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Cannabidiol Use for Fibromyalgia: Prevalence of Use and Perceptions of Effectiveness in a Large Online Survey

Published:January 02, 2021DOI:https://doi.org/10.1016/j.jpain.2020.12.001

      Highlights

      • Large survey of cannabidiol (CBD) use among N = 2701 participants with fibromyalgia.
      • Around 60% of participants with fibromyalgia had tried CBD in the past or currently used CBD.
      • Around 32% of participants currently used CBD, mostly for pain, anxiety, and sleep.
      • Around 30 to 40% reported much or very much relief across symptom domains.
      • Participants typically tried CBD due to inadequate relief from other medications.

      Abstract

      Cannabidiol (CBD) is widely advertised as helpful for chronic pain management but research is limited. Using a cross-sectional, anonymous survey, we examined patterns of naturalistic CBD use among individuals with fibromyalgia (FM) and other chronic pain conditions. Our objective was to better understand rates of CBD use, reasons for use and discontinuation, communication with healthcare professionals about CBD, and perceptions of CBD effectiveness and safety among people with FM. After excluding incomplete surveys, our study population consisted of N = 2,701 participants with fibromyalgia, primarily in the United States. Overall, 38.1% reported never using CBD, 29.4% reported past CBD use, and 32.4% reported current CBD use. Past-year cannabis use was strongly associated with past or current CBD use. Those using CBD typically did so due to inadequate symptom relief, while those not using CBD typically cited safety concerns as their reason for not using CBD. Two-thirds of participants disclosed CBD use to their physician, although only 33% asked for physician advice on using CBD. Participants used CBD for numerous FM-related symptoms (most commonly pain), and generally reported slight to much improvement across symptom domains. Around half of participants reported side effects, which were typically minor. Our findings are limited by selection bias and our cross-sectional design, which prevents causal associations. In conclusion, CBD use is common among individuals with FM and many individuals using CBD report improvements across numerous FM-related symptoms. Our findings highlight the need for additional rigorous studies to better understand CBD's potential for FM management.

      Perspective

      This article indicates that CBD use is common among people with fibromyalgia, and the results suggest that many derive benefit from using CBD across multiple symptoms domains. Clinicians should discuss CBD use with fibromyalgia patients, and future studies are needed to rigorously assess CBD's therapeutic value for fibromyalgia symptoms.

      Key words

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      References

      1. Administration USFaD. Warning Letters and Test Results for Cannabidiol-Related Products. 2019. Available at:https://www.fda.gov/news-events/public-health-focus/warning-letters-and-test-results-cannabidiol-related-products Accessed April 15, 2020

        • Bair MJ
        • Krebs EE
        Fibromyalgia.
        Ann Intern Med. 2020; 172: ITC33-ITC48
        • Bennett RM
        • Jones J
        • Turk DC
        • Russell IJ
        • Matallana L.
        An internet survey of 2,596 people with fibromyalgia.
        BMC Musculoskelet Disord. 2007; 8: 27
        • Bergamaschi MM
        • Queiroz RH
        • Chagas MH
        • de Oliveira DC
        • De Martinis BS
        • Kapczinski F
        • Quevedo J
        • Roesler R
        • Schroder N
        • Nardi AE
        • Martin-Santos R
        • Hallak JE
        • Zuardi AW
        • Crippa JA.
        Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naive social phobia patients.
        Neuropsychopharmacology. 2011; 36: 1219-1226
        • Boehnke KF.
        Pain management: Assembling a tool kit, building a life.
        JAMA. 2018; 320: 2201-2202
        • Boehnke KF
        • Gangopadhyay S
        • Clauw DJ
        • Haffajee RL.
        Qualifying conditions of medical cannabis license holders in the United States.
        Health Aff (Millwood). 2019; 38: 295-302
        • Boehnke KF
        • Scott JR
        • Litinas E
        • Sisley S
        • Clauw DJ
        • Goesling J
        • Williams DA.
        Cannabis use preferences and decision-making among a cross-sectional cohort of medical cannabis patients with chronic pain.
        J Pain. 2019; 20: 1362-1372
        • Boehnke KF
        • Scott JR
        • Litinas E
        • Sisley S
        • Williams DA
        • Clauw DJ.
        Pills to pot: Observational analyses of cannabis substitution among medical cannabis users with chronic pain.
        J Pain. 2019; 20: 830-841
        • Bonn-Miller MO
        • Loflin MJE
        • Thomas BF
        • Marcu JP
        • Hyke T
        • Vandrey R
        Labeling accuracy of cannabidiol extracts sold online.
        JAMA. 2017; 318: 1708-1709
      2. Brenan M. 14% of Americans Say They Use CBD Products. 2019. Available at: https://news.gallup.com/poll/263147/americans-say-cbd-products.aspx Accessed April 21, 2020

