How CBD Helps With Fibromyalgia
Fibromyalgia is a medical condition that causes widespread pain, sleep problems, tiredness, and mental and emotional distress. A 2015 study suggested that CBD may have therapeutic anti-inflammatory effects to help with fibromyalgia(1).
According to the study, CBD showed neuroprotective properties while promoting the brain’s cell repair, which may improve brain function in patients with fibromyalgia(2).
Fibromyalgia patients also experience abnormal pain perception processing that makes them more sensitive to pain than those without the medical condition.
According to the Centers for Disease Control and Prevention (CDC), fibromyalgia affects roughly four million US adults or about 2% of the US adult population(3).
Fibromyalgia inflames a part of the brain, which significantly contributes to pain and brain fog. The spinal cord and microglia in the brain also play an essential role in increasing the pain experienced by a fibromyalgia patient(4).
The body’s endocannabinoid system (ECS) possesses cannabinoid receptors known as CB1 and CB2. The latter plays an essential role in regulating the body’s immune system.
The CB1 and CB2 receptors also influence microglial cell function, which serves as the central nervous system’s primary form of active immune defense.
According to a 2016 study, treatment strategies that target these receptors may help improve inflammation(5).
Another study noted that CBD may also improve anandamide signaling, preventing the onset of behaviors linked to depression and anxiety(6).
Also a part of the ECS, anandamide is a neurotransmitter found in the brain that is responsible for regulating moods and homeostasis (state of balance).
Benefits of Using CBD for Fibromyalgia
Pain is the primary symptom experienced by people with fibromyalgia. Various studies have suggested that CBD may help relieve fibromyalgia pain.
An observational study was conducted between 2015 and 2017 to research the effects of CBD and tetrahydrocannabinol (THC) on fibromyalgia patients. THC is the main psychoactive component found in cannabis.
In the study, 52.2% of the patients (193 people) were reportedly struggling with high levels of pain.
Results showed that 81.1% of patients experienced overall improvements after CBD and THC treatment. Six months later, only 7.9% of patients (19 people) reported the same pain intensity(7).
In conclusion, the pain experienced by fibromyalgia patients is said to have declined from a median of 9.0 to 5.0.
Moreover, a study showed that nabilone (synthetic THC) was not well-tolerated by people with fibromyalgia(8). Thus, CBD used alone or in combination with THC may work better to ease fibromyalgia symptoms.
A 2015 review analyzed existing research done on the use of cannabinoids for chronic pain(9). However, the pain is linked to other disorders, like multiple sclerosis, and not only fibromyalgia.
The review suggested that there is high-quality evidence to support the use of CBD in relieving chronic pain.
Medical researchers also studied CBD’s potential in relieving neuropathic pain associated with malfunctioning or damaged nerves.
In a 2019 animal study, CBD demonstrated analgesic properties in rats, with the compound providing relief similar to painkillers(10).
The animal study suggested that regular intake of low-dose CBD may help relieve the pain linked with fibromyalgia. This statement is especially true concerning neuropathic pain caused by the condition(11).
Anxiety and Depression
Aside from chronic pain as a common symptom, fibromyalgia is also often accompanied by anxiety and depression.
Researchers have found CBD to have anxiolytic (anti-anxiety) and antidepressant properties that may reduce anxiety levels, stress, and depression(12).
According to a 2017 human study, an oral intake of 300 milligrams of CBD may contribute to lower cortisol levels and help ease anxiety(13).
Irritable Bowel Syndrome (IBS) Symptoms
Some patients with fibromyalgia also suffer from irritable bowel syndrome (IBS). This condition affects the large intestine and is characterized by abdominal pain, cramping, bloating, gas, constipation, or diarrhea.
An animal study explored how CBD counteracts the inflammatory environment in mice’s bowels and positively affects human colonic cultures(14).
This finding is backed by another study, which states that CBD is excellent in treating IBS. CBD also has no psychotropic effects, which are common in standard medicines(15).
Another symptom that people living with fibromyalgia also have to endure is low sleep quality.
A recent study that examined treatment-resistant epilepsy patients revealed that 30% of the participants experienced sleepiness after receiving one large dose of CBD(16).
Healthy volunteers were tested in another clinical trial to see if large doses of CBD can affect sleep and wake cycles.
The preliminary results of the trial turned out negative, hinting that CBD oil may improve sleep quality in fibromyalgia patients(17). However, more research is still required to determine the safety and efficacy of CBD’s use.
