CBD & Fibromyalgia Pain: Dosage, Benefits, Side Effects

Some of my patients with fibromyalgia have asked me about the benefit of using the cannabidiol (CBD) to relieve pain or improve sleep.

CBD has in fact been on sale over the counter in France for some time.

I therefore documented myself on the issue to answer the most frequent questions from my patients and Internet users on the subject: what dosage ?

What efficiency can we expect from it? After how long ? What is the best CBD ? And thehemp oil ?

To answer it as reliably and precisely as possible, I rely on:

• 📔 research deepened in the scientific literature international and English-speaking web on studies and documentation on the effects of CBD;
• 👩🏽‍⚕️ my interactions with people with fibromyalgia who have decided whether or not to take CBD, and their questions, reviews and testimonials.

Most of the information available in French on the subject comes from sites marketing CBD.

These sites sometimes overestimate the effects to be expected, or underestimate the quantities necessary to really expect a result. Hence the interest, I think, of this article.

If you have any comments or questions, do not hesitate to leave them in comment. This may interest or help other people.

📢 Disclaimer: Sensilia and Amazon affiliate links. Article last updated: September 2023

What do we mean by fibromyalgia?

It is generally your GP, a rheumatologist or a doctor specializing in pain who has made your diagnosis of fibromyalgia. The 3 main symptoms are:

• chronic pain, which generally affect several parts of the body;
• there fatigue ;
• of the sleeping troubles.

The mechanisms underlying pain in fibromyalgia are not well understood. Its treatment is based on medicinal and non-drug approaches.

We will focus on one of these non-drug approaches : taking CBD.

In fibromyalgia, we are not sure of the mechanisms causing the pain. This can make it difficult to effectively treat pain and its consequences (difficulties with daily activities or professional life).

What is CBD or cannabidiol?

The cannabis plant has been used for over 3,000 years to reduce pain. There are two interesting molecules in cannabis, both of which have an effect against pain:

• cannabidiol (called CBD) ;
• Δ9-Tetrahydrocannabinol (called THC).

CBD appears to have anti-inflammatory and anti-oxidant effects. It has fewer adverse effects of THC. This has been demonstrated by in-vivo animal studies.

In France like in other countries, only “pure” CBD (with a tiny dose of THC) is marketed, over-the-counter and legal.

⚠️ Do not confuse:

• CBD/cannabidiol = absence of THC or negligible quantity;
• therapeutic cannabis/cannabis = in general, CBD + THC;
• hemp oil : hemp is a plant that belongs to the same family as cannabis. But it does not contain CBD and therefore has no action against pain.

In this article, we focus on CBD/cannabidiol, without THC, because it is the most accessible in France. It can be made from plants or synthetically.

CBD exists under different forms, and can therefore be administered as desired:

• 💨 by inhalation/vaping (by smoking it);
• 💊 orally in flower, oil, capsule, tablets or honey;
• by spray in the nose or mouth;
• 🍶 by application to the skin;
• 🍵 by drinking infusions.

Her concentration also varies a lot depending on its shape and brand. This is why I dedicate an entire section of this article to the recommended CBD dosage for fibromyalgia.

How effective is CBD in fibromyalgia?

To relieve pain related to fibromyalgia, there are two main types of treatment:

• THE drug treatments, with or without a prescription;
• THE non-drug treatments : everything else, such as physical activity or taking CBD.

In the USA, 32% of people with fibromyalgia say they use CBD. And 2/3 of them take it without discussing it with their doctor, on their own initiative. We do not have figures for France.

But this tells us nothing about the effectiveness of CBD ! Does it really help relieve pain compared to:

• medication ;
• lack of treatment;
• a placebo?

To find out, you should ideally:

• know if the mechanisms of action of CBD are likely in theory to be effective against the fibromyalgia type of pain;
• havestudies which compare the evolution of pain or fatigue of people with fibromyalgia taking CBD, compared to those not taking it, or taking a placebo.

Theoretical effectiveness of CBD in fibromyalgia

As said previously, little is known about the mechanisms of pain in fibromyalgia. We know, for example, that the CBD can theoretically be effective for neuropathic pain. But it is more difficult to know for fibromyalgia.

This reasoning is also valid for medications against fibromyalgia.

CBD is theoretically effective against certain forms of pain. But because little is known about the mechanisms of pain in fibromyalgia, it is difficult to say whether it is effective against fibromyalgia pain.

