Taking CBD to treat fibromyalgia symptoms

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Alphagreen | CBD Blog | Educate, Empower, Enhance

14 min readMay 14, 2021

Fibromyalgia is a type of chronic disorder that causes widespread musculoskeletal pain, fatigue, memory, mood, and sleep issues. Scientists state that this condition amplifies painful sensations by affecting the way our central nervous system (i.e. the brain and spinal cord) process painful and non-painful signals. Fibromyalgia belongs to diseases that can be hard to understand even for healthcare providers. The symptoms of this disorder mimic the most common signs of other diseases and, as there are still no real tests to confirm the diagnosis, fibromyalgia is often misdiagnosed.

In medical practice, chronic pain is one of the most frequent complaints. According to the International Association for the Study of Pain (IASP), chronic pain, including joint and musculoskeletal pain, neck and back pain, cancer pain, post-surgical pain, trauma pain, and chronic headache, affects on average 20% (10 to 55%) of the adult population worldwide.

Chronic pain is considered not only as a social but as an economic burden as well to individuals, families, and society, with important physical and psychological consequences for people diagnosed with this condition. To date, fibromyalgia belongs to the main causes of chronic widespread pain (CWP). According to statistics, the prevalence of fibromyalgia in the general population reaches 6.6%, while women are more susceptible to this condition in comparison with men with a female-to-male ratio of 3:1. In women, the mean prevalence was 4.2%, while in men it reached 1.4%.

The prevalence of this disorder has been estimated in different areas and countries and on four continents — Europe, Africa, America, and Asia. The mean fibromyalgia rate was 2.5% in Europe, 3.1% in America, and 1.7% in Asia. In addition to this, the literature shows the value of fibromyalgia in urban areas between 0.7 and 11.4%, in rural areas between 0.1 and 5.2%, and in special populations values between 0.6 and 15%.

What are the main causes for disease and can fibromyalgia be prevented?

Many researchers state that the primary cause of this condition lies in the repeated nerve stimulation, which causes the brain and spinal cord of people diagnosed with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that are responsible for pain perception. Moreover, some of the receptors in the brain develop a sort of “memory of the pain” and become sensitised, which means they can overreact to painful and non-painful signals. There is a range of different factors that can trigger fibromyalgia, including:

Genetics

Fibromyalgia tends to occur in families and, according to researchers, there may be certain genetic mutations that may make a child more susceptible to developing the disorder if his parents or other relatives were diagnosed with this condition. Researchers have identified a few possible genes that may affect the transmission of chemical pain signals between the neurons in the central nervous system.

Physical or emotional events

Prolonged psychological stress or severe physical or emotional trauma, such as a car accident, for example, can trigger fibromyalgia even if none of your family members has had this condition. Several studies suggest fibromyalgia can be linked to post-traumatic stress disorder (PTSD).

Infections

Some infectious illnesses may trigger fibromyalgia or aggravate the symptoms. Conditions, such as flu, gastrointestinal tract infections, pneumonia, as well as those caused by Shigella bacteria, Salmonella, and the Epstein-Barr virus can also increase the risk of developing fibromyalgia.

In addition to this, risk factors for fibromyalgia can include:

Gender

As it was already mentioned above, most fibromyalgia cases are diagnosed in women, although the reason for such a gender disparity is still unclear.

Age

Although children may develop fibromyalgia, this condition most often occurs in the middle age and the risk of getting it increases as we get older.

Other disorders

Although fibromyalgia doesn’t refer to any of the forms of arthritis, people diagnosed with osteoarthritis, rheumatoid arthritis or lupus may be more likely to develop fibromyalgia.

There is also a theory that fibromyalgia could be an autoimmune condition as its symptoms look very similar to the signs of autoimmune disorders. In autoimmune diseases, such as multiple sclerosis (MS) or rheumatoid arthritis (RA), the immune system mistakenly attacks its own healthy tissues with proteins called antibodies just like it would normally attack bacteria or viruses. This theory has been hard to prove because fibromyalgia doesn’t cause inflammation and for the moment, reproducing autoantibodies haven’t been found.