CBD Dosage and Delivery Methods for Fibromyalgia
There is no official recommended CBD dosage for fibromyalgia since studies are limited(18). However, preliminary results from research and trials may provide patients with insights on dosing.
In a 2019 study, a group of fibromyalgia patients was observed for at least six months(19). All of the patients were administered a low dosage of cannabis, which was gradually increased throughout the study.
The approved median dose of cannabis started at 670mg a day and became 1,000mg a day at the study’s sixth month. The approved median dose of THC was 140mg, while the approved median dose of CBD was 39mg a day.
Before the treatment, 193 patients described their pain as high-intensity. After six months of treatment, only 19 patients reported high levels of pain.
In another study, researchers administered 200 mg of CBD and 10mg of THC to 20 patients with sleep problems to reverse insomnia and promote sleep. The small THC amount added to the treatment seemed to have amplified CBD’s effects(20).
However, relief of some symptoms has also been observed on CBD use without the THC. In the study, the dosage ranged from 25mg to 600mg.
The treatment duration and onset time of CBD’s effects on fibromyalgia may vary significantly on the type of symptoms you may have.
Many studies on fibromyalgia focus on the symptoms associated with it rather than examining fibromyalgia as a condition.
Some studies suggest that one to three weeks is needed to observe changes in fibromyalgia pain and stimulate pain-relief related to new bone growth(21).
Another study on anxiety and sleep in 103 patients demonstrated CBD’s anxiolytic (anti-anxiety) effects in one month(22).
Before you buy and take CBD oil for fibromyalgia, it is advisable to get medical advice from a doctor experienced in CBD use.
A trusted healthcare professional will guide you on proper dosage and ensure that CBD does not interfere with any medication.
Ideally, you should start with the lowest dose possible to better understand your body’s reaction to CBD.
If you do not notice changes in any of the symptoms, you may slowly increase your dosage. Observe and take note of any reaction or effects.
You should also consider the following factors when finding the right CBD dose:
- Severity of fibromyalgia symptoms
- Mild symptoms may improve with lower dosing. Meanwhile, a higher, more potent dose may be necessary for severe and chronic symptoms.
- Body weight
- Metabolism and absorption
- How CBD is consumed
Methods of Delivery
There are several ways you can take CBD to help with various symptoms of fibromyalgia, such as via tinctures, gummies, topicals, and vape products. These delivery methods vary in bioavailability or the body’s absorption rate of CBD.
CBD tinctures may be consumed through a sublingual method, which allows you to control the dosage. It involves placing a few drops of CBD oil under the tongue using a dropper.
With the sublingual method, CBD is absorbed directly into the bloodstream in about 10 to 15 minutes, while the effects may last for a few hours(23).
CBD oil may also be ingested through edibles, gummies, or capsules. These products provide a fixed dose of CBD, making it convenient for first-time users.
Vaping may deliver fast-acting effects as CBD is sent directly to your lungs. Thus, CBD is quickly absorbed into the bloodstream and circulated throughout the body.
However, vape use has several side effects, including dry mouth and throat, coughing, and shortness of breath(24). Different lung injuries and diseases are also associated with vaping, such as lipoid pneumonia and collapsed lung(25).
CBD-infused topicals may also be applied directly to the skin to relieve fibromyalgia pain. Topical products include CBD creams, gels, lotions, balms, and salves.
With the topical method, CBD is absorbed through the surface of your skin and interacts with localized cannabinoid receptors. Effects may be noticed within 30 to 90 minutes after application(26).
Although topicals are designed to target painful areas in the body, these products have a limited absorption, which is not enough to reach the bloodstream.
CBD vs. Other Treatments for Fibromyalgia
Fibromyalgia treatment usually consists of pain relievers, muscle relaxants, antidepressants, and sleep medicines(27).
These medications help improve mood, reduce fatigue, promote sleep, and ease other problems associated with fibromyalgia, such as irritable bowel syndrome and restless legs syndrome.
The United States Food and Drug Administration (FDA) has approved three drugs to reduce pain and improve function in people with fibromyalgia. These drugs are duloxetine (Cymbalta), milnacipran (Savella), and pregabalin (Lyrica)(28).
The drugs typically prescribed for fibromyalgia work to turn down “pain volume” in the central nervous system.
However, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and corticosteroids have been found to be largely ineffective in treating fibromyalgia pain(29).
Most patients that take these medications are subject to adverse side effects, such as nausea, dizziness, weakness, dry mouth, and constipation.
