Around 2 million people in the UK suffer from fibromyalgia, a neurological disorder resulting in widespread chronic pain for which there is currently no cure available.
Painkillers and antidepressants are prescribed to help manage the symptoms, but the benefits, if any, are often surpassed by the terrible side effects. This has led patients and their families to search for safer alternative treatments, such as cannabidiol (CBD).
CBD popularity surged when heartfelt videos of children with epilepsy becoming seizure-free went viral. It can also people with anxiety, depression chronic pain and their sex life. This was quickly followed by clinical trials that proved what advocates always knew; the plant can be a medicine.
Encouraging as this is, can cbd oil for fibromyalgia really relief some of the symptoms?
Fibromyalgia was once considered a fictitious disease, but then again so too were the medicinal properties of the cannabis plant. As both theories have now been disproved many people are now using this wonderous plant to help with an array of ailments.
But what exactly is CBD and is there evidence to back up the claims that fibromyalgia patients may benefit from using it?
Understanding CBD Oil
CBD is one of more than 120 cannabinoids extracted from the flower and leaf of the cannabidiol-rich cannabis plant. A strain that contains only a negligible amount of the psychotropic tetrahydrocannabinol (THC) cannabinoid and as such will never result in any euphoric ‘high’ feeling typically associated with cannabis.
CBD interacts with receptors located in the human endocannabinoid system (ECS), a molecular signalling system that promotes wellness by regulating biological systems.
The ECS regulates a variety of cognitive and physiological processes including mood, memory, inflammation, and appetite, but one aspect fibromyalgia patients will be interested in is how this cannabinoid can help with chronic pain relief.
CBD Oil for Fibromyalgia – How Does It Work?
CBD acts simultaneously on multiple pain targets by interacting with receptors located throughout the peripheral and central nervous system(CNS) – the pathway in which pain signals travel along. A pathway that is distorted in fibromyalgia patients.
When we experience sensory damage (burns, cuts etc), our brain is informed of this by peripheral sensory neurons known as nociceptors and responds by making us feel pain.
Cannabidiol regulates this perception of pain by affecting the activity of serotonin receptors which are known to influence pain through spinal processing of nociceptive information.
In addition to this, activation of CB2 receptors on keratinocytes (skin cells) stimulates the release of β-endorphin, which acts at μ opioid receptors on peripheral sensory neurons to inhibit the message of pain from nociception information.
Furthermore, when the body is in distress it naturally produces an endogenous cannabinoid known as anandamide which has been shown to suppress pain initiation. Unfortunately, this molecule is eradicated quickly from the body by an enzyme known as ‘fatty acid amide hydrolase’ or FAAH.
CBD inhibits FAAH thereby slowing down anandamide decomposition resulting in further pain suppression which may help fibromyalgia patients experience more pain relief.
Is CBD Effective for Fibromyalgia Pain?
CBD can help manage the chronic pain associated with fibromyalgia by directly or indirectly interacting with the receptors located throughout the body responsible for the perception of pain.
Cannabidiol has the ability to affect serotonin levels, anandamide levels, and opioid receptors all of which are known to influence our perception of pain.
Fibromyalgia patients experience a much more heightened form of pain due to the confusion that arises when chemical signals are being sent to and from the brain, but this unique molecule may have the potential to mitigate some of these ‘crossed wires’…
Chemical information messengers called neurotransmitters interact with glial cells which play a vital role in the spinal cord with regards modulation and amplification of pain, something that is exacerbated in patients with fibromyalgia.
Professor of anesthesiology at Stanford University, Dr. Elliot Krane, says that “when these glial cells become activated they can create a positive feedback loop” where “pain becomes its own disease” offering only rare and brief glimpses of respite.
This results in nervous system plasticity changes whereby the sensory experience we call pain is amplified and ultimately distorted. Existing medications, when they work, simply mask these problems whereas cannabidiol may offer a solution.
A 2017 study from Israel showed astrocyte (glial cells) activity to be suppressed by the presence of CBD in models of ischemia, Alzheimer-like and Multiple-Sclerosis-like neurodegenerative, sciatic nerve injury, epilepsy, and schizophrenia.
So If CBD does all this, why is it not recommended by doctors for fibromyalgia?
Why Has My Doctor Not Recommended CBD?
An NHS doctor may only prescribe Cannabis oil for certain conditions such as treatment-resistant epilepsy, or nausea from chemotherapy.
All other conditions, regardless of the research available, can not legally be suggested for CBD treatment without prior extensive and incredibly expensive clinical trials.
Thankfully though, CBD is classified as a food supplement in the UK and most parts of the world and as such is available throughout the country. But does that make it legal?
Is It Legal to Treat Fibromyalgia With CBD?
CBD is legal to purchase, consume, and help treat patients living with fibromyalgia in the UK. The only caveat is that manufacturers and retailers may not advertise it as a cure or remedy for symptoms or illnesses of any disease.
Purchasing the oil is the easy part but due to its classification as a food supplement it is difficult to get advice from UK health authorities on dosage, but there are a lot of resources out there that you can turn to.
Guidelines of CBD Dosage for Fibromyalgia
In all human studies, cannabidiol has been shown to exhibit a bell-shaped dose-response curve meaning the effects and benefits work at different dosage strengths for different people. It is not simply a case of more is better.
Dr. Sarah Brewer, a medical director and medical nutritionist at UK group ‘Healthspan’ says: “For General well-being, the recommended dose is 10 mg to 200 mg per day as a food supplement.”
Double-blind placebo-controlled studies into adults with anxiety showed 300 mg being the optimum dosage but this may not feasible for everyone and anecdotal evidence suggests effects can actually be found at much lower doses.
