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Microdising cbd oil for fibromyalgia

CBD Oil for Fibromyalgia: Can It Clear the “Fibro Fog”?

Fibromyalgia is a confusing and often misrepresented medical condition. It is characterized by widespread neuropathic pain, fatigue, dizziness, lowered mood, and cognitive impairments manifesting in poor focus and memory, often referred to as “fibro fog.”

The condition’s origin is often a mystery, but it’s assumed that it arises from one or a combination of both hereditary and environmental factors such as genetic mutations, various infections, and psychological or physical trauma.

The Scope of the Issue

The National Fibromyalgia Association estimates that around 10 million people in the US suffer from the condition, and put its global prevalence at between 3 and 6%. Females make up the vast majority of those affected, between 75 and 90%. Fibromyalgia is most common in middle-aged people, and it’s often developed by lupus and rheumatoid arthritis patients.

The aches and stiffness associated with fibromyalgia, which are felt throughout the body, are thought to be a consequence of repeated abnormal neural stimulation resulting in increased levels of neurotransmitters which signal pain.

The entire conflux of symptoms is also known to cause secondary issues which significantly degrade life quality, such as depression, anxiety, lack of ability to focus in work, and sleep disorders.

Conventional Fibromyalgia Symptom Management

The symptoms of fibromyalgia are usually treated with a combination of some of the following: psychotherapy, non-steroidal pain relievers (NSAIDs), depression/anxiety medication, lifestyle changes including exercise, yoga, and healthy nutrition, and various alternative healing methods such as acupuncture, biofeedback, or chiropractic treatments.

Can You Use CBD Oil for Fibromyalgia?

CBD oil is derived from Cannabis sativa, the same plant commonly grown for its psychoactive ingredient THC. However, CBD oil is produced from the strains of Cannabis sativa which were bred to reduce THC content to trace amounts (less than 0.3%). Due to this, using CBD oil for fibromyalgia symptom management does not produce a psychoactive effect.

The therapeutic potential of CBD oil is vast and well-researched. Some of the most well-documented medicinal applications of CBD oil are its potent analgesic and anti-inflammatory properties, which can be beneficial for neuropathic pain and stiffness, the primary symptoms associated with fibromyalgia.

CBD exerts these effects via the endocannabinoid system, one of the key internal pain regulation systems with modulatory actions at all stages of pain processing. Via indirect interaction with the endocannabinoid receptors throughout the body, CBD boosts the signaling of anandamide, a neurotransmitter linked to feelings of well-being and happiness. It then prevents its reuptake, pushing the excess quantities into the bloodstream, thereby reducing pain throughout the body.

Aside from the endocannabinoid system, CBD also interacts with:

  • TRPV1 receptors, reducing pain sensation and inflammation.
  • Alpha-3 glycine receptors, suppressing chronic inflammatory and neuropathic pain associated with dysfunction in these receptors.
  • Glutamate NMDA receptors, lowering the levels of glutamate in the brain and spinal cord and reducing sensations of pain.

Although these studies were conducted on rat models, they serve as insight for how CBD’s analgesic and anti-inflammatory effects play out in humans. These effects have been demonstrated extensively in scientific research.

While there isn’t much research available specifically on the effects of this cannabinoid on fibromyalgia, a review of studies from 2013 concluded that it can serve to relieve neuropathic pain as a symptom of various conditions, including rheumatoid arthritis, multiple sclerosis (MS), and fibromyalgia.

A more recent study looked into the effectiveness of three cannabis-based products with varying concentrations of THC and CBD on patients suffering from fibromyalgia. The researchers used:

  • 200 mg of Bediol, which has high amounts of both CBD and THC
  • 200 mg of Bedrolite, which has high amounts of CBD and low amounts of THC
  • 100 mg of Bedrocan, which has low amounts of CBD and high amounts of THC

The study reported that Bediol (high CBD and THC) was the only significantly more effective treatment than the placebo; it caused a 30% reduction in pain in 90% of the participants. However, it should be noted that the placebo itself reduced pain by the same margin in 55% of the patients, meaning that the psychological component in the pain sensation is considerable.

A combination of CBD and THC being found effective for treating generalized pain in fibromyalgia and similar conditions is not surprising. A large body of previous research has reported this effect, including another recent study specific to fibromyalgia patients, which included hundreds of participants, over 80% of which experienced significant pain relief after six months of cannabis treatment.

