Fibromyalgia and Cannabinoids
Fibromyalgia – this often means severe pain, exhaustion, sleep disorders and psychological suffering. The symptoms of chronic pain syndrome are varied and vary from patient to patient. Many of those affected have great difficulty in coping with their everyday life and their level of suffering is very high. As some studies have shown, the medical use of cannabis can have a beneficial effect on the disease.
Fibromyalgia – What is it?
Fibromyalgia syndrome (FMS) is characterised by muscle and connective tissue pain, which is particularly evident at certain pain points (tender points). Thus, the term fibromyalgia also means “fibre-muscle pain”. The pain can occur all over the body, but is usually felt near the joints. FMS belongs to the category of rheumatic diseases. In Germany, 2 percent of the population is affected by the chronic pain syndrome, and women are six to seven times more likely to suffer from it than men. 
The cause of the disease is unknown, but doctors assume that a genetic predisposition to the disease plays a role. In addition, traumas such as abuse in childhood, current psychological stress or chronic psychological stress such as stress can promote the development of the disease.
Typical symptoms are chronic, diffuse pain that occurs in different regions of the body and at extremely sensitive tender points. These are particularly sensitive points at the transition from muscles to tendons. In the past, doctors also used these tender points as criteria for diagnosing fibromyalgia, but this is now outdated.
People with fibromyalgia also have other symptoms like sleep disorders, REM sleep disorders and problems falling asleep and sleeping through the night. There are also symptoms like exhaustion and daytime tiredness, and sometimes joint pain and muscle cramps. The patient may experience subjective discomfort in the form of tingling or burning sensations in the hands and feet. Some patients also experience a lack of concentration and forgetfulness.
The illness is often accompanied by a psychological disorder, such as depressive moods. 20 to 30 percent of patients suffer from depression. In addition, the pain syndrome can be accompanied by gastrointestinal complaints, an irritable bladder or restless legs syndrome.
Other fibromyalgia symptoms can also occur:
- Dry mouth
- Excessive sweating
- Tension headache / migraine
- Menstruation complaints
Before they are diagnosed with fibromyalgia syndrome, people usually have many visits to doctors and often suffer from various physical symptoms for several years. But first of all, an inflammatory rheumatic illness has to be ruled out as the cause. The doctor will do a full physical examination. The laboratory blood test shows no abnormalities in fibromyalgia. Imaging diagnostics, such as ultrasound or MRT, do not produce any results either.
In the case of generalised pain that has lasted for more than three months, and when other diseases are ruled out, doctors diagnose fibromyalgia or somatoform pain disorder. By somatoform disorder, doctors mean pain for which no physical cause can be identified and which is often associated with severe psychosocial or emotional stress. The clinical pictures of FMS and somatoform pain disorder are often equated.
Therapy: What helps against fibromyalgia?
Fibromyalgia syndrome is a benign but chronic disease. For many people, dealing with this diagnosis is not easy. Therefore, patient training and patient support groups are an important part of the therapy. Those affected can find information on this through the Fibromyalgia Action UK charity and the American National Fibromyalgia and Chronic Pain Association.
In addition, patients should regularly take part in light sports such as Nordic walking or swimming. Relaxation exercises such as autogenic training or gymnastics are also recommended. Stress reduction and physical activity are an important step in increasing general well-being and quality of life. Physiotherapy or physical therapy with heat can also alleviate the symptoms. Exercising in warm water causes particularly well effects.
Psychotherapy is helpful for many patients. Cognitive behavioural therapy (CBT) in particular is used to treat various chronic pain disorders and sleep disorders.
The use of drugs is difficult because classic painkillers are rarely helpful in fibromyalgia syndrome. Especially those used in rheumatic therapy very often have side effects and should only be used in exceptional cases. If your doctor prescribes medication, these might be antidepressants like amitriptyline or serotonin reuptake inhibitors (SSRIs). Anticonvulsants can also be used. 
