Condition

CBD for Fibromyalgia

What is Fibromyalgia

Fibromyalgia, also sometimes called fibromyalgia syndrome (FMS) is a long-term condition that causes pain all over the body that is often accompanied by fatigue, sleep, memory and mood issues. It is believed that the condition amplifies painful sensations by affecting the way in which the brain processes pain signals. Patients report that the pain in these regions feels like a consistent dull ache.

Fibromyalgia is characterized by what is referred to as “regions of pain” with an overlap of certain regions at “trigger points” or “tender points.” Common trigger points included the following:

• Back of the head
• Tops of the shoulders
• Upper chest
• Hips
• Knees
• Outer elbows

A diagnosis of fibromyalgia is made by assessing the number of these “multi-site pain” regions, or trigger points, in addition to the severity (as opposed to duration) of musculoskeletal pain experienced. However, despite being the second most common condition affecting bones and muscles, it is still often misunderstood and misdiagnosed.

Although the exact cause of fibromyalgia is unknown, symptoms can sometimes occur spontaneously after a physical trauma, surgery, infection or significant psychological stress. However, they can also appear gradually and accumulate over time with no single triggering event. In addition, women are more at risk for developing fibromyalgia than are men.

Symptoms of Fibromyalgia

The main symptoms of fibromyalgia include:

• Widespread pain with the pain often being described as a constant dull ache that lasts for at least three months. To be considered widespread, the pain must occur bilaterally and above and below the waist.
• Fatigue and often waking up tired even though long periods of sleep are reported. This is primarily due to sleep being disrupted by pain, however, other sleep disorders, such as restless legs syndrome and sleep apnea, are also common.
• Cognitive difficulties, more commonly referred to as "fibro fog" in a patient with fibromyalgia, impair the patient’s ability to focus, pay attention and concentrate on mental tasks.

Additional symptoms and co-existing conditions also occur, including:

• Headaches, especially tension headaches
• Depression
• Anxiety
• Pain or a dull ache in the lower belly
• Dry eyes
• Bladder problems, such as interstitial cystitis
• Temporomandibular joint (TMJ) disorders
• Irritable bowel syndrome
• Sensitivity to cold, heat, light, or sound
• Numbness or tingling in your face, arms, hands, legs, or feet

Fibromyalgia Medications & Treatments

There is currently no known cure for fibromyalgia, and treatments focus on symptoms management. This includes a combination of medications and self-care, however, no one treatment works for all symptoms and patients are encouraged to see which treatments provide the most relief.

Pharmaceutical Interventions
Medications are prescribed to help reduce the pain of fibromyalgia and improve sleep with common choices, including:

• Pain relievers like over-the-counter drugs like nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen sodium are sometimes enough to provide pain relief. However, for more severe or acute cases, a prescription pain relievers such as tramadol or opioids are prescribed, although the latter is falling out of favor due to their highly addictive qualities and that they may worsen the pain over time.
• Antidepressants including duloxetine (Cymbalta), amitriptyline (Elavil) and milnacipran (Savella) as they may help ease pain and fatigue.
• Muscle relaxants like cyclobenzaprine can help promote sleep.
• Anti-seizure drugs can sometimes be useful in reducing certain types of pain with pregabalin (Lyrica) being the first drug approved by the Food and Drug Administration to treat fibromyalgia.

Non-Pharmaceutical Interventions
A variety of lifestyle changes and alternative therapies can help reduce the symptoms of fibromyalgia and that can vastly improve the quality of life of patients. Examples include:

• Regular moderate exercise is key to controlling fibromyalgia. Low-impact activities like yoga, tai chi, Pilates, and walking that build endurance, stretch and strengthen muscles are recommended to improve mobility. These types of exercises also release endorphins that can naturally improve pain, stress, depression and sleep difficulties.
• Physical therapy can teach patients exercises that will improve strength, flexibility, and stamina. Water-based exercises might be particularly helpful as body weight is supported and minimal strain is put on muscles and joints.
• Occupational therapy can advise patients to make adjustments to work areas or the way certain tasks are performed that will cause less stress on your body.
• Counseling and talking with a trained counselor can strengthen emotional and psychological coping mechanisms, as well as help, manage anxiety, stress and depression.
• Complementary therapies like massage, acupuncture, and chiropractic manipulation can help ease aches, pains, depression, and stress.

CBD for Fibromyalgia

Research & Scientific Evidence

The majority of research regarding cannabinoids and fibromyalgia investigates the effects of medical cannabis with many cannabinoid health care practitioners recommending tetrahydrocannabinol-cannabidiol combinations for effective symptom management. However, for many people and for a variety of reasons, medical cannabis is not an option, and cannabidiol (CBD) may prove to be an effective alternative.

Researchers investigated the ability of CBD and CBD analogues to suppress inflammatory and neuropathic pain. They published their results in a 2012 paper published in the Journal of Experimental Medicine.

After inducing inflammatory and neuropathic pain models, the researchers then injected CBD via intrathecal administration into the mice. Several hypersensitivity, locomotor and other measurement protocols were then analyzed to assess pain levels. In addition, spinal cord slices, biochemical and other molecular analyses were performed to investigate the mechanisms underlying CBD’s analgesic, anti-inflammatory, and antihyperalgesic effects.

The data showed that CBD significantly suppress chronic inflammatory and neuropathic pain via the spinal glycine receptors (GlyRs) that are an important target for the treatment of inflammatory and neuropathic pain.