We don’t fully understand why the combination of CBD and THC is more effective in treating neuropathic pain than just CBD alone, but we know that it’s more than just the sum of their combined effects on neurotransmitter receptors. The two cannabinoids seem to work in synergy, and this process is known as the “entourage” effect in cannabis.

This is why, if you’re not averse to consuming THC, you should consider using cannabis products, which can be purchased in medical marijuana dispensaries in states where medicinal cannabis use is legal. Otherwise, CBD oil should also be of help in fibromyalgia symptom management, although likely not quite as effective of a solution.

How to Use CBD Oil for Fibromyalgia?

CBD products are available in many forms, including oils for vaporizing, capsules, drops, teas, gummies, topical products, and others.

Vaporizing CBD oil can provide almost immediate pain suppression due to the compound entering the bloodstream rapidly through the lungs. However, this relief is not very long-lasting and it’s more recommended for acute pain episodes than for persistent pain. Depending on how your symptoms manifest, you may want to consider it.

Taking CBD orally in the form of capsules, gummies, or chocolates provides a longer effect duration, but the onset is also delayed (about 30min to 2h) as the compound needs to go through the digestive tract and get metabolized in the liver. Whether this delay can suit your needs will also depend on the nature of your symptoms.

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A good in-between solution is applying CBD tinctures sublingually. Sublingual administration allows the CBD to be relatively rapidly absorbed into the bloodstream (in about 5 to 20min), and the effects duration is comparable to that of oral intake. This is an adequate way to manage persistent pain.

If your pain is manifesting as localized stiffness or tenderness, you may want to consider topical CBD solutions. Rat model studies have shown that “Topical drug [CBD] application avoids gastrointestinal administration, first pass metabolism, providing more constant plasma levels,” thus mitigating the less optimal oral absorption rate. This means that this way of using CBD is most effective for localized pain points.

Additionally, if applied topically, the potential side effects of CBD oil are avoided as the compound doesn’t enter the bloodstream. If ingested orally, sublingually, or vaporized, CBD oil can cause a few relatively mild and infrequent side effects such as dry mouth, diarrhea, reduced appetite, drowsiness, and fatigue.

These side effects can be exacerbated in the case of interaction of CBD with certain over-the-counter (OTC) drugs, prescription medications, and dietary supplements. If you are already taking some pain relievers, it’s highly advised to consult your physician before taking CBD oil for fibromyalgia.

Finally, CBD can also greatly help with the secondary sufferings caused by fibromyalgia. Using CBD oil has proven effective in treating anxiety and depression, as well as for regulating sleep.

Have you tried using CBD oil for fibromyalgia already? What are your experiences?

If you haven’t, are you considering it? What are your concerns?

Please share them with us in the comments below.

About Xavier Francuski

Born in India, grew up in Serbia, lived and traveled throughout the world, Xavier’s uprooted existence fuels his instinct for exploration. With a masters degree in research psychology, he is a passionate educator on the topic of psychedelics, trying to reconcile the astounding nature of the realms beyond with what sense we can make of them in this one. Currently living in Southeast Asia and working as a staff writer for several major psychedelic websites.

CBD for Fibromyalgia

Fibromyalgia is a chronic disease with symptoms such as irritable bowel, joint pain, fatigue, migraines, insomnia, and chronic pain. Those who suffer from Fibromyalgia will, in many cases, have increased their sensitivity to pain. This is believed to be caused by the abnormal functioning of pain signals that are found in the central nervous system. Common pharmaceutical drugs that are used to treat Fibromyalgia include pain relievers such as sleep aids, muscle relaxants, opioids, and NSAIDs 1 .

Currently, many patients have decided to use CBD products to treat Fibromyalgia. This is because they find these natural products to have fewer side effects and they are safer to use compared to prescription medications.

Using CBD to Treat Fibromyalgia

There is still a need for more research to prove that CBD is effective in treating Fibromyalgia. It’s no coincidence that Fibromyalgia is caused by dysregulation of endocannabinoid deficiency. Endocannabinoid deficiency 2 refers to the endocannabinoid system functioning poorly. This usually results when one has lower than normal levels of endocannabinoids. If your body does not produce enough endocannabinoids you will be more sensitive to pain. Endocannabinoids are the neuro-modulators that control the way we perceive pain. When your body does not have enough supply of endocannabinoids your endocannabinoid system will not function properly in maintaining the body’s balance. This is the reason individuals suffering from Fibromyalgia experience higher than normal levels of pain.