Cannabinoids against fibromyalgia symptoms
Recent studies show that cannabinoids might be a useful treatment option for patients with fibromyalgia. For example, researchers from the Clinical Cannabis Research Institute in Israel have analysed data from fibromyalgia patients between 2015 and 2017 in a prospective observational study. The result: 81 percent of the study participants noticed a positive effect from cannabinoid therapy. 
The average pain intensity of the participating patients before treatment was 9 (on the pain scale from 1 to 10). By the end of the observation period, this value had dropped to 5. The most common side effects were mild, especially dizziness, dry mouth, and gastrointestinal problems.
Participants were given cannabis drugs in different compositions. They took cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) in the form of cannabis flowers and/or oil. The CBD and THC content of the medication also varied from person to person.
The authors of the study conclude that “medicinal cannabis can be an effective and safe treatment for fibromyalgia (…)”. Furthermore, the data indicates that “especially for those where standard pharmacological therapies have failed”, medicinal cannabis may be a promising therapeutic option. 
An older study from 2016 already suggested that nabilone might have a better effect on sleep in FMS than amitriptyline. But there were no significant differences between the two drugs for the symptoms of pain and upset. 
Cannabis therapy: Half of the patients can do without other medicines
Also very interesting is a recent study from 2020, in which Israeli scientists interviewed 101 cannabis patients suffering from FMS. They found that treatment with cannabis-based drugs enabled almost half of the patients (47%) in avoiding any other therapy. Slightly more than half (51%) reduced the dose or the number of other drugs used to treat their symptoms. Only one patient discontinued treatment. 
The average improvement in sleep and pain was just over 77 percent. Other symptoms improved less, but more than half of the people interviewed said that cannabis therapy made them spend more time outdoors. The authors of the study concluded that medical cannabis was “an effective treatment for fibromyalgia”. Almost a quarter of the patients reported mild adverse effects. However, these did not lead to discontinuation of the treatment.
High THC content particularly effective for fibromyalgia
Cannabis with a high content of tetrahydrocannabinol (THC) shows good results in treating the pain caused by FMS, but cannabidiol (CBD) does not provide any relief for patients. This is the finding of a 2019 fibromyalgia study by the Leiden University Medical Center (LUMC) in the Netherlands .
The study was conducted by LUMC in collaboration with Bedrocan, a producer of medical cannabis flowers. The research was a randomised, placebo-controlled study that investigated the analgesic effect of cannabis flowers through inhalation in 20 fibromyalgia patients with chronic pain. Three different cannabis varieties with known THC/CBD ratios were used. A placebo without THC and CBD was also used.
The two groups that received cannabis flowers with high THC content felt significantly less pain during the tests than the other patients. They were taking a drug with a lot of CBD and little THC or no cannabis at all.
Fibromyalgia patients: Cannabis use against symptoms and complaints
Very positive results were already obtained in 2018 by scientists from Israel who conducted a survey of cannabis users suffering from fibromyalgia. The researchers sent an internet-based questionnaire to three large fibromyalgia Facebook groups in Israel. The results of the survey showed that cannabis use had a beneficial effect on the patients’ symptoms of pain and sleep problems. Few reported adverse effects or feelings of dependence on cannabis.
For 94 percent of the people who took part in the survey, cannabis use brought relief from pain and for 93 percent improved sleep quality. In addition, the respondents reported positive effects on their psychological disorders. For example, 87 percent felt that the symptom of depression improved and 62 percent felt that existing anxiety states were reduced. 
Recent studies show that treatment with cannabis-based drugs can relieve the pain caused by fibromyalgia. However, more research is needed here too. For example, future trials should aim to compare medical cannabis with the standard treatment for fibromyalgia, so that the right place of cannabinoids in the therapy can be determined.
THC in particular seems to have a special role in the treatment of fibromyalgia symptoms. It is therefore worth investigating how THC works in the long-term therapy of the disease. Of particular interest here is the question of whether fibromyalgia patients can reduce other medications with THC. The effect of cannabis therapy on the other symptoms of fibromyalgia, apart from chronic pain, also needs to be researched.
 Sagy, I.; Bar-Lev Schleider, L.; Abu-Shakra, M.; Novack, V. Safety and Efficacy of Medical Cannabis in Fibromyalgia. J. Clin. Med. 2019, 8, 807. doi: 10.3390/jcm8060807.
