Can CBD oil help fibromyalgia?
Fibromyalgia is a long-term health condition characterised by chronic widespread pain and an increased sensitivity to pressure on the body. Also called fibromyalgia syndrome (FMS), it can include a number of other symptoms and can lead to anxiety and depression. It may affect between 2% and 8% of the population and is significantly more common in women.
Fibromyalgia symptoms and associations
- Chronic widespread pain
- Increased sensitivity to pressure
- Extreme tiredness or fatigue
- Difficulty sleeping
- Problems with memory and concentration
- Numbness / tingling feelings
- Irritable bowel syndrome (IBS)
The specific causes of fibromyalgia are still far from clear but it appears to be associated with changes to the way the central nervous system processes pain signals. It can be triggered by a physically or emotionally traumatic event, such as injury or illness, grief or loss. There may also be an inheritable element to it.
There is no single cure for fibromyalgia and the symptoms are often treated with a combination of traditional medicines such as painkillers and anti-depressants, counselling and cognitive behavioural therapy (CBT) and lifestyle changes.
Exercise and anti-inflammatory diets – cutting out processed foods such as refined sugar and carbohydrates – can help to reduce pain and other symptoms in many people with fibromyalgia.
However, variations in symptoms and responses to treatments mean potential natural remedies remain of interest to sufferers.
CBD, or cannabidiol, is one of a number of compounds known as cannabinoids found in cannabis and hemp plants. Unlike the psychoactive cannabinoid THC, CBD does not produce the ‘high’ associated with smoking cannabis. However, it is becoming increasingly popular as a natural wellness remedy and initial research suggests it may have benefits for numerous health conditions.
Can CBD help fibromyalgia?
Since the root cause of fibromyalgia is not fully understood, treatments tend to focus on the symptoms and there is good evidence that CBD can treat some of these, including pain, sleeping problems and anxiety.
A 2011 review of studies, and a 2015 follow-up, looked at the effect of cannabinoids including CBD on chronic pain. It concluded that they can have significant success in reducing pain and that they are a safe alternative to existing medications, exhibiting minimal side-effects.
A retrospective study of psychiatric patients looked at the impact CBD had on both anxiety and sleep disorders. It found that almost 80% of subjects saw a reduction in anxiety within their first month of taking CBD while 67% reported improved sleep during the same period.
Animal research has also provided initial suggestions that CBD may induce anti-depressant-like effects in mice and rats comparable to those of a clinical anti-depressant, imipramine (brand name Tofranil). The study said the effects were likely the result of CBD’s interaction with receptors that produce the mood-stabilising hormone serotonin.
Specific studies into the use of CBD to treat fibromyalgia are rare but several have looked at the effects of cannabis on the condition.
A study of three strains of pharmaceutical grade cannabis given to fibromyalgia patients showed a reduction for a significant number in the pain caused by an electrical stimulus, as well as an increase in their thresholds for pressure pain. This was only seen in varieties of cannabis containing THC as well as CBD, although the addition of CBD did appear to improve the effect. The study also noted that in the case of the high-CBD cannabis strain, doses may have been too low to produce a significant effect.
A 2011 study found that cannabis use reduced pain and stiffness in fibromyalgia patients, and increased a feeling of relaxation and wellbeing.
And a questionnaire-based study published in 2019 concluded that medical cannabis appeared to be a safe and effective alternative treatment for fibromyalgia symptoms with pain intensity significantly reduced in 81% of patients over a six-month period.
How does CBD work?
Some of CBD's therapeutic effects may relate to its interaction with our cell-signalling system the Endocannabinoid System (ESC).
The ECS is responsible for homeostasis, the maintenance of a range of internal functions and responses, including pain, inflammation and the immune system.
The ECS consists broadly of:
- Two types of receptors (CB1 and CB2), found on the surface of certain cells
- Two types of endocannabinoid molecules (Anandamide and 2-AG)
- Two major enzymes (FAAH and MAGL)
Endocannabinoids are produced by the body as required. They bind to the receptors, prompting them to signal cells to take action. After use, the endocannabinoids are broken down by the enzymes.
Some plant cannabinoids, like THC, can also bind to the ECS receptors, leading to a variety of responses, positive and negative. While CBD does not appear to bind to the receptors, it does influence the ECS. One theory is that it inhibits the enzymes’ ability to break down endocannabinoids, thereby prolonging effects such as pain relief.