Fibromyalgia is difficult to diagnose and in some cases, can be challenging to treat. In general, treatments for this condition include medications and self-care strategies that can help to manage the disease symptoms and improve the quality of life of the patient. No one treatment of the existing today works for all fibromyalgia symptoms, although a combination of a variety of treatment strategies can have a cumulative effect on the disease symptoms.

Fibromyalgia — symptoms, diagnosis, and treatment methods

One of the most common symptoms of fibromyalgia is so-called “regions of pain”. The pain in these areas feels like a consistent dull ache, that may last for more than three months.

According to the changes to the fibromyalgia diagnostic criteria published in 2016, a doctor will consider a fibromyalgia diagnosis along with other possible conditions if the patient has musculoskeletal pain in four out of five regions of pain. Previously, the pain duration was the primary criteria for a fibromyalgia diagnosis, although nowadays, the diagnosis process is focused on the sites of musculoskeletal pain and its severity. Other symptoms of this condition include:

Fatigue
Sleep problems, including nonrestorative sleep (sleeping for long periods of time without feeling rested)
Headaches
Anxiety
Depression
Pain
A dull ache in the lower part of the belly
Trouble focusing
Bladder problems (such as interstitial cystitis)
Dry eyes

The central nervous system of people with fibromyalgia diagnosis may misinterpret the normal pain signals or overreact to them. Such a reaction from the brain and nerves may be due to the chemical disruption in the brain or abnormalities in the dorsal root ganglion — represent a group of nerve roots, which carry sensory neural signals to our central nervous system (CNS) from the peripheral nervous system (PNS). In addition to the mentioned symptoms, fibromyalgia can also affect the energy level and emotions of the patient.

Another common sign of fibromyalgia and its characteristic feature is fibromyalgia fog, which is also known as “fibro fog” or “brain fog”. This symptom of the disease impairs the ability to concentrate on mental tasks, focus, and pay attention. The main signs of this fuzzy feeling also include:

Memory lapses
Trouble staying alert

According to the study investigating “fibro fog”, some people diagnosed with fibromyalgia find mental problems even more upsetting than the chronic pain they feel.

Fibromyalgia is considered a “female disorder” as it is more common, and symptoms are usually more severe in women. Women have more widespread pain, morning fatigue, and symptoms of inflammatory bowel disease (IBD) than men. However, the situation changed in 2016, when revisions to diagnostic criteria of this disease have been applied. After such changes, more men are being diagnosed with this disorder, which means the degree of distinction between fibromyalgia prevalence in men and women may decrease over time. Along with women, men also have severe pain and emotional changes from fibromyalgia. A survey held in 2018, investigated the impact of this disease on men. It was revealed that men with fibromyalgia have negative experiences with physical and mental health, relationships, quality of life, and careers as a result of the disease symptoms.

In many cases, fibromyalgia may coexist with other conditions, including:

Irritable bowel syndrome (IBS)
Postural tachycardia syndrome
Chronic fatigue syndrome
Migraine
Painful bladder syndrome

Such symptoms as fatigue, pain, and trouble sleep associated with fibromyalgia disease can significantly interfere with the people’s ability to function on the job or at home. The frustration of dealing with this condition can also result in depression and health-related anxiety.

As for fibromyalgia diagnosis, in the past, doctors would check eighteen specific points or “regions of pain” on the body to check how many of them were painful when pressed firmly. However, newer guidelines published in 2016 by the American College of Rheumatology don’t require such a point exam anymore. Instead of this, the primary factor for the diagnosis of this condition is widespread pain throughout the body, which lasts for at least three months. Today, fibromyalgia diagnosis is possible if an individual has pain in at least four out of five areas mentioned in the new guidelines:

Right upper region, including jaw, shoulder or arm
Left upper region, including jaw, shoulder or arm
Right lower region, including the buttock, hip or leg
Left lower region, including the buttock, hip or leg
The axial region, which includes the neck, chest, back or abdomen

If a person has pain in four of these regions, the doctor will include fibromyalgia in the list of suspected diseases, and its next step is to rule out other conditions that may have similar symptoms.

To conduct a definitive diagnosis, a healthcare professional may order several tests:

Complete blood count
Erythrocyte sedimentation rate (ESR) test
Thyroid function test
Cyclic citrullinated peptide test
Antinuclear antibody
Celiac serology
Rheumatoid factor test
Vitamin D test

If there is a risk that the patient may be suffering from sleep apnea, along with other fibromyalgia symptoms, the doctor may recommend an overnight sleep study.