The CBD had been known to assist in endocannabinoid system balance since it interferes with the process of the body breaking down the endocannabinoids. In case you have any deficiency, taking CBD will act as a supplement as it increases the levels of endocannabinoids.

What are the effects of using CBD for Fibromyalgia?

People who use CBD to treat Fibromyalgia have reported the following benefits:

  • Pain Relief on Prescription Painkillers
  • Less Inflammation
  • Improved mood

Side effects of using CBD to treat Fibromyalgia

In many cases, you will find that CBD has fewer side effects on your body when you use it to treat Fibromyalgia. However, when used in high quantities it will have some sedating effects. Some other effects include diarrhea and stomach upset.
To learn more, read our dedicated guide on possible CBD side effects.

CBD dosage for Fibromyalgia

The recommended dosage of CBD can vary widely depending on the CBD oil concentration of the product you have chosen to use. Everyone is different and therefore reacts differently to CBD.

We recommend the step-up method of Leinow & Birnbaum as described in their book “CBD: A patient’s guide to Medical Cannabis” 3 . Leinow & Birnbaum recommend starting with a microdose if you suffer from pain.

For more details on dosage and microdose read our article on CBD dosage:

It is advised that you consult your doctor before you start to use CBD especially when you are new to the product and you are already taking other medications. This is because CBD may interfere with the drugs that you may be taking.

What Kind of Terpenes Are Best for Treating Fibromyalgia?

The features of some terpenes are beneficial to control the symptoms of fibromyalgia 4 . These kinds of terpenes work well when they are combined with CBD. It is advised to try to find the products that have high levels of terpenes by testing them in a laboratory.

Some of the terpenes that you can test are:

  • Linalool: relaxing and pain-relieving
  • Pinene: is an anti-inflammatory compound
  • B- caryophyllene: is a pain-relieving and anti-inflammatory compound

What Does Research Say about Fibromyalgia and Cannabinoids?

In studies, fibromyalgia patients were only given THC without other painkillers. Participants reported that they had significantly less pain 5 .

Dr. Russo is a medical professional who has written so many articles based on the deficiency of clinical endocannabinoid. In his studies, it has been seen that some common conditions such as irritable bowel syndrome, migraines, and fibromyalgia can be caused by endocannabinoids deficiency in the body 6

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Cannabidiol for Fibromyalgia (The CANNFIB Trial) (CANNFIB)

Fibromyalgia is serious chronic pain condition which is often accompanied by sleep disturbances, fatigue and disability and reduced quality of life. There is no cure and treatments are based on reliving symptoms and maintaining function. The currently available medical treatments are not helping many patients, and many get side-effects. Medical cannabis is sought after among patients and many use this medication un-licenced, although it is not properly documented if it works or is safe. Therefore, it is necessary to investigate the effects and safety of medical cannabis in a properly designed randomized trial. The aim of the study is to investigate if cannabidiol (CBD) can improve pain, sleep, function and quality of life in patients with fibromyalgia. The study will include 200 patients, who will receive either cannabidiol or placebo over a period of 24 weeks. Participants will be closely looked after for improvements in their condition and for potential side-effects to ensure safety.

Condition or disease Intervention/treatment Phase
Fibromyalgia Drug: Cannabidiol Drug: Placebo Phase 3

BACKGROUND: Fibromyalgia is a serious chronic pain condition affecting 2-5 % of the background population. The disease burden in most affected individuals is substantial; with widespread musculoskeletal pain, high pain intensity, often accompanied by sleep disturbances, fatigue, cognitive dysfunction, and emotional distress. Fibromyalgia is associated with disability and muscle fatigue, affecting daily life activities, leading to poor social participation and incapacity for normal employment. Studies have shown that many patients, are not satisfied with the treatments offered, and rate their health and quality of life after treatment as poor.