Effectiveness of CBD against fibromyalgia: studies

Most studies on CBD and fibromyalgia focus on the effects of CBD combined with THC. However, this form of CBD is not marketed in France.

It is only in studies where CBD is combined with THC that people taking it describe a significant reduction in their pain, compared to those taking a placebo. (Khurshid 2021)

But there are very few studies on the subject. There is therefore uncertainty about the effectiveness of CBD taken in isolation, without THC.

Same thing for the side effects of CBD. When reported, these are:

• drowsiness,
• diarrhea,
• vomiting,
• fatigue.

Mild to moderate severity.

The effectiveness of CBD alone (without THC) has not really been studied against fibromyalgia.

Risk of drug interaction

Cannabidiol interacts with many other molecules.

If you take it in large doses and over a long period, the ideal is to discuss it with a doctor who is familiar with your own drug treatment as well as the interactions of CBD.

Particularly if we take:

• of the estrogen medications and the oral contraceptive pill. Consuming high amounts of CBD can reduce or even eliminate the effectiveness of the contraceptive pill;
• A anti-vitamin K (AVK), warfarin (this is an anticoagulant). It is advisable to check the INR at the start of CBD consumption in someone taking warfarin;
• of the cancer immunotherapies : potential reduction in their effectiveness (by reduction in the immune reaction linked to the consumption of CBD).
• Source: Henson 2022, Grayson 2018

Thanks to researcher Jérémy Henson from the University of New South Wales (Australia) for reminding me of the existence of these interactions.

What dosage/dosage of CBD in case of fibromyalgia?

In the United States, 1/3 of people suffering from fibromyalgia do not know how much CBD they take per day. Those who know it say they take between 16 and 27 mg per day. (Boehnke 2022)

Is this the right dosage to expect CBD to be effective?

In the only study evaluating the effectiveness of taking CBD without THC for fibromyalgia compared to a placebo, the amount taken per day was 18 mg. But pain was not reduced in these people compared to those taking a placebo (Khurshid 2021).

It is therefore reasonable to think that you should not take less than 18 mg/day of CBD to expect significant effectiveness.

Recommended CBD dosages per day are much higher for neuropathic pain, on which we have more perspective on the effectiveness of CBD. They are from 2.85 mg/kg per day to 50 mg/kg/day. That is, for example, from 285 to 5000 mg/day for a person weighing 100 kilos!

Against joint pain linked to osteoarthritis, 250 to 500 mg of CBD per day are recommended.

The minimum dosage to expect CBD to be effective against fibromyalgia pain is 20 mg/day. See several hundred milligrams per day!

What is the best form of CBD for fibromyalgia?

The effectiveness of CBD depends on its dosage, but also on how it is taken. Two CBD elms are more recommended against chronic pain, and therefore against fibromyalgia:

• CBD to swallow (pill, oil, capsule, capsule, CBD flowers or crystals);
• CBD which diffuses through the mucous membranes (spray).

The least recommended forms are inhaled and vaped forms.

(Haüser 2018)

Better to take for fibromyalgia from CBD that is swallowed (capsule, pill, flower, oil).

Best CBD Oil for Fibromyalgia: Review

Many establishments and websites sell CBD. The most difficult thing is to identify products containing a sufficiently large quantity of CBD.

Here is the result of my research.

CBD Oil for Osteoarthritis if you reside in America, Oceania, Africa, or Asia

Here is the oil that I found on a website for which I found:

• the most reliable feedback
• the most detailed information on the quantity and nature of the products.

I am not being compensated to speak about them, but by clicking the link, if you make a purchase, I may receive a small commission.

Additionally, it becomes 10% cheaper for you if you use the code CONC10 on purchases for CBD CONCENTRATES products.

CBD Oil for Osteoarthritis if you reside in Europe (UK, etc.)

After several years of attempting to find a manufacturer that clearly communicated on this matter, I discovered the CBD brand Sensilia. They provide clear information about the quantity of CBD contained in their products and in each serving, which I find highly commendable. Moreover, the prices are quite reasonable considering the CBD content.

I am not being compensated to speak about them, but by clicking the link, if you make a purchase, I may receive a small commission.

Additionally, it becomes 10% cheaper for you if you use the code NDB10 on purchases over 50 euros.

CBD Oil in a non-online store near you

You will probably be able to find similar products in a store near you. Remember to ask for the precise quantity of CBD per serving.

If the seller doesn’t know how to answer you (that’s already honest on his part!), I advise you to find another store.

What is the difference between CBD and hemp oil?

