Can a Daily Dose of CBD Help With Fibromyalgia?
- Fibromyalgia is a serious and common medical condition that affects almost four million adult Americans. The condition is characterized by symptoms like widespread and chronic body pain, mental and emotional issues, low sleep quality, and exhaustion(1).
- People have been seeking alternative treatments to fibromyalgia, with cannabidiol (CBD) showing much promise due to its alleged therapeutic benefits. Clinical trials and studies suggest that CBD can treat symptoms related to the disorder, such as chronic pain, low sleep quality, depression, and anxiety(2-3).
- US Food and Drug Administration or FDA-approved medications for fibromyalgia have potential side effects, some of which may be fatal(4). Adverse reactions may include nausea, drowsiness, lack of energy, and fatigue.
- Still, CBD is not a panacea or miracle cure that can solve the problems related to fibromyalgia. It is recommended to seek medical advice before using any CBD product for optimal CBD dosage and ensure overall well-being.
Why People Are Taking CBD for Fibromyalgia
With an estimated 2% to 4% of the worldwide population being people who have fibromyalgia, many are becoming interested in trying alternative treatments to provide relief for its symptoms(5).
Cannabidiol (CBD), the non-psychoactive component obtained from the cannabis plant, is one of the treatments people are looking into today.
Existing studies suggest that CBD may be used to provide effective therapeutic relief for fibromyalgia symptoms, particularly for chronic pain, depression, anxiety, and sleep disturbances.
A review of pain-related CBD studies reported that CBD treatments significantly reduced pain for the clinical trials’ patients(6).
The trial participants were a mix of patients with different conditions causing intractable chronic pain, such as multiple sclerosis and spinal cord injury.
Additionally, findings suggested that CBD creams and gels’ direct application to painful areas may help provide more effective relief for inflamed or swollen joints due to arthritis(7).
The study noted that bypassing the digestive system allows transdermal or topical CBD to have greater bioavailability or absorption rate(8).
CBD undergoes the first-pass metabolism when it passes through the digestive tract. The liver metabolizes and breaks down the CBD and other cannabinoids, which leads to less CBD entering the bloodstream and producing therapeutic effects(9).
CBD also showed promising results for individuals with sleep disorders and high anxiety, according to a study published in The Permanente Journal(10).
The findings indicated that almost all patients involved in the clinical trials tolerated CBD well, although the authors called for further research.
The study reported that 79.2% of adults displayed lower anxiety scores within one month of taking CBD. Meanwhile, 66.7% of adults with sleep problems experienced improved sleep quality(11).
How CBD Oil Works to Alleviate Symptoms of Fibromyalgia
Scientists have hypothesized that the cause of fibromyalgia may be tied to the endocannabinoid system (ECS)(12).
Findings suggested that clinical endocannabinoid deficiency or a decrease in endocannabinoid function may lead to higher sensitivity to pain, as well as disturbances in mood, sleep, and digestion functions(13).
The therapeutic benefits of CBD stem from the compound’s interaction with the body’s ECS.
Studies suggested that the ECS regulates different body functions, such as the sleep cycle, pain management, and appetite(14).
The ECS is composed of endocannabinoids, cannabinoid receptors, and enzymes.
Endocannabinoids are similar to plant-based cannabinoids or phytocannabinoids, like CBD and THC. However, endocannabinoids are naturally produced by the human body.
Endocannabinoids interact with the cannabinoid receptors to help keep the body functioning smoothly.
Cannabinoid receptors are found throughout the body. Studies noted two main types of cannabinoid receptors in humans, CB1 and CB2(15). Both CB1 and CB2 receptors are primarily found in the nervous system.
CB1 receptors are largely abundant in the central nervous system and involved in regulating pain. Studies also noted that CB1 receptors play a role in chronic pain and neurodegenerative disorders, like multiple sclerosis and Huntington’s disease(16).
Meanwhile, CB2 receptors are mainly found in immune cells and the peripheral nervous system(17). These receptors are responsible for helping regulate the body’s immune system and inflammatory response(18).
Research has shown that CBD is an antagonist to CB1 and CB2 receptors. Rather than binding to the receptors, CBD influences and helps prevent the receptors’ overactivation(19).
