cbd tincture for fibromyalgiaDecember 15, 2021
Fibromyalgia is a disorder characterized by widespread pain, exhaustion, poor sleep quality, and cognitive difficulties that sufferers often experience as brain fog. Photo by: Gina Coleman/Weedmaps.
Habib does point out that the patients in the study consumed oil containing both CBD and THC extracts. “A small fraction of our patients used oil, and mostly containing THC, so only a very small number of patients used pure CBD oil,” he said.
While there is a still a need for larger randomized trials, Habib, a rheumatologist in Netanya, Israel, believes that the research is promising and that it is worth trying medicinal cannabis for fibromyalgia soon after diagnosis, rather than considering it as an option when opioids fail.
For the estimated 2% to 4% of the global population who suffer from this condition, the majority of whom are women, there is an increasing interest in alternative therapies that may provide relief from the symptoms. Cannabidiol (CBD) oil is currently attracting attention as an alternative form of treatment.
“CBD oil on its own, without any other medications or treatments, typically does not give strong analgesic effects,” Liptan explained. “Successful pain relief without any additional prescription medications usually requires products that contain some amount of THC in addition to the CBD.”
Fibromyalgia is a disorder characterized by widespread pain, exhaustion, poor sleep quality, and cognitive difficulties that sufferers often experience as brain fog. It is a contentious condition, with medical experts often disagreeing about what constitutes a diagnosis of fibromyalgia, and some debating its existence at all.
There is still no research specifically investigating CBD oil as a treatment for fibromyalgia. However, in 2018 research was published in the “Journal of Clinical Rheumatology” suggesting medicinal cannabis may represent an effective treatment for the illness.
Chronic pain is also often accompanied by other conditions: anxiety or depression are present in almost 80% of the chronic pain population. The co-existence of pain and depression is particularly true for fibromyalgia patients. CBD can help alleviate anxiety in this population. In one 2017 human study, 300 milligrams of CBD taken orally caused a measurable drop in anxiety and cortisol levels.
In addition, CBD has seems to offer neuroprotective properties and stimulate cell repair in the brain. This could improve brain function in fibromyalgia patients. CBD oil may also diminish anxiety and depressive behaviors by boosting anandamide signaling, according to results of a double-blind, randomized clinical trial published in 2012 in “Translational Psychiatry”. Anandamide is a neurotransmitter that facilitates homeostasis and balanced mood.
What the experts say.
Dr. Ginevra Liptan, director of The Frida Center for Fibromyalgia and author of “The FibroManual: A Complete Fibromyalgia Treatment Guide For You. And Your Doctor,” reported that many of her patients have experienced relief from symptoms such as muscle tension, pain, anxiety, and insomnia as a result of combining CBD oil with their mainstream medications. Like Habib, however, she emphasizes that CBD oil appears to be more effective when teamed with THC.
Problematically, the FDA-approved drugs traditionally used to treat fibromyalgia have limited efficacy, with commonly used first-line medications such as duloxetine and pregabalin offering little respite from prevailing symptoms such as pain. Fibromyalgia patients often also complain of side effects associated with these medications.
Liptan also notes that the extent to which patients experience relief varies from patient to patient. Some notice only a mild improvement in their pain, while others notice significant pain relief. While cautious not to depict CBD oil as a panacea, Liptan emphasizes that CBD oil represents a safe form of pain relief for fibromyalgia and that it is definitely worth consideration as a treatment.
CB2 receptors within the body can modulate microglial cell function. One 2016 study in the Swiss journal “Cellular and Molecular Life Sciences” suggested that therapeutic strategies aimed at CB2 receptors could provide a promising treatment for inflammation. The therapeutic effects of CBD on inflammation have been documented in a range of studies, such as one published in 2015 in the journal “Bioorganic and Medicinal Chemistry.”
Dr. George Habib is the co-author of a 2018 retrospective review study in the “Journal of Clinical Rheumatology” investigating medical cannabis as a treatment for fibromyalgia, and he believes it offers fibromyalgia patients hope. ”In general, the impression (from the study) was that this type of medication is more effective than pregabalin and duloxetine,” Habib said.