There is often a confusion between CBD and hemp oil. Some people think it’s the same thing, when it’s not.

Hemp is a plant belonging to the same species as cannabis. But the hemp contains almost no cannabidiol or THC.

⚠️ Hemp therefore does not relieve pain. Neither in case of fibromyalgia, nor in case of other pathology.

What alternative to CBD for pain in fibromyalgia?

What are the other non-drug approaches to hopefully reduce the pain of fibromyalgia?

There regular physical activity allows :

• slightly reduce pain;
• slightly reduce the negative impact of the disease on quality of life.

Physical exercises must be practiced for at least 13 to 24 weeks, in sessions of 30 to 60 minutes, at least once a week. The intensity of the sessions should be increased gradually. (Albuquerque 2022, Cochrane 2017)

Cognitive-behavioral therapies can reduce pain in the short term (Mascarenhas 2021). They are generally carried out in France by a psychiatrist or psychologist.

***

Still have questions or comments? See you in the comments!

You might also like these articles:

1. CBD for better sleep?
2. CBD, arthritis & joint pain
3. CBD & neuropathic pain

📕 Scientific sources 📕

I searched the international medical literature (via Pubmed) for articles on the use of CBD/cannabidiol or therapeutic cannabis in cases of fibromyalgia. Here are the articles (all in English) that I selected and on which this article is based. Fibromyalgia is one of the pathologies for which the effect of CBD is the most discussed and studied, but especially when combined with THC.

Effectiveness of CBD

Khurshid H, Qureshi IA, Jahan N, Went TR, Sultan W, Sapkota A, Alfonso M. A Systematic Review of Fibromyalgia and Recent Advances in Treatment: Is Medicinal Cannabis a New Hope? Cureus. 2021 Aug 20;13(8):e17332. doi:10.7759/cureus.17332. PMID: 34567876; PMCID: PMC8451533.

Walitt B, Klose P, Fitzcharles M-A, Phillips T, Häuser W. Cannabinoids for fibromyalgia. Cochrane Database of Systematic Reviews 2016, Issue 7. Art. No.: CD011694. DOI: 10.1002/14651858.CD011694.pub2. Accessed 18 May 2022.

Amount of CBD taken

Boehnke KF, Gagnier JJ, Matallana L, Williams DA. Cannabidiol Product Dosing and Decision-Making in a National Survey of Individuals with Fibromyalgia. J Pain. 2022 Jan;23(1):45-54. doi: 10.1016/j.jpain.2021.06.007. Epub 2021 Jun 30. PMID: 34214700; PMCID: PMC8716664.

CBD with THC

Chaves C, Bittencourt PCT, Pelegrini A. Ingestion of a THC-Rich Cannabis Oil in People with Fibromyalgia: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Pain Med. 2020 Oct 1;21(10):2212-2218. doi:10.1093/pm/pnaa303. PMID: 33118602; PMCID: PMC7593796.

van de Donk T, Niesters M, Kowal MA, Olofsen E, Dahan A, van Velzen M. An experiment randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia. Bread. 2019 Apr;160(4):860-869. doi: 10.1097/j.pain.0000000000001464. PMID: 30585986; PMCID: PMC6430597

Fibromyalgia and pain: other effective non-drug therapies

Mascarenhas RO, Souza MB, Oliveira MX, Lacerda AC, Mendonça VA, Henschke N, Oliveira VC. Association of Therapies With Reduced Pain and Improved Quality of Life in Patients With Fibromyalgia: A Systematic Review and Meta-analysis. JAMA Intern Med. 2021 Jan 1;181(1):104-112. doi: 10.1001/jamainternmed.2020.5651. PMID: 33104162; PMCID: PMC7589080.

Albuquerque MLL, Monteiro D, Marinho DA, Vilarino GT, Andrade A, Neiva HP. Effects of different protocols of physical exercise on fibromyalgia syndrome treatment: systematic review and meta-analysis of randomized controlled trials. Rheumatol Int. 2022 May 23. doi: 10.1007/s00296-022-05140-1. Epub ahead of print. PMID: 35604435.

Bidonde J, Busch AJ, Schachter CL, Overend TJ, Kim SY, Góes SM, Boden C, Foulds HJ. Aerobics exercise training for adults with fibromyalgia. Cochrane Database Syst Rev. 2017 Jun 21;6(6):CD012700. doi:10.1002/14651858.CD012700. PMID: 28636204; PMCID: PMC6481524.