CBD has also been shown to affect the CB2 receptors and inhibit immune cell migration, which triggers an anti-inflammatory response(20).
Although widespread pain, inflammation, and muscle tenderness are the identifying symptoms of fibromyalgia, the condition also heavily affects the brain.
This effect is evident in the other symptoms associated with fibromyalgia, particularly anxiety, depression, and brain fog or difficulties in concentrating and remembering information(21).
A study also showed that the interactions of CBD with CB1 receptors may help reduce anxiety and regulate fear(22).
The Pros and Cons of CBD Oil for Fibromyalgia
- CBD is a non-psychoactive cannabinoid. It does not induce a high or cause hallucinations like marijuana.
- Industrial hemp-derived CBD oil and other CBD products only contain trace amounts of THC, the primary psychoactive compound in cannabis plants.
- The therapeutic benefits of CBD may help reduce chronic pain levels and ease inflammation for fibromyalgia patients, based on the studies mentioned earlier.
- CBD may also help with comorbid or overlapping conditions with fibromyalgia, such as irritable bowel syndrome (IBS)(23).
- Studies suggested that CBD may improve sleep quality, ease anxiety and depression, and reduce stress(24).
- Continued use of high-dose CBD (up to 1,500mg of CBD per day) is repeatedly well-tolerated and does not cause serious adverse effects, according to one study(25).
- CBD is widely considered safe, especially by long-time users, although there is still a possibility of experiencing side effects, like appetite loss or sleepiness.
- CBD may have potential adverse interactions with other medications, which may cause existing health conditions to worsen. Using CBD together with anti-anxiety medications may also raise the risk of drowsiness and sedation(26).
- There are still states where CBD is considered illegal or have specific restrictions on which CBD products are allowed(27).
- State laws and regulations regarding CBD and medical marijuana use continue to change and get amended. Laws may still change in favor of or against CBD use in the future.
- Only one CBD-based drug has been officially approved for medical use by the FDA(28).
The legality of CBD and CBD products may be the most significant disadvantage of using CBD oil as an alternative treatment for fibromyalgia.
Industrial hemp-derived CBD oil has been legalized in the federal United States through the passage of the 2018 Farm Bill(29). However, some states still have stricter regulations or outright prohibit CBD use.
The FDA also notes that Epidiolex, a CBD-based medication for rare forms of epilepsy, is the only FDA-approved CBD product(30).
The FDA advises consumers to exercise caution when using and buying CBD products, especially those that make unproven health claims. Without the FDA’s approval, CBD products may only be marketed for therapeutic relief.
Always seek medical advice before trying any CBD product to help relieve pain or other health issues.
A physician knowledgeable in CBD use may also offer more accurate CBD strength, dosage, and intake method recommendations to help facilitate better health outcomes.
How CBD Oil Compares to Alternative Treatments for Fibromyalgia
Available medications for treating fibromyalgia come with many possible side effects, which may affect patient compliance with the treatments.
For instance, duloxetine and milnacipran, two FDA-approved drugs for fibromyalgia, may raise the risk of suicidal thoughts(31). The two drugs may also cause high blood pressure, high cholesterol, and tremors.
CBD, despite its possible side effects, notably still has a good safety profile, according to the World Health Organization(32).
Many fibromyalgia patients are turning to CBD and other alternative and natural treatments to avoid such serious side effects.
Physical activities may help manage fibromyalgia symptoms, like stiffness and pain(33). Yoga and tai chi may also provide therapeutic pain-relieving benefits and meditation opportunities for better overall well-being(34).
Taking CBD oil in conjunction with such natural remedies may provide better results and pain relief.
Experts note that a combination of different treatments often provides the best results for fibromyalgia patients(35).
Dietary supplements are also a popular alternative treatment for fibromyalgia. Melatonin supplements, for example, are often used to help improve sleep quality(36).
Many brands now offer CBD oil formulations containing ingredients such as melatonin and curcumin to provide more significant therapeutic health benefits.
Curcumin is a compound derived from turmeric that offers anti-inflammatory benefits and may help manage arthritis, muscle soreness, and anxiety(37).
Opioid painkillers are a common alternative treatment of fibromyalgia, despite their poor effectiveness in observational studies.