There is also a solid body of evidence that indicates CBD may alleviate certain symptoms associated with fibromyalgia, such as pain, sleep disruptions, anxiety, and depression.
Fibromyalgia sufferers also often experience difficulty with sleep. In a March 2019 study, published in “Epilepsy Research,” a single, large dose of CBD induced sleepiness among 30% of participants who suffered from treatment-resistant epilepsy. In another clinical trial with healthy volunteers, however, a single large dose of CBD did not create any change in sleep or wake cycles. CBD oil may help fibromyalgia sufferers with sleep, though further research is needed.
She, therefore, endorses the use of full-spectrum CBD oils for fibromyalgia. “I see much greater benefit from full-spectrum CBD oils, which contain other cannabinoids and sometimes trace amounts of THC, compared to the CBD isolates, which do not have the synergistic effects of the whole plant extract.”
The brain is one of the key areas affected by fibromyalgia, with brain inflammation contributing to pain and brain fog. Recent research suggests that microglia in the brain and spinal cord play a role in fibromyalgia. When certain cells become activated, they can contribute to inflammation by amplifying pain signaling and transmission.
As the ravages of the opioid epidemic lead many to avoid these powerful painkillers, a significant number of people with fibromyalgia are finding an effective replacement in CBD-containing products, finds a new Michigan Medicine study.
Yet the finding that products containing only CBD also provided pain relief and were substituted for pain medications is promising and merits future study, noted Boehnke.
“I was not expecting that level of substitution,” said Boehnke, noting that the rate is quite similar to the substitution rate reported in the medical cannabis literature. People who said they used CBD products that also contained THC had higher odds of substitution and reported greater symptom relief.
Fibromyalgia is one of many chronic pain conditions that remains stubbornly difficult to treat.
Boehnke stressed the need for more controlled research into how CBD may provide these benefits, as well as whether these benefits may be due to the placebo effect.
The cannabis-derived substance provides fewer side effects, with less potential for abuse.
CBD, short for cannabidiol, is the second most common cannabinoid in the cannabis plant, and has been marketed for everything from mood stabilization to pain relief, without the intoxicating effects produced by the most common cannabinoid, THC. THC, which stands for delta-9-tetrahydrocannabinol, is the ingredient in marijuana that causes people to feel high.
For this study, the team focused on 878 people with fibromyalgia who said they used CBD to get more insight into how they used CBD products.
Boehnke and his team surveyed people with fibromyalgia about their use of CBD for treatment of chronic pain.
The U-M team found that more than 70% of people with fibromyalgia who used CBD substituted CBD for opioids or other pain medications. Of these participants, many reported that they either decreased use or stopped taking opioids and other pain medications as a result.
The cannabis industry has exploded, aided by the legalization of medical and recreational marijuana in states around the United States and the removal of hemp-derived CBD from Schedule 1 status—reserved for drugs with no currently accepted medical use and a high potential for abuse—at the federal level.
Clinically, opening up lines of discussion around CBD use for chronic pain is imperative, said Boehnke, for medication safety reasons as well as for “enhancing the therapeutic alliance and improving patient care.”
“CBD is less harmful than THC, as it is non-intoxicating and has less potential for abuse,” said Kevin Boehnke, Ph.D., a research investigator in the Department of Anesthesiology and the Chronic Pain and Fatigue Research Center. “If people can find the same relief without THC’s side effects, CBD may represent a useful harm reduction strategy.”
The team noted that much of the widespread use of CBD is occurring without physician guidance and in the absence of relevant clinical trials. “Even with that lack of evidence, people are using CBD, substituting it for medication and doing so saying it’s less harmful and more effective,” he said.
Previous research shows that some people substitute medical cannabis (often with high concentrations of THC) for opioids and other pain medications, reporting that cannabis provides better pain relief and fewer side effects. However, there is far less data on CBD use.
“Fibromyalgia is not easy to treat, often involving several medications with significant side effects and modest benefits,” Boehnke explained. “Further, many alternative therapies, like acupuncture and massage, are not covered by insurance.”
Additional authors include Joel J. Gagnier, Lynne Matallana and David A. Williams.