        • Campos AC
        • Moreira FA
        • Gomes FV
        • Del Bel EA
        • Guimaraes FS.
        Multiple mechanisms involved in the large-spectrum therapeutic potential of cannabidiol in psychiatric disorders.
        Philos Trans R Soc Lond B Biol Sci. 2012; 367: 3364-3378
        • Capano A
        • Weaver R
        • Burkman E.
        Evaluation of the effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients: a prospective cohort study.
        Postgrad Med. 2019; 132: 56-61
        • Carlini EA
        • Cunha JM.
        Hypnotic and antiepileptic effects of cannabidiol.
        J Clin Pharmacol. 1981; 21: 417S-427S
        • Chagas MH
        • Eckeli AL
        • Zuardi AW
        • Pena-Pereira MA
        • Sobreira-Neto MA
        • Sobreira ET
        • Camilo MR
        • Bergamaschi MM
        • Schenck CH
        • Hallak JE
        • Tumas V
        • Crippa JA.
        Cannabidiol can improve complex sleep-related behaviours associated with rapid eye movement sleep behaviour disorder in Parkinson's disease patients: A case series.
        J Clin Pharm Ther. 2014; 39: 564-566
        • Clauw DJ.
        Pain management: Fibromyalgia drugs are 'as good as it gets' in chronic pain.
        Nat Rev Rheumatol. 2010; 6: 439-440
        • Clauw DJ.
        Fibromyalgia: A clinical review.
        JAMA. 2014; 311: 1547-1555
        • Compton WM
        • Han B
        • Jones CM
        • Blanco C
        • Hughes A.
        Marijuana use and use disorders in adults in the USA, 2002–14: Analysis of annual cross-sectional surveys.
        The Lancet Psychiatry. 2016; 3: 954-964
      3. Corroon J, MacKay D, Dolphin W. Labeling of cannabidiol products: A public health perspective. Cannabis and Cannabinoid Research. 2020

        • Corroon J
        • Phillips JA.
        A cross-sectional study of cannabidiol users.
        Cannabis Cannabinoid Res. 2018; 3: 152-161
        • Crippa JA
        • Derenusson GN
        • Ferrari TB
        • Wichert-Ana L
        • Duran FL
        • Martin-Santos R
        • Simoes MV
        • Bhattacharyya S
        • Fusar-Poli P
        • Atakan Z
        • Santos Filho A
        • Freitas-Ferrari MC
        • McGuire PK
        • Zuardi AW
        • Busatto GF
        • Hallak JE
        Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: A preliminary report.
        J Psychopharmacol. 2011; 25: 121-130
        • de Faria SM
        • de Morais Fabricio D
        • Tumas V
        • Castro PC
        • Ponti MA
        • Hallak JE
        • Zuardi AW
        • Crippa JAS
        • Chagas MHN.
        Effects of acute cannabidiol administration on anxiety and tremors induced by a Simulated Public Speaking Test in patients with Parkinson's disease.
        J Psychopharmacol. 2020; 34: 189-196
        • De Gregorio D
        • McLaughlin RJ
        • Posa L
        • Ochoa-Sanchez R
        • Enns J
        • Lopez-Canul M
        • Aboud M
        • Maione S
        • Comai S
        • Gobbi G.
        Cannabidiol modulates serotonergic transmission and reverses both allodynia and anxiety-like behavior in a model of neuropathic pain.
        Pain. 2019; 160: 136-150
        • Devinsky O
        • Cross JH
        • Laux L
        • Marsh E
        • Miller I
        • Nabbout R
        • Scheffer IE
        • Thiele EA
        • Wright S
        Cannabidiol in Dravet syndrome study G. trial of cannabidiol for drug-resistant seizures in the Dravet syndrome.
        N Engl J Med. 2017; 376: 2011-2020
        • Dixon HX
        • Benjamin DC
        • Meng T
        • Yujiang F.
        The effectiveness of topical cannabidiol oil in symptomatic relief of peripheral neuropathy of the lower extremities.
        Curr Pharmaceut Biotechnol. 2019; 20: 1-13
      4. Foundation A. Patients Tell Us About CBD Use. 2019. Available at: http://blog.arthritis.org/news/patients-tell-us-cbd-use/ Accessed June 5, 2020