Furthermore, guidelines have recommended against the use of opioid analgesics for fibromyalgia, partly due to concerns over the opioid crisis in the US(38). Frequent and high dosage of opioids may lead to a fatal overdose.
Findings also indicate that CBD may be more effective for chronic pain management than opioids(39). Additionally, some states have recognized the potential benefits of medical cannabis for treating opioid use disorder(40).
CBD Dosage and Usage for Fibromyalgia
Dr. Ginevra Liptan, the author of The Fibro Manual and the director of the Frida Center for Fibromyalgia in Portland, encourages her patients to try CBD oil and cannabis products to manage fibromyalgia symptoms.
A fellow fibromyalgia sufferer, Dr. Liptan, noted in a podcast interview that CBD products with THC content may be best for patients.
CBD products are categorized into three types: full-spectrum, broad-spectrum, and pure CBD isolates.
While all three types offer therapeutic benefits, only full-spectrum CBD contains THC, which may provide additional analgesic effects(41).
Full-spectrum CBD products also produce an entourage effect, where the cannabinoids, terpenes, and other compounds boost each others’ therapeutic benefits.
How Much CBD Should One Take for Fibromyalgia
Seasoned CBD users always recommend beginners to start with a low dose and to slowly increase their dosing as needed.
No study or organization has released an official recommended CBD oil dosage for fibromyalgia, though there are recommended CBD dosages for specific fibromyalgia symptoms.
A review of different studies offers the following CBD dosage suggestions, based on promising trial results(42):
- Chronic pain: 2.5mg to 20mg CBD per day
- Insomnia or sleep disorders: 40mg to 160mg CBD daily
- Generalized social anxiety disorder: 6.7mg to 10mg CBD per kilogram of body weight per day (or an average of at least 400mg CBD daily)
Some CBD brands and review websites also have CBD dosage calculators to help consumers determine the optimal dosage based on their weight and health needs. There are also CBD dosage calculator apps available for Android and iOS.
Talking with a healthcare professional familiar with CBD is one of the safest ways to determine proper CBD dosage for fibromyalgia.
How to Take CBD Oil for Fibromyalgia
Fibromyalgia patients may choose from different delivery methods for taking CBD oil.
The speed it takes for CBD to take effect for fibromyalgia patients depends largely on the chosen delivery or intake method.
For instance, inhaling or vaping CBD has a bioavailability (rate of absorption) of 34% to 46% within 10 minutes(43).
A popular method of consuming hemp oil is taking it sublingually. This entails holding the CBD oil or tincture underneath the tongue for up to one minute before swallowing it.
CBD oils and tinctures usually come with marked droppers for easier dosage measurement.
Additionally, CBD oils may be used for vaping, as long as it does not use medium-chain triglycerides (MCT) oil as a carrier oil.
Findings suggest that heating up and smoking MCT oil may be linked to lung problems(44).
For topical CBD options, fibromyalgia patients may choose between creams, lotions, salves, balms, gels, or transdermal patches. CBD brands have also started offering CBD bath bombs, soaps, and shampoos.
Choosing the Best CBD Oil for Fibromyalgia
CBD and hemp-derived products are available in different forms aside from oils or tinctures. Consumers may choose from edibles, such as gummies and capsules, or topicals, like creams and gels.
Topicals may be more suited for fibromyalgia patients who want targeted pain relief(45).
The following are other tips for choosing quality products:
- Look for CBD products made from non-genetically modified (non-GMO) hemp plants. It’s also recommended to choose hemp oil extracted from whole plants.
- The best CBD oils are also often from brands that are transparent about their hemp sourcing or farming, CBD extraction methods, and CBD potency.
- Make sure to research products online first. High-quality and safe CBD products should be tested at independent laboratories and come with certificates of analysis (COA).
- Reliable brands with quality CBD products ensure that they do not make any unsubstantiated health claims and give proper disclaimers.
Take note that CBD oil sold at retailers, pharmacies, or health food stores are hemp-based and follow the federally mandated 0.3% THC content.
Fibromyalgia patients interested in trying high-THC CBD oil would find it in licensed cannabis dispensaries. This type of oil is also more accurately called cannabis oil.
However, buying cannabis-derived products may require a medical marijuana ID, a doctor’s recommendation, and other proof of having a qualifying debilitating medical condition.
