CBD Oil for Fibromyalgia: Is it Effective, Safe, or Legal?
Further research is needed to prove its effectiveness
Adrienne Dellwo is an experienced journalist who was diagnosed with fibromyalgia and has written extensively on the topic.
Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more.
David Ozeri, MD, is a board-certified rheumatologist from Tel Aviv, Israel specializing in arthritis, autoimmune diseases, and biologic therapies.
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 healthcare providers 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 healthcare providers 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.
Non-Drug Fibromyalgia Treatments
Fibromyalgia treatments other than medications include:
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 healthcare provider 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.
Frequently Asked Questions
There’s no single answer for this question. Everyone needs to try different treatments and see what works for them.
Common fibromyalgia painkillers include:
– Cymbalta (duloxetine), Savella (milnacipran), amitriptyline
- Anti-seizure drugs – Lyrica (pregabalin), Neurontin (gabapentin)
- Opioids (despite a lack of evidence that they’re effective) – Vicodin (hydrocodone/acetaminophen), OxyContin (oxycodone) and related products
Fibromyalgia needs a customized treatment regimen and there’s no “best” treatment that’s been identified. Three drugs are FDA-approved for fibromyalgia—Lyrica (pregabalin), Cymbalta (duloxetine), and Savella (milnacipran)—but many other drugs and supplements are used to treat this condition.
How To Use CBD for Fibromyalgia
People suffering from fibromyalgia are finding that cannabis products containing CBD work for treating their symptoms, often with less negative side effects than prescription medications.
Before we look at the research into CBD for fibromyalgia, let’s take a step back and understand what fibromyalgia is.
What is fibromyalgia?
Fibromyalgia is a chronic disease characterized by symptoms of chronic pain , insomnia , migraines , fatigue, joint pain, mood issues and symptoms of an irritable bowel. While we don’t know the cause(s) of fibromyalgia, it appears to be a sort of hypersensitivity condition where both painful and non-painful stimuli are perceived as pain.
People with fibromyalgia suffer from an increased sensitivity to pain.
This is thought to be caused by an abnormal functioning of pain signals in the central nervous system.
Commonly used treatments for fibromyalgia are pain relievers like NSAIDs and opioids, acupuncture, muscle relaxants, and sleep aids. Exercise therapy, relaxation techniques and stress-reduction techniques can also be helpful. Recently, the European League Against Rheumatism ( EULAR ) recommended against using NSAIDs.
Some patients are instead opting for CBD products to treat their fibromyalgia.
They are finding that CBD derived from hemp is safer and has fewer side effects than the prescription medications they were previously using.
How does CBD work for fibromyalgia?
While there are many theories about the underlying causes of fibromyalgia, one possibility is that fibromyalgia is one of the conditions caused by an endocannabinoid deficiency or dysregulation of the endocannabinoid system (ECS). Other theories are based in genetics, a history of physical or emotional abuse, hormonal disruptions and other conditions like anxiety and depression that may alter the perception of pain 1 , 2 .
The ECS is a naturally occurring regulatory pathway which plays a role in controlling major systems like the nervous system and the immune system. Overall, a healthy ECS controls sleep, appetite, memory, reproduction, mood and the perception of pain. An endocannabinoid deficiency/dysregulation occurs when a person has a poorly functioning endocannabinoid system, resulting from having abnormal levels of endocannabinoids.
If a person’s body doesn’t produce sufficient amounts or types of endocannabinoids, they may be more sensitive to pain.
Without a sufficient supply or type of endocannabinoids, the endocannabinoid system cannot properly do its job of maintaining balance in the body — and thus it is believed that people with fibromyalgia experience more pain than what is usual.
CBD can potentially help support the endocannabinoid system: one way CBD may do this is by slowing down the body’s natural process of breaking down endocannabinoids 3 .
What are the effects of using CBD for fibromyalgia?
People using hemp-derived CBD for fibromyalgia are reporting the following benefits:
- Improved mood
- Pain relief
- Improved sleep
- Less inflammation
- Reduction or cessation of prescription medication and henceforth a decrease in negative side effects
What are the side effects of using CBD for fibromyalgia?
Generally, CBD has few side effects and is well tolerated. However, it can be sedating for some people, especially if it is used in high doses.
Some people have reported fatigue, upset stomach and diarrhea to be additional side effects.
Always start with a low dose of CBD and slowly work your way up.
It’s a good idea to take CBD the first few times in the comfort of your home, when you do not have to drive, in case you do experience some negative side effects.
How should I use CBD for fibromyalgia (What dosage should I use)?
People with fibromyalgia symptoms are finding the best delivery methods to be capsules or sublingual tinctures because of the speed of the effects from these methods—sublingual dosing is a bit faster. Vaping can be used, but you should know that there are potentially risks inhaling these compounds. We just don’t know.
Most CBD products come as either broad-spectrum (which contain no THC) or full-spectrum products, which contain ≤0.3% THC. CBD is non-intoxicating (non-psychoactive) while THC can be psychoactive. If you are concerned about either the legality or the intoxicating nature of a CBD product, it is best to stick with the broad-spectrum CBD products.
If you are completely new to using CBD, it’s always best to start with a low dose of broad-spectrum CBD product and increase the dose very slowly. 5 – 10 mg of CBD is usually the lowest dose—but if you use edibles like gummies, you can cut them in ¼’ s or ½ ‘s to start with.
Increase the CBD dosage as needed until you reach the desired effect.
Always speak with a doctor before using CBD, especially if you already take other medications. CBD can cause drug interactions.
What are terpenes and are terpenes useful for helping with fibromyalgia?
When CBD is extracted from the hemp plant, another very large class of plant substances—the terpenes—are extracted as well. Terpenes are currently a “hot research” topic because many have beneficial medicinal properties that may work alongside CBD in what is known as the “entourage effect”. The following terpenes are good to look for because they work synergistically with CBD to provide relief from inflammation 4 .
- β-caryophyllene (beta-caryophyllene)
- α-Pinene (alpha-pinene)
What does the research have to say about cannabinoids and fibromyalgia?
You should know that many of the clinical studies on CBD and fibromyalgia also used THC. This may be difficult and even illegal in some states that do not allow THC to be sold. If you live in a state where medical or “recreational” cannabis is not legal, your best bet may be to try CBD in a full-spectrum product—according to the 2018 Farm Bill , these products can legally contain ≤0.3% THC.
In a recent review on CBD in fibromyalgia, the authors stated “While the current evidence is still limited, emerging data do suggest a positive effect of cannabis in fibromyalgia. Cannabis use is not without risks, including psychiatric, cognitive, and developmental as well as the risks of addiction.
As such, clinical judgment is warranted to weigh these risks and prescribe to patients who are more likely to benefit from this treatment. Further research is required to define appropriate patient selection and treatment regimens 5 .”
Other studies have provided support for using cannabinoids for fibromyalgia, though often for pain relief, some THC was thought to be important 6 , 7 .
Recently, the Arthritis Foundation —which has an interest in fibromyalgia—released guidelines for the use of CBD in arthritis pain.
They state that “ We are intrigued by the potential of CBD to help people find pain relief and are on record urging the FDA to expedite the study and regulation of these products. While currently there is limited scientific evidence about CBD’s ability to help ease arthritis symptoms, and no universal quality standards or regulations exist, we have listened to our constituents and consulted with leading experts** to develop these general recommendations for adults who are interested in trying CBD 8 . ” The Arthritis Foundation has also urged the FDA to speed up the approval of CBD products for pain relief.