Early research suggests CBD may help people with fibromyalgia.

Only recently legal in the U.S., cannabidiol (CBD) is widely recognized as an effective analgesic. Of the people using CBD to treat their medical conditions, 62% use it to manage joint pain, arthritis, and chronic pain, such as fibromyalgia.

Fibromyalgia is a chronic, rheumatic disorder that mostly affects women in their 50s and 60s. Characterized by widespread muscular and bone pain, pressure tenderness, and generalized fatigue, other symptoms include anxiety, depression, insomnia, and PTSD.

Despite affecting some 3% of the population, researchers have not identified the causes of fibromyalgia. Currently, there is no cure. In addition, fibromyalgia is frequently diagnosed as another disease or disorder.

Fibromyalgia and other chronic, overlapping pain conditions are clinically challenging to characterize because there isn’t a specific pathology or test to diagnose the condition.

An emerging public health issue, chronic pain is a global problem of massive proportions, especially in industrialized countries. Disabling pain affects 1 in 4 elderly Europeans, more than half of Australia’s seniors (including as many as 80% of nursing home residents), and 19% of Americans.

Standard treatments for fibromyalgia

OTC remedies, such as Tylenol (acetaminophen), Advil (ibuprofen), or Aleve (naproxen sodium), may help relieve chronic pain and inflammation. Tramadol, a prescription medication with effects similar to opioids, has also been used successfully. The doctor will probably avoid prescribing narcotics because of the dangers of addiction. Narcotic use could also worsen the pain over time.

Duloxetine and milnacipran, prescription antidepressants, may reduce pain and fatigue. Certain tricyclic antidepressants and muscle relaxants may also be prescribed.

Certain anti-seizure drugs, such as gabapentin and pregabalin, sometimes help reduce fibromyalgia pain symptoms. The U.S. Food and Drug Administration approved pregabalin, an anti-seizure medication, the first drug specifically for the treatment of fibromyalgia.

However, there is no single standard treatment for fibromyalgia. Doctors often use multiple over-the-counter and prescription drugs to address specific symptoms, which many times include unpleasant or even intolerable side effects. Complicating treatment is the fact that the effectiveness of a course of treatment varies from individual to individual.

Treating symptoms of fibromyalgia with CBD

Research findings support CBD’s effectiveness in reducing pain, improving sleep, and diminishing refractory (intractable) pain associated with fibromyalgia.

CBD reduces inflammation in the brain. Inflammation contributes to perceived pain, inducing hibernation in the brain’s glial cells (cells that hold nerve cells in place and help them work the way they should).

CBD also demonstrates some neuroprotective properties, such as lessening traumatic brain damage by stimulating cell repair. This reaction indicates that CBD could improve brain function and reduce fog common in fibromyalgia.

Orally and topically, in studies of rats with inflamed, painful joints and nerve damage, CBD reduced pain behaviors. It also lowered stress response behaviors (fight or flight), a response that in fibromyalgia is overactivated.

The body’s endocannabinoid system (ECS) regulates immune system response, promotes and improves sleep and appetite, and helps alleviate pain. Researchers have shown CBD affects ECS receptors to reduce chronic pain perception.

Cannabis and fibromyalgia

Although cannabis—the whole plant—has been reported to be effective in reducing pain, there have been no human trials on CBD alone. 

While there are no currently published studies on fibromyalgia and CBD alone, there is research that examines the effects of the multiple cannabinoids in cannabis, or medical marijuana, on fibromyalgia. Results are mixed, and more human studies are required to confirm the early promise of some studies.

A small 2011 study of limited duration included 56 fibromyalgia patients; most were women. Divided into two groups of 28 participants each, one group consisted of non-cannabis users and the other of cannabis users whose frequency and quantity cannabis use varied. After 2 hours, cannabis users reported reduced pain and stiffness and increased sleepiness. Researchers found the cannabis users also had slightly better mental health scores.

A 2019 Dutch study looked at the effect of cannabis on 20 women with fibromyalgia. During the study, each participant received 3 different cannabis varieties and a placebo containing no cannabinoids:

• 200 mg of cannabis with high levels of CBD and THC (Bediol)
• 200 mg of cannabis with high levels of CBD and low levels of THC (Bedrolite)
• 100 mg of cannabis with high levels of CBD and high levels of THC (Bedrocan)

Researchers found similar spontaneous pain scores in people using the placebo, compared to those using some of the non-placebo varieties.

Bediol relieved pain for a more significant number of people than the placebo, a 30% reduction in spontaneous pain for 18 of 20 participants. Eleven placebo users also reported a 30% reduction.

Bediol and Bedrocan, high-THC varieties, showed significant improvement in pressure pain thresholds compared to the placebo.

Bedrolite, which is high in CBD and low in THC, showed no evidence of relieving spontaneous or evoked pain.

An Israeli study, “Safety and Efficacy of Medical Cannabis in Fibromyalgia,” published in 2019 in the Journal of Clinical Medicine, studied 367 people with fibromyalgia for 6 months. Of the participants, 82% were women.

Nurses advised study participants before taking medical cannabis about the cannabis strains available, delivery methods, and dosage.

Participants began the study with an average dosage of 670 mg/day, increasing to a median of 1,000 mg/day by the end of the 6-month study period. The average approved THC dosage was 140 mg, and CBD was an average of 39 mg a day.

The researchers could only follow up with approximately 70% of the participants, which limited their ability to draw concrete conclusions. Also, researchers used many different cannabis strains, making it difficult to compare the effects of CBD-rich and THC-rich strains.

As the study began, 52.5% of participants, 193 people, rated their pain levels as high. At 6 months, and of those who responded (approximately 70% of participants), 19 people reported high pain levels. Despite the 30% decrease in participants, researchers still concluded cannabis is effective and safe for the treatment of fibromyalgia.

Research into the benefits of CBD, especially for chronic pain, is still in the early stages. While there are some successes, the FDA has not yet approved CBD as a treatment for fibromyalgia.

While CBD can be a useful tool for pain management, consult a physician before beginning a course of treatment to avoid adverse side effects or interactions with your current medication regimen.