        • Gurley BJ
        • Murphy TP
        • Gul W
        • Walker LA
        • ElSohly M.
        Content versus label claims in cannabidiol (CBD)-containing products obtained from commercial outlets in the state of Mississippi.
        J Diet Suppl. 2020; (1-9)
        • Han B
        • Compton WM
        • Blanco C
        • Jones CM.
        Trends in and correlates of medical marijuana use among adults in the United States.
        Drug Alcohol Depend. 2018; 186: 120-129
        • Hauser W
        • Jung E
        • Erbsloh-Moller B
        • Gesmann M
        • Kuhn-Becker H
        • Petermann F
        • Langhorst J
        • Thoma R
        • Weiss T
        • Wolfe F
        • Winkelmann A.
        The German fibromyalgia consumer reports - a cross-sectional survey.
        BMC Musculoskelet Disord. 2012; 13: 74
        • Hauser W
        • Petzke F
        • Sommer C.
        Comparative efficacy and harms of duloxetine, milnacipran, and pregabalin in fibromyalgia syndrome.
        J Pain. 2010; 11: 505-521
        • Hauser W
        • Walitt B
        • Fitzcharles MA
        • Sommer C.
        Review of pharmacological therapies in fibromyalgia syndrome.
        Arthritis Res Ther. 2014; 16: 201
        • Hurd YL
        Leading the next CBD wave-safety and efficacy.
        JAMA Psychiatry. 2020; 77: 341-342
        • Iffland K
        • Grotenhermen F.
        An update on safety and side effects of cannabidiol: A review of clinical data and relevant animal studies.
        Cannabis Cannabinoid Res. 2017; 2: 139-154
        • Laprairie RB
        • Bagher AM
        • Kelly ME
        • Denovan-Wright EM.
        Cannabidiol is a negative allosteric modulator of the cannabinoid CB1 receptor.
        Br J Pharmacol. 2015; 172: 4790-4805
        • Linares IM
        • Zuardi AW
        • Pereira LC
        • Queiroz RH
        • Mechoulam R
        • Guimaraes FS
        • Crippa JA.
        Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test.
        Braz J Psychiatry. 2019; 41: 9-14
        • Malfait AM
        • Gallily R
        • Sumariwalla PF
        • Malik AS
        • Andreakos E
        • Mechoulam R
        • Feldmann M.
        The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis.
        Proc Natl Acad Sci U S A. 2000; 97: 9561-9566
        • Masataka N.
        Anxiolytic effects of repeated cannabidiol treatment in teenagers with social anxiety disorders.
        Front Psychol. 2019; 10: 2466
        • Nitecka-Buchta A
        • Nowak-Wachol A
        • Wachol K
        • Walczynska-Dragon K
        • Olczyk P
        • Batoryna O
        • Kempa W
        • Baron S.
        Myorelaxant effect of transdermal cannabidiol application in patients with TMD: A randomized, double-blind trial.
        J Clin Med. 2019; 8
        • Philpott HT
        • O'Brien M
        • McDougall JJ.
        Attenuation of early phase inflammation by cannabidiol prevents pain and nerve damage in rat osteoarthritis.
        Pain. 2017; 158: 2442-2451
        • Poklis JL
        • Mulder HA
        • Peace MR.
        The unexpected identification of the cannabimimetic, 5F-ADB, and dextromethorphan in commercially available cannabidiol e-liquids.
        Forensic Sci Int. 2019; 294: e25-e27
        • Russo EB.
        Taming THC: Potential cannabis synergy and phytocannabinoid-terpenoid entourage effects.
        Br J Pharmacol. 2011; 163: 1344-1364
        • Russo EB.
        Cannabidiol claims and misconceptions.
        Trends Pharmacol Sci. 2017; 38: 198-201
        • Russo EB
        • Burnett A
        • Hall B
        • Parker KK.
        Agonistic properties of cannabidiol at 5-HT1a receptors.
        Neurochem Res. 2005; 30: 1037-1043
        • Schrepf A
        • Moser S
        • Harte SE
        • Basu N
        • Kaplan C
        • Kolarik E
        • Tsodikov A
        • Brummett CM
        • Clauw DJ