 Walitt B, Klose P, Fitzcharles MA, Phillips T, Häuser W. Cannabinoids for fibromyalgia. Cochrane Database Syst Rev. 2016;7(7):CD011694. Published 2016 Jul 18. doi:10.1002/14651858.CD011694.pub2
 Habib G, Avisar I. The Consumption of Cannabis by Fibromyalgia Patients in Israel. Pain Res Treat. 2018;2018:7829427. Published 2018 Jul 22. doi:10.1155/2018/7829427
Gesa Riedewald ist seit 2017 als Medical Writer für das Thema Cannabis als Medizin tätig. Sie hat langjährige Erfahrung in den Bereichen Text und Kommunikation, unter anderem bei Leafly und in der Healthcare-Branche. Die fundierte und wissenschaftliche Berichterstattung zum medizinischen Einsatz von Cannabis liegt ihr am Herzen.
Fibromyalgia and Cannabinoids: recent studies show that treatment with cannabis-based drugs can relieve the pain caused by this illness.
CBD for Fibromyalgia
David Ozeri, MD, is a board-certified rheumatologist. He is based in Tel Aviv, Israel, where he does research at Sheba Medical Center. Previously, he practiced at New York-Presbyterian Hospital.
CBD oil is getting a lot of popular attention as a potential treatment for fibromyalgia. So far, we don’t have a lot of research on it, but we do have some — and it’s promising.
Still, a lot of people don’t really understand what CBD oil is or how it works, and it tends to be wrapped up in the controversy over medical marijuana. That can make people hesitant to try it. There’s also a lot of confusion over whether it’s legal—but there are also some positive changes on that subject.
What Is CBD Oil?
CBD stands for “cannabidiol,” which comes from the cannabis plant. Yes, the cannabis plant is where we get marijuana. However, CBD oil doesn’t have any psychoactive properties, which means it doesn’t get you high.
The substance responsible for the high associated with marijuana comes from a different substance, which is called THC (tetrahydrocannabinol.) Growers who want to maximize the plant’s high use breeds and techniques that focus on higher THC levels. Meanwhile, cannabis that’s grown for hemp is generally richer in CBD than THC, and that’s where CBD is derived from.
CBD that’s extracted from cannabis is being used for a lot of medical purposes, and you can find a lot of impressive-sounding claims online. Are they true? From a scientific standpoint, the answers are more like “possibly” and “some of them appear to be” than a firm “yes,” and it depends on which claims you’re looking at.
People are using CBD oil for a lot of different medical purposes, including:
- Chronic pain and inflammation
- Pain from glaucoma
- Epilepsy, especially in children
- Social anxiety disorder
- Bipolar disorder
- Multiple sclerosis
- Parkinson’s disease
- Movement problems from Huntington’s disease
- Assistance with smoking cessation
- Stopping the growth of cancerous tumors
As of mid-2018, CBD oil is not FDA-approved for any conditions. Research in the United States is in the early stages, though, since for decades, legal restrictions made it extremely difficult to study the medical benefits of marijuana or any of its components. We may see applications submitted to the agency as research continues to move forward.
CBD oil is used in various ways. You can smoke it, swallow capsules, use it under the tongue, in spray or drop form, and topically.
Research for Fibromyalgia
General CBD research is in its infancy, so research on CBD for fibromyalgia could be considered embryonic. We just don’t have much to go on right now. A 2016 survey of the literature concluded that there’s not enough evidence to recommend any cannabis-based treatments for fibromyalgia or other rheumatic conditions.
However, this topic is likely to get a lot of future attention, for several reasons.
First, we have a pain epidemic in the U.S., and fibromyalgia is a major contributor to that. Current treatments just aren’t good enough for most of us, so there’s an enormous financial incentive to find something that’s better at relieving our pain and other symptoms.
We also have an opioid addiction and overdose epidemic. Studies have demonstrated that when a state legalizes marijuana, the number of opioid prescriptions drops . That’s good news for doctors looking for safer pain treatments, law enforcement agencies struggling to control the tide of illegal opioid use, and lawmakers looking for solutions to the opioid problem.