What Is Fibromyalgia?
Fibromyalgia is a prevalent medical condition characterized by widespread and chronic muscle pain. According to rheumatologists’ observations, it is second only to osteoarthritis as the most commonly observed pain disorder(46).
The medical community first used the term “fibromyalgia” in 1976, though the condition has been recognized since 1904 as fibrositis. Descriptions of fibromyalgia’s major symptoms, widespread pain and tender points, were first made in 1972(47).
Persistent fibromyalgia pain can greatly affect patients’ quality of life. It can impede people’s ability to work, perform daily tasks, and maintain relationships.
The National Fibromyalgia and Chronic Pain Association estimates that around 10 million Americans in total, and between 3% to 6% of people around the world, suffer from fibromyalgia(48).
Despite being a common medical issue, however, doctors still do not know the cause of fibromyalgia. Doctors have also yet to find a definitive cure for the condition.
Moreover, many people with fibromyalgia remain undiagnosed. A study found that although 44 out of 830 survey respondents reported experiencing fibromyalgia symptoms, only a dozen were formally diagnosed with the condition(49).
Symptoms of Fibromyalgia
The common symptoms of fibromyalgia include:
- Widespread pain
- Muscle tenderness and tightness
- Chronic fatigue and general exhaustion
- Poor sleep quality and sleepiness
- Depression or anxiety
- Brain fog or cognition issues, such as concentration memory problems(50)
- Headaches and migraines
- Neuropathic pain, such as tingling or numbness in the arms and legs
- Digestive issues, such as irritable bowel syndrome
Fibromyalgia sufferers may also experience dry eyes or dry mouth, restless leg syndrome, pelvic pain, and urinary problems.
Individuals who experience widespread pain throughout their body and any common fibromyalgia symptoms for at least three months are advised to approach their family physician or a rheumatology doctor.
Treatment Options for Fibromyalgia
Available fibromyalgia treatments can provide temporary relief and help manage the symptoms, particularly during flare-ups. The treatments include non-drug therapies, such as physical exercise, and medications.
The FDA approved one anti-seizure medication and two antidepressant drugs for treating fibromyalgia(51).
However, the potential side effects of some fibromyalgia medications adversely affect patient compliance. These side effects may include drug dependency, nausea, and irritability(52).
Thus, patients turn to alternative treatments to help improve their conditions or supplement their current treatment plans.
Cannabidiol (CBD), one of the many cannabinoids naturally found in cannabis plants, has become a topic of interest for fibromyalgia patients.
CBD extracts are derived from industrial hemp, a type of Cannabis sativa plant specifically grown to have low tetrahydrocannabinol (THC).
Methods for extracting CBD include olive oil CBD extraction and solvent CBD extraction, such as using ethanol or butane. Supercritical CO2 extraction is widely used and regarded as a clean and cost-effective CBD extraction method(53).
THC is a cannabinoid also found in cannabis plants. Unlike CBD, however, THC is the compound in cannabis that causes psychoactive effects.
THC induces a high among users when taken in large concentration, which is why THC content in hemp-derived CBD products is highly controlled.
Federal law and many state laws have legalized industrial hemp and hemp-based products, including CBD oil. High-THC cannabis is still illegal, although medical marijuana may be available to patients with qualifying medical conditions(54).
Use of Cannabis for Fibromyalgia
Currently, no study has yet to report definitive findings showing CBD as a dependable treatment for fibromyalgia sufferers. Most of the existing studies examine medical cannabis use for fibromyalgia, rather than just CBD.
Although medical cannabis also contains CBD, it is not readily available to the public due to its high THC content.
Commercially available and legal hemp-derived CBD contains less than 0.3% THC, while medical marijuana may contain up to 5% THC, depending on the state(55).
Research showed that 64.5% of medical cannabis users in the US in 2016 used cannabis for chronic pain(56).
An observational study in the Journal of Clinical Medicine in 2019 noted the positive effects of cannabis among 81.1% of surveyed fibromyalgia patients(57).
According to the study, the patients reported lower pain scores following a six-month medical cannabis treatment plan.
Before the treatment, 103 patients rated their pain intensity as 10 on a pain scale of zero to 10. Only three patients reported a pain intensity of 10 after taking medical cannabis.