Meanwhile, CBD is a natural alternative that has shown minimal adverse reactions when taken continuously. These reactions to CBD are also more uncommon than the side effects of most pharmaceutical drugs for fibromyalgia treatment.
This statement is backed by a review from the World Health Organization (WHO). Based on WHO’s report, CBD was generally well-tolerated during several open-label trials and has an excellent safety profile(30).
Note that the symptoms of fibromyalgia may vary for each individual. Since CBD provides a range of therapeutic effects, it may not always be the best choice in alleviating the symptoms associated with the medical condition.
Risks and Side Effects of Using CBD for Fibromyalgia
Although CBD has potential therapeutic benefits for fibromyalgia and is considered safe to use, side effects may still occur.
Possible adverse reactions to CBD may include dry mouth, nausea, diarrhea, fatigue, drowsiness, loss of appetite, gastrointestinal problems, changes in mood and alertness, and liver damage(31).
A mice study suggested that CBD may increase the risk of liver toxicity, especially if taken in significant quantities(32).
Moreover, a study concluded that CBD has a complex pharmacokinetic profile(33). It is possible for CBD to interact with other drugs and dietary supplements, which may cause more harm than good.
You should avoid CBD if your supplements or medications carry a warning about grapefruit.
Examples of medications with grapefruit warning are buspirone (anti-anxiety drug) and cholesterol drugs, like atorvastatin (Lipitor) and simvastatin (Zocor)(34).
The United States Food and Drug Administration (FDA) also warns consumers against various CBD products being primarily marketed with unsubstantiated therapeutic claims and sold as supplements.
The FDA currently does not regulate the purity and safety of dietary supplements(35). Therefore, most CBD products available in the market do not have approval from the FDA.
Since there is no agency to check if they have undergone thorough testing, some CBD products may contain unknown ingredients. It may be difficult for you to determine if they are safe and effective to use.
Epidiolex is the only FDA-approved prescription drug product derived from a purified form of CBD(36).
This drug is used to treat seizures associated with two rare forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome, in individuals two years of age and older.
How to Choose High-Quality CBD Products
While there are many CBD brands you can find in the market today, you should purchase CBD oil from legitimate and reputable providers only.
However, it may be challenging to identify which CBD products are reliable and safe to use, especially when various products are available.
Choosing the best CBD for fibromyalgia depends on the type of symptoms you experience, the type of CBD product chosen, and your preferences.
The following factors are essential in choosing high-quality CBD products:
Types of CBD Oils
There are three CBD oil types to choose from: full-spectrum, broad-spectrum, and CBD isolates.
Full-spectrum CBD oil contains all the cannabis plant’s naturally occurring cannabinoids and phytocompounds
During the extraction process and filtration, none of the cannabinoids are removed from the whole-plant extract.
Although full-spectrum products contain THC, the amount is less than 0.3%. This THC content is not enough to produce psychoactive effects and get an individual high.
According to a 2005 study, full-spectrum CBD extracts had greater therapeutic properties than pure CBD and produced an entourage effect(37). This effect is a result of the synergistic interaction between cannabinoids and terpenes.
Broad-spectrum CBD contains multiple cannabinoids and other chemical compounds in the cannabis plant. These compounds may include vitamins, minerals, and fatty acids to produce an entourage effect.
Although the entourage effect is possible with broad-spectrum CBD, it is important to note that the effect is more associated with full-spectrum CBD due to the presence of all the cannabis plant’s phytocompounds.
Broad-spectrum CBD oil goes through the normal extraction process. However, the THC compound is removed from the extract.
CBD isolates only contain cannabidiol, making them the purest form of CBD oil. This type of CBD is THC-free and does not have any other cannabinoids, terpenes, or fatty acids from the hemp plant.
During the extraction process, CBD is filtered out after the cannabinoids are extracted. Then, CBD goes through a chilling process called winterization to remove all other chemical compounds.
Source of Hemp
Since CBD products are derived from the hemp plant, you should pay attention to the product’s source of hemp.
Some CBD providers may use harsh chemicals, such as pesticides, fertilizers, or genetically modified organisms (GMOs) in the hemp. Trace amounts of these chemicals in the product could potentially put you at risk.
For this reason, it is advised to choose a CBD company that provides sufficient information on its hemp source and opt for organically grown, non-GMO hemp.
Hemp can come from different sources, like Europe and Asia. In the United States, hemp is mostly grown in Colorado, Oregon, and Kentucky.
Locally grown hemp is recommended, as US farmers and growers are required to possess certification from state departments of agriculture.