The best dosage advice is always to start small and slow. Every person has their own unique endocannabinoid system and the right dosage amount will often vary based on :
- Height & Weight
- Your body's tolerance to CBD
- Condition being treated
- Concentration/strength of the product
The below diagram will give you a really good base to work from until you find the dosage right for you.
|Weight||Recommended dosage for mild effects||Recommended dosage for moderate effects||Recommended dosage for strong effects|
|5-11 stone</sp||12 mg||18 mg||22.5 mg|
|11-17 stone||15 mg||22.5 mg||30 mg|
|17 stone||18 mg||27 mg||45 mg|
People tend to take cbd oil first thing in the morning and the last thing at night but others prefer to microdose throughout the day. It is recommended that you consume cannabidiol with high-fat foods as this is believed to increase absorption in the blood.
There is one other popular method by an American doctor that may suit fibromyalgia patients for finding their perfect dosage.
The Dr. Dustin Sulak Dosing Method
A popular method used by fibromyalgia was developed by Dr. Dustin Sulak, a physician in Maine, USA, who provides an easy process for finding the dosage that is right for you.
Regardless of which method of consumption you choose, vaping, gummies, tincture etc, Begin by taking a very small amount (1-5mg) in the morning and after one hour, you proceed to ask yourself the following 3 questions:
- How easy is it to breathe?
- How comfortable and calm does your body feel?
- How easy is it for you to smile naturally?
You then rate your scores from 1 – 10 and do this every hour.
If your scores are the same after the first hour then slowly increase your dose and rate yourself again using the same 3 questions.
Continue to do this until you feel a noticeable difference.
Eventually, you will reach the stage where increasing your dosage will not result in higher subjective scores meaning you have found your optimum dosage.
Dr. Sulak suggests dosing 3 to 4 times a day for optimum results, but can this be too much?
Treatment Options Using CBD
Due to an ever-growing market, there are a growing number of ways of getting CBD into your body, resulting in more and more innovative ways with something to suit everyone and every palate.
Topicals include salves, balms, and creams that contain typical skincare ingredients infused with CBD oil. Topicals are applied directly to the site of pain or infection to work on that specific area. They can also be used to improve conditions such as acne and to also just give you clearer, better-looking skin. These are particularly popular for people with skin conditions, muscular pains and joint aches.
Smoking or Vaping
Smoking and vaping CBD involves flower or oil being burned (smoked) or heated (vaped) and entering the lungs. Pulmonary absorption results in a rapid onset of effects. Those looking for immediate relief should opt for vaping flower rather than smoking as it does not have the toxins that are created from combustion.
Tinctures provide an easy, effective and ideal medium for precise dosing. Using a pipette, drops are placed under the tongue where there are numerous veins that quickly absorb the oil into the circulatory system.
For some, the taste of cannabidiol can be too strong and if that is the case then edibles such as delicious cakes, chocolates, gummy bears, CBD drinks are all great options.
Capsules offer a precise method for those looking for accurate dosing. With different strengths available, as well as a vegetarian option, there is a capsule for everyone.
Another fast and effective method similar to tinctures is the oromucosal method in which CBD is sprayed into the mouth and gums and quickly absorbed into the circulatory system.
Using a special spray bottle CBD oil is breathed into the nose where thin mucosa absorbs the oil for fast-acting results.
For those who, for whatever, reason cannot swallow capsules, edibles, etc, there are suppositories which can be taken and are absorbed into the cellular walls and mucous membranes of the anus.vThe lower and middle veins allow CBD to bypass the digestive system, therefore rapidly entering the bloodstream
CBD Oil – Are There Side Effects?
CBD oil has a remarkable safety profile which was confirmed by a 2017 study of clinical data and animal studies. Researchers even concluded that “CBD has a better side effect profile in comparison to ‘traditional’ drugs.”
The majority of studies looked at epilepsy and psychotic disorders with the most commonly reported side effects reported being:
- Changes in appetite/weight.
- Potential drug on drug interactions
CBD oil is being used to aid sleep and as such larger doses may bring on some drowsiness. In epilepsy studies using epidiolex (patented CBD mixture with other ingredients), 21% experienced tiredness.
Diarrhoea is only mentioned as a side effect in 10% of epilepsy participants who received epidiolex whereas in other studies of pure CBD (nothing added) there is no mention of diarrhoea as a side effect.
Changes in Appetite/Weight
Again in epilepsy clinical trials, 16% of participants reported reduced appetite. Weight loss was reported in 2% of trialists.
Drug on drug Interactions
Cannabidiol may interact with enzymes in your liver potentially increasing or decreasing pharmaceutical drugs. Something anyone on blood thinners, for example, should consult their doctor prior to use
Interestingly this is not necessarily a negative as in one 13 week study of children, CBD increased the bioavailability of the anti-epileptic drug and in turn reduced the dosage required resulting in fewer side effects.
Cannabidiol has the ability to mimic certain endogenous cannabinoids functions by interacting directly or indirectly with receptors located throughout the body. This results in a plethora of potential medicinal benefits using cbd oil for fibromyalgia patients including providing chronic pain relief, reduced inflammation and anti-anxiety effects.
Considering its safety profile and infrequent, mild potential side effects CBD oil would certainly be prudent for patients and their families to do their own research and seriously consider this alternative to synthetic pharmaceutical drugs.
It is also worth reiterating the importance of premium, 3rd party independently tested oil to ensure the product you receive is the highest quality, as inferior products often contain no CBD at all. A better quality product will offer significantly better results.
Finally, there is a clear consensus that starting small and slow is the best option so you find the right dosage that works for you.