Eighty-two patients reported pain intensity scores of four to five, six months after the treatment.
Additionally, the researchers observed only mild side effects among less than 10% of the study participants(58). The side effects include dizziness and dry mouth.
A similar study in the Journal of Clinical Rheumatology in 2018 had nearly identical favorable results(59).
The study had 26 participants, the majority of whom were women with fibromyalgia. The patients all reported significant improvements in their symptoms after they started taking medical cannabis.
Moreover, 50% of the patients stopped taking other fibromyalgia treatment medications due to the positive results(60).
The scientists on both studies noted the effectiveness and safety of medical cannabis for treating fibromyalgia, although further research is still needed.
Fibromyalgia is a common and potentially debilitating medical condition that causes chronic pain all over the body. Its symptoms include poor sleep quality, fatigue, and brain for or cognitive problems.
Although FDA-approved medications are available, many patients still turn to alternative treatments due to potential adverse reactions.
Available studies on the potential benefits of CBD for chronic pain, sleep issues, anxiety, and depression make it a good candidate as an alternative fibromyalgia treatment.
However, it is important to note that CBD is not a miracle cure-all. Moreover, the effects of CBD may vary from person to person. The best CBD oil for fibromyalgia for one patient may not have the same effects for another.
Fibromyalgia patients planning to try CBD should always consult a medical professional before buying CBD or adding it to their treatment regimen.
- Centers for Disease Control and Prevention. Fibromyalgia. Retrieved from https://www.cdc.gov/arthritis/basics/fibromyalgia.htm
- Habib, G., & Artul, S. (2018). Medical Cannabis for the Treatment of Fibromyalgia. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 24(5), 255–258. Retrieved from: https://www.sativaisticated.com/wp-content/uploads/2018/04/Medical-Cannabis-for-the-Treatment-of-Fibromyalgia-Medical-Cannabis-Medical-Marijuana-Research-for-Autoimmune-Disease-Fibromyalgia.pdf
- 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
- Arthritis Foundation. Medications for treating fibromyalgia symptoms. Retrieved from https://www.arthritis.org/diseases/more-about/medications-for-treating-fibromyalgia-symptoms
- Häuser W, Fitzcharles MA. Facts and myths pertaining to fibromyalgia. Dialogues Clin Neurosci. 2018;20(1):53‐62.
- Argueta, D. A., Ventura, C. M., Kevin, S., Sagi, V., & Gupta, K. (2020, April 30). A Balanced Approach for Cannabidiol Use in Chronic Pain. Frontiers pharmacology, 11, 561. https://www.frontiersin.org/articles/10.3389/fphar.2020.00561/full
- Hammell, D. C., Zhang, L. P., Ma, F., Abshire, S. M., McIlwrath, S. L., Stinchcomb, A. L., & Westlund, K. N. (2016). Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis. European journal of pain (London, England), 20(6), 936–948. https://doi.org/10.1002/ejp.818
- Pond SM, Tozer TN. First-pass elimination. Basic concepts and clinical consequences. Clin Pharmacokinet. 1984 Jan-Feb;9(1):1-25. doi: 10.2165/00003088-198409010-00001. PMID: 6362950. https://pubmed.ncbi.nlm.nih.gov/6362950/
- 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
- Russo E. B. (2016). Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes. Cannabis and cannabinoid research, 1(1), 154–165. https://doi.org/10.1089/can.2016.0009
- Hazekamp, A. (2018). The Trouble with CBD Oil. Med Cannabis Cannabinoids, 65-72. doi: 10.1159/000489287. Retrieved from: https://www.karger.com/Article/FullText/489287#
- Lu, H. C., & Mackie, K. (2016). An Introduction to the Endogenous Cannabinoid System. Biological psychiatry, 79(7), 516–525. https://doi.org/10.1016/j.biopsych.2015.07.028
- Kendall, D. A. & Yodowski, G. A. (2017, Jan. 4). Cannabinoid Receptors in the Central Nervous System: Their Signaling and Roles in Disease. Frontiers in cellular neuroscience. https://www.frontiersin.org/articles/10.3389/fncel.2016.00294/full#h8
- Lu, H. C., & Mackie, K. (2016). Op. cit.