The next stage once a definitive diagnosis was made is to choose the appropriate treatment program. Currently, there is no cure for fibromyalgia, although, with the correctly chosen treatment, its symptoms may be well managed, that can significantly improve the quality of the patient’s life and alleviate the symptoms. Improving the general health and minimising the symptoms are two primary goals of fibromyalgia treatment. It can be achieved by both medications and self-care strategies, as, according to healthcare professionals, a variety of treatment methods may provide the most effective result due to the cumulative effect.

Medications prescribed for fibromyalgia treatment can help to reduce pain and improve sleep. Among the most common options are:

Pain relievers

Pain is the hallmark of fibromyalgia and, probably the most debilitating symptom of this condition. Over-the-counter (OTC) medications such as ibuprofen, naproxen sodium, or acetaminophen can be prescribed to alleviate the widespread pain. In severe cases, when other medications don’t work, a doctor can prescribe opioids. For other cases, opioid medications are not recommended, as they can lead to serious side effects and addiction, as well as can worsen the pain over time.

Anti-seizure drugs

Medications for epilepsy treatment can also be useful in alleviating certain types of fibromyalgia pain. Drugs, such as Gabapentin (Neurontin) and Lyrica are also prescribed for some cases, along with over-the-counter medications. Moreover, Lyrica (pregabalin) was the first drug to treat fibromyalgia, which was approved by the Food and Drug Administration.

Antidepressants

Fibromyalgia is not only about pain — for many patients, psychological symptoms of this disease, such as anxiety, depression, fatigue, and sleep problems, are more debilitating than the physical symptoms. Medications, such as milnacipran (Savella) and duloxetine (Cymbalta) may help to ease fatigue associated with this condition, while amitriptyline or muscle relaxants may improve sleep quality, as well as work on rebalancing neurotransmitters.

In the case, if prescribed medications don’t entirely relieve fibromyalgia symptoms, the healthcare provider may recommend trying alternative natural remedies. Most of the natural treatments are focused on reducing pain and lowering stress and can be used alone or together with traditional medication treatment. Among the common natural remedies for fibromyalgia are:

Physical therapy
Exercise
Meditation
Acupuncture
Massage therapy
Yoga
Tai chi
A balanced diet

The balanced diet is important in fibromyalgia treatment as it can help to keep the body healthy, provide the patient with a constant energy supply, and prevent symptoms from getting worse. Dietary strategies recommended for fibromyalgia symptoms include:

Drinking plenty of water
Exercising as often as it’s possible
Eating more plant than meat
Eating fruits and vegetables, along with low-fat dairy and whole grains
Reducing the amount of sugar
Limiting the caffeine intake
Quit smoking

CBD as a newcomer in fibromyalgia treatment

Not so long ago, the list of fibromyalgia treatments has been replenished with a new natural option — medicinal cannabis.

In particular, cannabidiol (CBD) and tetrahydrocannabinol (THC) have long been known for their health benefits and are currently studied as potential treatments for many different diseases and conditions, including the chronic ones. Both these compounds belong to more than a hundred of cannabinoids found in the cannabis plant, and for the moment, belong to the most well studied medicinal substances found in the plant. THC is most famous for its psychoactive properties or so well-known “high” feeling that recreational users of cannabis often seek. However, besides this, THC is a potent analgesic and is considered as a possible alternative to opioid treatment. This cannabinoid shows a great promise for many diseases, although due to its intoxicating properties, its research, as well as medicinal usefulness is limited as most patients are seeking pain relief that wouldn’t impact their thinking. Because of this, CBD or cannabidiol is considered as a more promising treatment option as it holds the great medicinal potential for a range of conditions and has no psychoactive side effects at all.

The possibility of using CBD as an active agent for reducing fibromyalgia symptoms has appeared not so long ago. The research of its properties for this condition is still continuing, although results of the studies that have been done in both animals and humans, along with anecdotal evidence from fibromyalgia patients are promising. Many patients diagnosed with fibromyalgia have reported benefit for their symptoms after taking CBD. They mentioned alleviation of such symptoms as pain, anxiety, muscle tension, and insomnia.