In short, their study provided several lines of evidence to suggest that CBD suppresses persistent inflammatory and neuropathic pain by targeting α3 GlyRs, making it a potentially effective pain treatment for patients suffering from fibromyalgia.

In a 2016 review published in Cannabis and Cannabinoid Research, the author characterizes Fibromyalgia as a disease that is underpinned by clinical endocannabinoid deficiency syndrome (CEDS), which may also explain co-existing conditions like migraines and IBS.

The theory is that if endocannabinoid function is decreased, the neuropathic pain responses increase, along with joint inflammation, nocioception, mood disturbances, and sleep abnormalities characteristic of fibromyalgia will follow.

For instance, the endocannabinoid system (ECS) affects autonomic outflow through the peripheral and central nervous systems via the CB1 receptors present in the sympathetic nerve terminals. The activation of these receptors inhibits noradrenaline (norepinephrine) release that dampens the sympathetically mediated pain. Similarly, connective tissues are also modulated by the ECS, with inflammatory degradation of connective tissues potentially being dampened by CB1 receptors. In summary, the evidence suggests that plant cannabinoids such as CBD can provide a “gentle pharmacological nudge” that may jump-start the ECS and restore homeostasis in the body which may, in turn, help patients effectively manage and reduce many of the symptoms and co-existing conditions associated with fibromyalgia.

In a 2019 study published in the journal Pain, researchers wanted to provide new insights into the therapeutic efficacy of CBD and its mechanism of action in allodynia and anxiety-like behavior in neuropathic pain.

Adult male rats were divided into naïve, sham, and neuropathic pain induced experimental groups. For acute in vivo dose–response electrophysiological experiments, cumulative injections of CBD (0.05 - 0.25 mg/kg) were given while 5 mg/kg/day for 7 days were administered for the repeated condition. The effects and mechanisms of CBD was assessed using in vivo electrophysiology, mechanical allodynia, and behavioral assays.

The researchers found that treatment with CBD reduced mechanical allodynia, decreased anxiety-like behavior, and normalized 5-HT activity. In addition, repeated treatment with low-dose CBD induced analgesia predominantly through TRPV1 activation in neuropathic pain conditions.

Ingestion of a THC-Rich Cannabis Oil in People with Fibromyalgia: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Hemp contains many cannabinoids. By taking individual CBD oils (full/wide spectrum), we deliver a low concentration of THC to your body. Published in 2020, a randomized, double-blind, controlled study attempted to determine the effect of the use of THC-rich cannabis oil on patients with fibromyalgia, which is characterized by chronic, generalized muscle and joint pain.

Patients were randomly assigned to two groups: the first one was taking THC-rich oil, the second one was taking placebo. The initial dose in both groups was 1 drop of oil per day by sublingual method. Patients were followed at baseline and every 10 days for 8 weeks, during which the dose was increased by 1 drop at each assessment point. The first group finally received a 30 ml bottle of hemp oil of the White Widow variety with a concentration of 24.44 mg/ml THC and 0.51 mg/ml CBD - in the ratio of 48:1 THC/CBD. The placebo group received a dose of olive oil. Clinical effects were assessed at each visit to establish a change or maintain further dosing. 17 women participated in the study, their average age was 51.9 years. People in the cannabis group had previously used depressants, opioids or benzodiazepines. In both groups, patients could use mild analgesics and anti-inflammatory drugs on an ad hoc basis. At each visit, patients completed the Fibromyalgia Impact Questionnaire (FIQ), which assesses physical function, well-being, and physical and mental symptoms. The total number of points that could be obtained in each subpoint was 10. A higher number of points obtained after completing the questionnaire means a greater impact on the quality of life of the participants.

score compared to placebo. The analysis of individual items in the FIQ allows for a significant improvement in the scores concerning: "well-being", "performance of work" and "pain". There were no negative effects of cannabis extract, which means that taking CBD/THC is safe in the treatment of chronic pain, in this case resulting from fibromyalgia

Anecdotal Evidence

In addition to the scientific evidence indicating that CBD shows potential for managing many of the symptoms and co-existing conditions associated with fibromyalgia, anecdotal evidence also shows that CBD may improve help for some patients. However, as mentioned, it would seem that many people find greater symptom relief when using CBD with THC. Self-reported evidence indicates that the use of medical cannabis is associated with beneficial effects on some fibromyalgia symptoms for many patients.

CBD as a Complementary Treatment

CBD can be helpful as a complementary therapy for fibromyalgia patients in a variety of ways. As mentioned, many patients have co-existing conditions and CBD can help alleviate many of these. For instance, CBD can help relieve gastrointestinal issues such as irritable bowel syndrome, diarrhea, and nausea. Likewise, CBD can reduce symptoms associated with depression and anxiety while its calming properties can help mediate insomnia and other types of sleep difficulties and promote REM sleep that may relieve “fibro fog”.

Bottom Line

To date, the majority of the research on cannabinoids and fibromyalgia revolve around THC or a combination of THC and CBD. However, we do know that CBD has several benefits that can directly help manage and reduce many fibromyalgia symptoms. Tin addition to what has been outlined above, CBD also has the ability to  suppress pain processing by activating the CB1 receptors that suppress pain signals as well as CB2 receptors which stimulate opioid receptors. Similarly, CBD can also act as a powerful ally when used as a complementary therapy. However, speak to your treating physician before using CBD as it is contraindicated with use with certain medications. They can also monitor dosage, symptom severity and other clinical parameters, helping ensure that your CBD treatment is both safe and effective.