CBD for Fibromyalgia

Because fibromyalgia is often a diagnosis of exclusion, blood tests are taken alongside a complete physical and neurological exam ^{4 Galvez-Sánchez, C. M., & Reyes Del Paso, G. A. (2020). Diagnostic Criteria for Fibromyalgia: Critical Review and Future Perspectives. Journal of clinical medicine, 9(4), 1219. https://doi.org/10.3390/jcm9041219} .

Given how misdiagnosed and misunderstood fibromyalgia remains, it should come as no surprise that treating the condition is also often difficult. To date, no cure for fibromyalgia exists, and most treatment protocols are multidisciplinary, relying on patients to partner in the self-management of their care. Treatment often involves non-pharmacological and pharmacological approaches ^{5 Kwiatek R. (2017). Treatment of fibromyalgia. Australian prescriber, 40(5), 179–183. https://doi.org/10.18773/austprescr.2017.056} .

Non-pharmacological therapies might include education on managing the disease and help developing coping skills, as the chronic nature of the condition often lingers. Exercise and physical therapy are also routinely prescribed ^{5 Kwiatek R. (2017). Treatment of fibromyalgia. Australian prescriber, 40(5), 179–183. https://doi.org/10.18773/austprescr.2017.056} .

Drug therapy is usually seen as providing a supportive role in symptom management and may include:

• Antidepressants
• Antiepileptic drugs
• Tramadol

Every patient’s treatment protocol is different, and most treatments are only partially successful in helping to manage the symptoms associated with the condition ^{6 Macfarlane, G. J., Kronisch, C., Dean, L. E., Atzeni, F., Häuser, W., Fluß, E., Choy, E., Kosek, E., Amris, K., Branco, J., Dincer, F., Leino-Arjas, P., Longley, K., McCarthy, G. M., Makri, S., Perrot, S., Sarzi-Puttini, P., Taylor, A., & Jones, G. T. (2017). EULAR revised recommendations for the management of fibromyalgia. Annals of the rheumatic diseases, 76(2), 318–328. https://doi.org/10.1136/annrheumdis-2016-209724} .

Two very recent studies have identified the potential benefits of medical cannabis in the treatment of fibromyalgia.

The first, published in 2019, looked into the safety and efficacy of using cannabis to treat fibromyalgia. Over the course of two years, 367 fibromyalgia patients initiated treatment with medical cannabis (including THC) and completed questionnaires throughout their treatment. During the study period, patients reported an overall reduction in pain intensity on a scale of 0-10 from a median of 9.0 to 5.0. Overall, comfort level with cannabis treatment was associated with this treatment outcome ^{7 Sagy, I., Bar-Lev Schleider, L., Abu-Shakra, M., & Novack, V. (2019). Safety and Efficacy of Medical Cannabis in Fibromyalgia. Journal of clinical medicine, 8(6), 807. https://doi.org/10.3390/jcm8060807} .

The second study was published in 2020. This one started with 102 fibromyalgia patients who were considered stable in treatment (including receiving central sedatives and opioids) but who hadn’t yet found relief. Study participants were prescribed two cannabis extracts, both with THC and CBD. At the end of the study period, 47 percent of patients had found enough relief to either reduce or altogether quit their painkiller prescriptions. Over a third of patients also reported achieving better sleep as well as a reduction in anxiety, depression, and pain ^{8 Giorgi, V., Bongiovanni, S., Atzeni, F., Marotto, D., Salaffi, F., & Sarzi-Puttini, P. (2020). Adding medical cannabis to standard analgesic treatment for fibromyalgia: a prospective observational study. Clinical and experimental rheumatology, 38 Suppl 123(1), 53–59.} .

Unfortunately, both of these studies involved the use of both THC and CBD. To date, there is no research into the potential benefits of just CBD in the treatment of fibromyalgia.

That doesn’t mean there is no reason to believe CBD for fibromyalgia could work, however. In fact, several studies that suggest CBD could prove beneficial in the treatment of many of the most bothersome symptoms associated with fibromyalgia.

For example, research has found CBD to be effective in managing and treating difficult to treat pain. Researchers believe this is because of the way CBD interacts with the endocannabinoid system and the pain receptors located throughout that system ^{9 Russo E. B. (2008). Cannabinoids in the management of difficult to treat pain. Therapeutics and clinical risk management, 4(1), 245–259. https://doi.org/10.2147/tcrm.s1928} .

More recent research has shown that CBD can also prove beneficial in treating anxiety and sleep disorders, both of which often plague fibromyalgia patients ^{10 Shannon, S., Lewis, N., Lee, H., & Hughes, S. (2019). Cannabidiol in Anxiety and Sleep: A Large Case Series. The Permanente journal, 23, 18–041. https://doi.org/10.7812/TPP/18-041} .

And perhaps most importantly, CBD has a relatively high safety profile— certainly higher than most of the drugs typically prescribed to treat fibromyalgia ^{11 Larsen, C., & Shahinas, J. (2020). Dosage, Efficacy and Safety of Cannabidiol Administration in Adults: A Systematic Review of Human Trials. Journal of clinical medicine research, 12(3), 129–141. https://doi.org/10.14740/jocmr4090} . Which makes this cannabinoid worth at least giving a shot for patients who feel as though they have tried everything else and are still struggling to find relief.

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