CBD oil is believed to be effective against pain and inflammation, and, in its pure form, it’s generally regarded as safe.
Finally, while anecdotal evidence certainly isn’t scientific proof of anything, we have an abundance of it from people with fibromyalgia who say CBD helps them, and you can bet that when patients who have hard-to-treat conditions tell their doctors something works, it piques their interest.
As for the scientific motivations behind further study, consider that CBD is believed to help relieve:
When it comes to fibromyalgia symptoms, those three are significant.
A 2017 paper published in Expert Opinion on Therapeutic Targets suggested CBD as a possible way to diminish the activity of brain cells called glia, which leads to central sensitization. That’s a major feature of fibromyalgia and other central sensitivity syndromes such as chronic fatigue syndrome, irritable bowel syndrome, and migraine.
Fibromyalgia also involves something called endocannabinoid deficiency. That’s the system that deals with your body’s natural endocannabinoids as well as cannabis products that you may take in. That makes cannabis products a promising treatment.
A 2016 review published in Cannabis and Cannabinoid Research found evidence that CBD is effective in migraine and irritable bowel syndrome, which are related to fibromyalgia. It also stated that some cannabis-based treatments appeared effective for fibromyalgia. The authors stated that CBD is often preferable to patients due to the high and other effects associated with THC.
Some have suggested that CBD can fight inflammation. Fibromyalgia isn’t currently classified as an inflammatory condition, but research suggests that at least some cases may involve inflammation of a body-wide web of connective tissue called the fascia. If that’s accurate, it could be one more reason CBD should be considered.
We don’t have a full picture of the possible side effects of CBD. Some reported side effects include:
- Changes to liver enzymes used to process drugs
- Dry mouth
- Low blood pressure
- Increased tremor in Parkinson’s disease, at high doses
These effects are possible but require more study, according to the World Health Organization:
- Alteration of hormonal levels
- Immune system stimulation at low levels, and immune suppression at higher levels
Addiction and abuse don’t appear to be problems with CBD, and it appears to have a low toxicity level meaning that it takes a lot to overdose.
Is CBD Oil Legal?
You’d think the question, “Is CBD legal?” would be answerable with a simple yes or no. It hasn’t been, and while it’s getting easier to answer that question, it’s still not cut-and-dried (nor is the question of whether or not CBD oil can result in a positive drug test).
You’ve long been able to find a lot of claims by hemp growers and CBD sellers that their product is legal in all 50 states as long as it contains less than 0.3 percent THC. However, a 9th Circuit Court of Appeals ruling disagreed.
Enter the 2018 Farm Bill. This piece of legislation was wildly popular in both the Senate, where it was passed in June of 2018, and the House, where it was passed in December of 2018 and signed into law soon after. It re-classified hemp as a legal agricultural product, which makes CBD products legal at the federal level.
In states where marijuana and/or CBD is legal, there’s no longer a clash between state and federal law. That’s a win for those wanting to take CBD products medicinally.
However, some states have specific laws on the books banning hemp products. So what does the Farm Bill mean for those states?
Technically, federal law overrules state law. That doesn’t mean that those states will stop arresting and trying people on CBD charges, though, especially if they want to challenge the new federal law. If you’re in one of those states, be safe and talk to an expert about any possible trouble you could get into for using CBD products.
The website ProCon.org has information about which states have laws specific to CBD oil. A site called Governing maintains a map of where marijuana is legal in some form.
A Word From Verywell
Certainly, you have a lot to consider when it comes to any treatment, and even more so when it comes to CBD. Consider the pros and cons—including the legal ones—carefully. Be sure to discuss this option with your doctor to make sure you’re safe, and, as with any treatment, watch for side effects.
With legal changes in-store and more research coming, expect things to change rapidly when it comes to CBD oil and other cannabis-based treatments. We’ll likely know a great deal more about the effectiveness and safety of these products a few years from now.
Find out what we know about CBD oil for fibromyalgia, the possible side effects, and whether CBD oil is legal where you live.