There is currently is no cure for fibromyalgia, and management aiming at symptom reduction and maintenance of optimal functioning is recommended by clinical guidelines, including both non-pharmacological and pharmacological treatment strategies. Recommendations for the pharmacological treatment of fibromyalgia propose antidepressants and anticonvulsants, which target central pain processing mechanisms. These treatments have been tested in controlled trials for their efficacy in patients with fibromyalgia, and meta-analyses on these interventions have revealed that overall effect sizes are modest, as only a minority of patients have substantial benefit (patient reported pain relief of 50% or greater), while more have moderate benefit (patient reported pain relief of 30% or greater). Many patients have no or minimal benefit or will discontinue the treatment due to side effects. However, it appears that even moderate reductions in pain may lead to considerable increase in self-reported quality of life and other outcome domains in this specific patient population.

Medical cannabis is popularly advocated for different health conditions including chronic pain, both among politicians and in the general population in Denmark, although evidence is sparse efficacy and on what types of medical cannabis to use and what dosages to prescribe for the different conditions. In addition, safety issues such as adverse events and serious adverse events is not properly assesed. Physicians are reluctant to prescribe medical cannabis to their patients, and many patients living with chronic pain are known to self-administer unlicensed medical cannabis. The extent of actual cannabis use is unknown, although, one study has documented that 13% of patients with fibromyalgia use cannabis regularly with a more extensive use among male patients compared to females. Numbers from a Danish context show that only 17 out of 286 (6%), patients with fibromyalgia participating in a multidisciplinary rehabilitation program in Bispebjerg and Frederiksberg hospital during 2018, stated that they were using self-administrated cannabis on a regular basis (unpublished data). As self-administrated off-label use of cannabis is illegal in Denmark, this number may well be underreported. Still, individuals diagnosed with fibromyalgia who do admit to cannabis use, are sharing stories with health professionals about how unlicensed cannabis has improved their coping with everyday life, functional ability, pain, sleep, fatigue, mood and overall health related quality of life. Such compelling stories cannot be ignored and underline the necessity of exploring the efficacy of medical cannabis in a proper research design (i.e. with good internal validity).

The use of the cannabis plant for medical purposes is limited in Europe and the European addiction societies stresses the need for further studies on the efficacy and possible dangers regarding medical cannabis intake. Regulations are lacking on registration and medical indications, and the development of uniform compounds regarding strength and types of products and rules concerning sales and marketing.

In Denmark, production and distribution of medical cannabis is illegal. However, starting from January 1st, 2018, a four-year pilot scheme has been legalized and approved by the Danish Medicines Agency, allowing for medical cannabis in the treatment of conditions such as multiple sclerosis, spinal injuries and nausea after chemotherapy and neuropathic pain. Although patients suffering from fibromyalgia have few treatment options for management of their disabling condition, this group is not included in the pilot scheme. However, it is legal for physicians to prescribe cannabis for this and other patient groups.

Medical cannabis Medical cannabis is the term for medications derived from dried cannabis plants in the form of capsules, pills or extracts/oils. The top shoot of the plant contains 100 cannabinoids that are divided into two subgroups; Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), affecting the cannabinoid type 1 receptors located in the central nervous system, and the cannabinoid type 2 receptors located outside of the central nervous system. While the THC cannabinoids have psychoactive, appetite stimulating and nausea reducing effects, cannabidiol has anti-inflammatory, anti-convulsive and immune modulating effects. Studies are inconclusive regarding the effect of cannabidiol on appetite and food intake. Cannabinoids are known to be highly lipophilic and to accumulate in fatty tissue, and may influence the metabolism, fat distribution and accumulation in users. It has been implicated that both TCH and CBD have pain reducing effects. CBD is confirmed to have a favorable safety profile compared to THC.

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The US Food and Drug Administration (FDA), has approved Epydiolex® as the first prescription cannabis drug derived from the cannabis plant, for treating rare and severe forms of epilepsy. Synthetically manufactured cannabis such as dronabinol (USA) and nabilone (USA and UK), have been approved earlier in the treatment of nausea after chemotherapy. The only synthetic cannabis based approved drug in Denmark is Sativex® for the treatment of multiple sclerosis. However, none of the cannabis drugs are currently approved for the treatment of chronic pain conditions.

Evidence is sparse on medical cannabis in the treatment of fibromyalgia. In a Cochrane review on herbal cannabis (hashish, marihuana), plant-based and synthetic cannabinoids for fibromyalgia, only two out of four identified studies on the topic were included, due to small sample sizes, short-term duration and poor reporting of the other studies. The two studies were both on synthetic cannabinoid (nabilone). No high-quality studies on plant-based cannabis could be identified. Evidence for efficacy was inconsistent as one study favored nabilone on pain and quality of life, compared to placebo, and the other study favored nabilone on sleep compared to Amitriptyline (anti-depressant). However, the quality of the studies was low, and tolerability was low due to side effects.

