to 200 mg daily have been used safely for up to 13 weeks. With the guidance of a healthcare provider, a specific prescription CBD product (Epidiolex) has been used at higher doses and for longer durations.
CBD can cause some side effects, such as dry mouth, low blood pressure, light headedness, and drowsiness. Signs of liver injury have also been reported with high doses of the prescription form of CBD, called Epidiolex.
When applied to the skin: There isn’t enough reliable information to know if CBD is safe or what the side effects might be.
Special precautions & warnings:
Pregnancy and breast-feeding: It may be unsafe to take CBD if you are pregnant or breast feeding. CBD products can be contaminated with other ingredients that may be harmful to the fetus or infant. Stay on the safe side and avoid use.
Children: It is possibly safe for children to take a specific prescription CBD product (Epidiolex) by mouth in doses up to 25 mg/kg daily. This product is approved for use in children with certain conditions who are at least 1 year old. It isn’t clear if other CBD products are safe in children.
Liver disease: People with liver disease may need to use lower doses of CBD.
Parkinson disease: Some early research suggests that taking high doses of CBD might make muscle movement and tremors worse in some people with Parkinson disease.
Are there interactions with medications?
Are there interactions with herbs and supplements?
Are there interactions with foods?
CBD can be taken with food or without food. But taking it with food can cause the body to absorb more CBD than when it is taken without food. This might increase the effects of CBD.
Fatty foods or drinks, such as whole milk, and alcohol can also make the body absorb more CBD.
What dose is used?
CBD has most often been used by adults in doses of 200 mg or less per day. Speak with a healthcare provider to find out what dose might be best for a specific condition.
For information on using prescription CBD, a product called Epidiolex, speak with a healthcare provider.