CBD also interacts with a number of other receptors that could help explain its effect on pain. They include opioid receptors, involved in pain relief, serotonin (5-HT) receptors, which influence mood, and a receptor known as TRVP1, which produces the sensation of scalding heat.
There are currently two medications containing CBD approved for use in the UK.
Epidyolex (spelled Epidiolex in the US and elsewhere) contains purified CBD and is used to treat two rare forms of early-onset epilepsy.
Nabiximols (brand name Sativex) is made from equal amounts of THC and CBD and can help with some symptoms of multiple sclerosis.
Both drugs can be prescribed on the NHS, but not by a GP, only by a specialist doctor, and only to treat these specific conditions.
CBD itself is not available on the NHS and there are no CBD-based medicines prescribed for fibromyalgia. However, CBD is available to buy over the counter in a number of formats.
CBD products for fibromyalgia
CBD comes in a wide range of products, including bottled CBD oils, vaping liquids, capsules, edible gummy sweets, creams and cosmetics.
On balance, a good quality CBD oil tested by a third party laboratory offers the best combination of efficient uptake, measured dosing and traceability of ingredients, without the health concerns associated with vaping.
CBD oils are usually sold as a solution of CBD in a carrier oil such as hemp, olive or coconut. Bottles generally come with a built-in dropper allowing for accurate dosing. CBD oil can be swallowed directly, or added to food and drink, but the most efficient way to take it is sublingually – under the tongue.
Simply place the required number of drops under your tongue and hold there for a minute or two before swallowing. This allows the CBD to be absorbed through the capillary-rich membrane, bypassing the destructive digestive processes. The CBD therefore gets to work faster and more of it reaches the bloodstream.
Another option that may work for people with fibromyalgia is topical CBD creams, which can be applied directly to areas of pain or inflammation. Because they do not penetrate into the bloodstream, they won’t have the ‘whole body’ effect of CBD oil but may target specific pain points via the endocannabinoid receptors in the skin.
One 2018 study concluded that topical CBD creams could be ideal for localised pain symptoms, as well as peripheral neuropathic pain caused by nerve damage.
The appropriate amount of CBD for any given individual varies based on a number of factors including body mass and personal chemistry, so whatever the condition you wish to treat, the best way to determine the right amount of CBD for you is to start small and work your way up.
Begin with a low dose, perhaps 10mg, and record how you feel over a few days. If you don’t experience any adverse effects and think a larger dose could be beneficial, increase it by a similar increment and continue the process until you find the optimum amount for you.
To get an idea of the range of doses that might be appropriate for you, use the Jersey Hemp CBD oil dosage calculator, which calculates a low, medium and high dosage based on your weight, using recommended amounts of 1-6mg of CBD for every 10 pounds of body mass. It also tells you how many drops of oil you need to take for each dosage when using either 5% or 10% CBD oil.
You should also be aware that the UK’s Food Standards Agency recommends as a precaution that healthy adults take no more than 70mg of CBD per day.
CBD is recognised by the World Health Organization as having “a good safety profile” and posing no discernible risk to public health. The Court of Justice of the European Union recently backed this up, concluding that CBD “does not appear to have any psychotropic effect or any harmful effect on human health”.
Clinicians generally consider CBD to be ‘well tolerated’ by patients, and in many areas are pursuing further research into its benefits partly because of its low level of adverse effects compared with some traditional pharmacological medicines.
It’s also very important when considering taking CBD to be aware that it can interact in a potentially dangerous way with some medications.
CBD inhibits the enzymes that break down a number of drugs in the body. This can increase the amount of the drug in the system to dangerous levels and accentuate any side-effects.
One of the enzymes CBD influences is also inhibited by grapefruit and some related citrus fruits, so you should never take CBD with a medication that carries a grapefruit warning without first speaking to your doctor.
However, CBD also inhibits enzymes responsible for metabolising some other drugs so can still effect medication that does not have a grapefruit warning. That means you should always consult your doctor before taking CBD if you are on any medication.
The author of this article is not a medical expert and nothing in this article constitutes medical advice or gives rise to a medical practitioner/patient relationship. You should seek specialist medical advice where required. Never disregard professional medical advice or refrain from seeking it because of something you have read here.