Recent systematic reviews, have investigated the existing evidence on the effectiveness of cannabinoids for chronic non-cancer pain, including fibromyalgia. No impact on physical and emotional functioning has been found, and only low-quality evidence found improved sleep and patient global impression of change. Thus, it was concluded to be unlikely that cannabinoids are effective in the treatment of non-cancer pain, as findings were inconsistent. Survey studies, however, have showed favorable effect on fibromyalgia symptoms and health-related quality of life, and improved pain management and sleep, among users of unlicensed cannabis compared to non-users, although no information on type and dosages of cannabis was given in the surveys. Negative patients’ perspectives themes such as the high cost, the negative effects of cannabis and the “views of others”, including their health care professionals, were also identified. A recent retrospective study showed significantly favorable outcomes on fibromyalgia symptoms among medical cannabis users, and only mild adverse events. However, the retrospective design, the relatively small sample size and short duration reduced the quality of the study.

Based on the high demand and an increasing popularity of medical cannabis – which is currently used unlicensed among many patients with fibromyalgia, despite the lack of high-quality evidence on efficacy and safety, a well-designed randomized trial with a large sample size and clinically relevant duration is warranted.

OBJECTIVES: The aim of this trial is to assess the efficacy and safety of cannabidiol use compared to placebo, and to evaluate the safety and tolerability of cannabidiol compared to placebo in patients with fibromyalgia over 24 weeks.

HYPOTHESES: The primary hypothesis of the study is that pain intensity will be significantly reduced in participants receiving cannabidiol compared to those receiving identically appearing placebo after 24 weeks.

Secondary hypotheses are that sleep quality and duration, activities of daily living and quality of life, will be improved in participants receiving cannabidiol compared to those receiving placebo after 24 weeks. It is also hypothesized that participants receiving cannabidiol will improve on several supportive exploratory secondary outcomes (see outcome measures section), and that a higher proportion of those receiving cannabidiol will have a substantial benefit (50 % pain reduction) and a moderate benefit (30 % pain reduction).

STUDY DESIGN: The trial is designed as a single-center, randomized, placebo-controlled, double blind and parallel-group trial.; the trial contains three periods: A pre-randomization screening period (week -8 to 0), a main trial period (week 0 to 24), and a post interventional observation period (week 24 to 36). The trial is designed to determine the efficacy and safety of cannabidiol use for patients with fibromyalgia.

The trial is scheduled to start inclusion of first patient first visit, February 2021 or as soon as possible thereafter, and the study period will go on for two year and end with the last patient last visit in December 2022.

Eligible participants, who are included at screening, will be randomized in a 1:1 manner to receive either cannabidiol 50 mg or placebo. Allocation will also be stratified based on sex (male vs. female), age and pain intensity (over vs. under 7 on the Fibromyalgia Impact Questionnaire Revised version (FIQ-R) pain numeric rating scale, to ensure that the groups are equal. A computer-generated randomization sequence will create subject identification numbers and allocate the subjects to treatment arms. The randomization sequence will be created by an independent biostatistician using a random number generator (SAS Proc Plan), and subsequently entered in the electronic Case Report Form (e-CRF), that will be developed specifically for the study, by an independent data manager. If unblinding of a participant is required due to an adverse event, the primary investigator can request to break the randomization code for the individual patient, via the independent data manager. The unblinding will always be performed at patient level and unblinding can take place any time during the day (24/7). Randomization and concealed allocation are done electronically in the e-CRF at the randomization visit (week 0).

The study will be conducted at the Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen. The Parker Institute is a well-established research institute and clinical department with secretariat, data managers and Good Clinical Practice (GCP) trained health care professionals including physicians and study nurses. Monitoring will be conducted from the initiation and throughout the trial by the GCP-unit at Bispebjerg and Frederiksberg hospital, in accordance with the GCP rules and regulations.

The trial will end when the last patient has completed the last visit as well as the 12-week post interventional observation period, or prematurely discontinued the intervention or withdrawn from the trial, which comes last.