        Top down or bottom up? An observational investigation of improvement in fibromyalgia symptoms following hip and knee replacement.
        Rheumatology (Oxford). 2019; 59: 594-602
        • Schrepf A
        • Williams DA
        • Gallop R
        • Naliboff BD
        • Basu N
        • Kaplan C
        • Harper DE
        • Landis JR
        • Clemens JQ
        • Strachan E
        • Griffith JW
        • Afari N
        • Hassett A
        • Pontari MA
        • Clauw DJ
        • Harte SE
        • Network MR.
        Sensory sensitivity and symptom severity represent unique dimensions of chronic pain: a MAPP Research Network study.
        Pain. 2018; 159: 2002-2011
        • Shannon S
        • Lewis N
        • Lee H
        • Hughes S.
        Cannabidiol in anxiety and sleep: A large case series.
        Perm J. 2019; 23: 18-041
        • Stockings E
        • Campbell G
        • Hall WD
        • Nielsen S
        • Zagic D
        • Rahman R
        • Murnion B
        • Farrell M
        • Weier M
        • Degenhardt L.
        Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: A systematic review and meta-analysis of controlled and observational studies.
        Pain. 2018; 159: 1932-1954
        • Thiele EA
        • Marsh ED
        • French JA
        • Mazurkiewicz-Beldzinska M
        • Benbadis SR
        • Joshi C
        • Lyons PD
        • Taylor A
        • Roberts C
        • Sommerville K
        • Group GS.
        Cannabidiol in patients with seizures associated with Lennox-Gastaut syndrome (GWPCARE4): A randomised, double-blind, placebo-controlled phase 3 trial.
        Lancet. 2018; 391: 1085-1096
        • van de Donk T
        • Niesters M
        • Kowal MA
        • Olofsen E
        • Dahan A
        • van Velzen M.
        An experimental randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia.
        Pain. 2019; 160: 860-869
        • Warren JW
        • Clauw DJ.
        Functional somatic syndromes: Sensitivities and specificities of self-reports of physician diagnosis.
        Psychosom Med. 2012; 74: 891-895
        • Warren JW
        • Clauw DJ
        • Langenberg P.
        Prognostic factors for recent-onset interstitial cystitis/painful bladder syndrome.
        BJU Int. 2013; 111: E92-E97
        • Warren JW
        • Howard FM
        • Cross RK
        • Good JL
        • Weissman MM
        • Wesselmann U
        • Langenberg P
        • Greenberg P
        • Clauw DJ.
        Antecedent nonbladder syndromes in case-control study of interstitial cystitis/painful bladder syndrome.
        Urology. 2009; 73: 52-57
        • Williams DA.
        Phenotypic features of central sensitization.
        J Appl Biobehav Res. 2018; 23: e12135
        • Williams DA
        • Schilling S.
        Advances in the assessment of fibromyalgia.
        Rheum Dis Clin North Am. 2009; 35: 339-357
        • Wolfe F
        • Clauw DJ
        • Fitzcharles MA
        • Goldenberg DL
        • Hauser W
        • Katz RS
        • Mease P
        • Russell AS
        • Russell IJ
        • Winfield JB.
        Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia.
        J Rheumatol. 2011; 38: 1113-1122
        • Wolfe F
        • Walitt BT
        • Katz RS
        • Lee YC
        • Michaud KD
        • Hauser W.
        Longitudinal patterns of analgesic and central acting drug use and associated effectiveness in fibromyalgia.
        Eur J Pain. 2013; 17: 581-586
        • Xu D
        • Cullen B
        • Tang M
        • Fang Y
        The effectiveness of topical cannabidiol oil in symptomatic relief of peripheral neuropathy of the lower extremities.
        Curr Pharmaceut Biotechnol. 2019; 21: 390-402
        • Zuardi AW
        • Rodrigues NP
        • Silva AL
        • Bernardo SA
        • Hallak JEC
        • Guimaraes FS
        • Crippa JAS.
        Inverted U-shaped dose-response curve of the anxiolytic effect of cannabidiol during public speaking in real life.
        Front Pharmacol. 2017; 8: 259