The certification ensures that hemp is grown in an area with strict regulations and quality standards. These certifications are also only issued if good cultivation practices are followed.
Hemp farms part of the pilot programs in Kentucky, Colorado, and North Carolina are also ideal hemp sources(38).
CBD extracts are obtained from the hemp plant using various extraction methods, including carbon dioxide (Co2), ethanol, steam distillation, and natural solvents.
Co2 extraction is one of the preferred methods for making CBD products. This extraction method uses carbon dioxide to separate the CBD oil from the plant material.
The extraction process involves a series of pressurized chambers and pumps to expose carbon dioxide to high pressure and very low temperatures.
Using Co2 extraction produces the safest and purest CBD oils. According to an analysis, this method results in high CBD concentrations—as much as 92%(39).
Another commonly used method is ethanol extraction. Ethanol, a plant-based solvent, is used to extract chemical compounds from the cannabis plant.
In this process, the hemp plant material is heated and soaked in ethanol for a specific amount of time. Then, the final solution is filtered to separate the liquids from the hemp plant matter.
CBD and THC Content
You should know how much CBD and THC you are getting from your chosen CBD oil. Dosages are expressed in milligrams (mg) and vary depending on the product form.
Some products do not specify their CBD potencies and only list their total cannabinoid content. This amount may include other related compounds and not just CBD and THC.
CBD and THC are two primary cannabinoids from the cannabis plant. CBD is a non-psychoactive compound found in hemp, while THC is abundant in marijuana and commonly associated with a feeling of high.
With less than 0.3% THC content, CBD is generally safe to use. However, high concentrations of THC may produce psychoactive effects and be detected in drug tests.
CBD oil products are typically made by extracting cannabidiol from the cannabis plant. CBD is then infused into a carrier oil to improve the bioavailability of the product.
There are various carrier oils used in CBD products. Two of the most commonly used oils are hempseed and MCT (medium-chain triglycerides) oil.
The term “hemp oil” is not to be confused with “hempseed oil.” Hemp oil is produced by extracting the oil from hemp, while hempseed oil is extracted from the seeds of the hemp plant.
However, hempseed oil has no CBD content. This carrier oil is rich in omega fatty acids, vitamin E, protein, and bioactive compounds that are beneficial to the body.
Meanwhile, MCT oil is derived from palm or coconut oil. MCT is a type of fatty acid that allows quick absorption, metabolization, and use.
Other CBD Product Ingredients
Other ingredients are sometimes added to CBD products for consistency, flavoring, and other health benefits. Some CBD brands offer products that are free from gluten and vegan-friendly.
For instance, CBD oils or gummies come in a wide range of flavors to mask the strong taste of pure hemp extract. The flavoring also allows CBD oil to be added to food and beverages.
However, you should take note of the other ingredients used in CBD oil. Make sure that CBD products do not contain additives and artificial ingredients by reading the product label.
Third-Party Lab Testing
When choosing a CBD product, it is crucial for you to check whether the CBD company subjects its products to testing by external laboratories. Third-party laboratory testing ensures the safety, purity, potency, and quality of CBD oil products.
Lab test results or certificates of analysis (COA) must be readily accessible on the company’s website. The lab result usually indicates the total amount of cannabinoids in a CBD product.
The COA also reports if the product contains harmful contaminants, such as preservatives, bacteria, pesticides, residual solvents, mycotoxins, and heavy metals.
You should see if the company’s claims about the potency of their CBD products match that of the third-party lab results.
Legality of CBD
CBD is readily available in most parts of the United States. However, the legality of CBD in different states may have varying levels of restriction.
In December 2015, the Food and Drug Administration eased the regulatory requirements to allow researchers to conduct further CBD investigations and trials(40).
On the federal level, the Farm Bill of 2018 legalized hemp-derived CBD oil with less than 0.3% THC(41). The law allowed the growth, production, and manufacturing of hemp federally.
The 2018 Farm Bill also removed industrial hemp as a Schedule I drug from the federal Controlled Substance List.
Meanwhile, all 50 states have their laws allowing CBD with varying degrees of restriction. Many states have passed cannabis-related laws legalizing CBD-rich oils containing high levels of THC(42).
Medical cannabis may be allowed for patients with qualifying conditions under a state’s medical marijuana program(43). Patients may be required a diagnosis and prescription from a licensed physician before being allowed to use CBD.
You should research the exact legal stipulations applicable to CBD in the area where it would be purchased and used.