Although, as we all know, anecdotal evidence is not enough to confirm any health benefits and the decisive role still remains for scientifically confirmed results of studies. CBD has been studied for reducing the most common symptoms of fibromyalgia, including nerve pain, joint pain, insomnia, anxiety, depression, and post-traumatic stress disorder (PTSD). Based on the results of the studies held, it was revealed that CBD could cause the following effects on animals:

CBD reduces brain inflammation, which in the case of fibromyalgia is one of the main contributors to pain and brain fog
CBD has demonstrated neuroprotective abilities, such as lessening brain damage after trauma by stimulating cell repair. Such feature of this cannabinoids may be used to improve brain function and reduce “fibro fog” in fibromyalgia patients
CBD puts glial cells in the brain into hibernation. The activation of this type of cells plays a key role in the development of chronic widespread pain (CWP) and the excess pain volumes seen in fibromyalgia
When taken both orally and topically, CBD reduced pain in rats with neuropathic pain (damaged nerves) and inflamed and painful joints. In fibromyalgia pain, both malfunctioning nerves and inflammation play a critical role
CBD also demonstrated the ability to lower the fight-or-flight nervous system activity in rats that were subjected to stress. In the case of fibromyalgia, the fight-or-flight system is usually overdrive, so this property of CBD may be useful

In animal studies, CBD has shown positive results, but what about humans?

In human studies, CBD has been extensively investigated for anxiety and found to be helpful. The results of brain imaging studies have shown the cannabinoid can lower both feelings of anxiety and calmed areas in the anxiety centres of the brain. Researchers suggest CBD effects for anxiety can be due to its activity in serotonin receptors. In addition to this, the whole-plant cannabis has been reported to be also effective in reducing pain in humans with fibromyalgia, rheumatoid arthritis, multiple sclerosis, and diabetic neuropathy, although for the moment, no human trials on CBD alone for pain relief have been done. What abouts the effects provided by the combination of THC and CBD for these symptoms? Let’s check what the research says.

According to the review of the effects of cannabis on the reduction of chronic pain published in 2017, cannabis is effective in treating chronic pain in adults. In addition to this, it was also revealed that cannabis products might also help improve sleep in people with fibromyalgia. However, authors of the study state that more research is needed to examine different forms, ways of administration, a combination of cannabinoids, and their doses.

In another study, twenty-eight fibromyalgia patients who were cannabis users and twenty-eight non-users were taking cannabis to investigate its benefits for the disease symptoms. The route of cannabis administrations was smoking (54%), oral (46%), and combined (43%). After two hours of cannabis use, VAS (visual analogue scales) scores of the study participants showed a significant enhancement of relaxation, reduction of pain and stiffness, and an improved feeling of well being. Moreover, 43 percent of all participants reported strong pain relief, 43 percent reported mild pain relief, and 7 percent reported no difference in their pain symptoms. Also, 81 percent of the study participants reported that cannabis provided significant relief from sleep issues.

The bottom line

To date, research investigating the cannabis effectiveness in treating fibromyalgia symptoms in humans is limited. According to the Handbook of Cannabis and Related Pathologies, most of the evidence available today assessing the cannabis effectiveness in treating anxiety, mood problems, muscle stiffness, and headaches associated with fibromyalgia comes from observational studies and surveys. More clinical studies and human trials are needed to come to any conclusions and evaluate all the cannabis effects on the symptoms of this condition. According to researchers, medicinal cannabis might be able to help manage pain, anxiety, and sleep disturbances associated with fibromyalgia.

Cannabinoids and CBD, in particular, can help with depressions and anxiety, as well as can be used as muscle relaxants providing mild pain relief and inducing a sense of calm and sleepiness, that can help with insomnia. CBD is definitely not a panacea or a “cure-all” compound, although it is still beneficial for a range of conditions, including some fibromyalgia symptoms. In addition to this, CBD is much safer than many other pain-relieving options often prescribed for this condition.

Together with THC, CBD provides higher effectiveness that may be due to the entourage effect between these compounds, although additional studies are necessary to evaluate the side effects of such combination and define the most effective and safe ratio of these cannabinoids. Positive results from each of the studies provide a powerful boost to the entire medicinal cannabis industry, sparking a new wave of research and uncovering more and more health benefits of the cannabis plant.