- Manzanares, J., Julian, M., & Carrascosa, A. (2006). Role of the cannabinoid system in pain control and therapeutic implications for the management of acute and chronic pain episodes. Current neuropharmacology, 4(3), 239–257. https://doi.org/10.2174/157015906778019527
- Hazekamp, A. (2018). Op. cit.
- Pertwee R. G. (2008). The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: delta9-tetrahydrocannabinol, cannabidiol and delta9-tetrahydrocannabivarin. British journal of pharmacology, 153(2), 199–215. https://doi.org/10.1038/sj.bjp.0707442
- Arthritis Foundation. Fibro Fog. Op. cit.
- Blessing, E. M., Steenkamp, M. M., Manzanares, J., & Marmar, C. R. (2015). Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 12(4), 825–836. https://doi.org/10.1007/s13311-015-0387-1
- Ahmed, W., & Katz, S. (2016). Therapeutic Use of Cannabis in Inflammatory Bowel Disease. Gastroenterology & hepatology, 12(11), 668–679. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193087/
- Shannon S, Lewis N, Lee H, Hughes S. (2019). Cannabidiol in anxiety and sleep: A large case series. The permanente journal, 23(18), 41. DOI: https://doi.org/10.7812/TPP/18-041
- Iffland, K., & Grotenhermen, F. (2017). An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. Cannabis and cannabinoid research, 2(1), 139–154. https://doi.org/10.1089/can.2016.0034
- U.S. Food and Drug Administration. (2020, March 5). What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD. https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis
- ProCon.org. (2020, Dec. 3). States with Legal Cannabidiol (CBD). ProCon/Encyclopedia Britannica, Inc. https://medicalmarijuana.procon.org/states-with-legal-cannabidiol-cbd/
- U.S. Food and Drug Administration. (2018, March 27). FDA Approves First Drug Comprised of an Active Ingredient Derived from Marijuana to Treat Rare, Severe Forms of Epilepsy. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-comprised-active-ingredient-derived-marijuana-treat-rare-severe-forms
- Hudak, J. (2018, Dec. 14). The Farm Bill, hemp legalization and the status of CBD: An explainer. Retrieved from https://www.brookings.edu/blog/fixgov/2018/12/14/the-farm-bill-hemp-and-cbd-explainer/
- U.S. Food and Drug Administration. (2018, March 27). Op. cit.
- Arthritis Foundation. Medications for treating fibromyalgia symptoms. Op. cit.
- World Health Organization (2018, June). Cannabidiol (CBD) Critical Review Report. Retrieved from https://www.who.int/medicines/access/controlled-substances/WHOCBDReportMay2018-2.pdf
- Bidonde, J., Busch, A., Schachter, C., Overend, T., Kim, S., Goes, S., Boden, C., & Foulds, H. (2017, June 21). Aerobic exercise training for adults with fibromyalgia. Cochrane database of systematic reviews. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012700/full
- Wang, C., Schmid, C. H., Rones, R., Kalish, R., Yinh, J., Goldenberg, D. L., Lee, Y., & McAlindon, T. (2010). A randomized trial of tai chi for fibromyalgia. The New England journal of medicine, 363(8), 743–754. https://doi.org/10.1056/NEJMoa0912611
- American College of Rheumatology. (2019). Op. cit.
- Costello, R. B., Lentino, C. V., Boyd, C. C., O’Connell, M. L., Crawford, C. C., Sprengel, M. L., & Deuster, P. A. (2014). The effectiveness of melatonin for promoting healthy sleep: a rapid evidence assessment of the literature. Nutrition journal, 13, 106. https://doi.org/10.1186/1475-2891-13-106
- Hewlings, S. J., & Kalman, D. S. (2017). Curcumin: A Review of Its Effects on Human Health. Foods (Basel, Switzerland), 6(10), 92. https://doi.org/10.3390/foods6100092
- Goldenberg, D. L., Clauw, D. J., Palmer, R. E., & Clair, A. G. (2016, May). Opioid Use in Fibromyalgia: A Cautionary Tale. Mayo clinic proceedings, 91(5). https://www.mayoclinicproceedings.org/article/S0025-6196(16)00102-6/pdf
- Capano, A., Weaver, R., & Burkman, E. (2020). Evaluation of the effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients: a prospective cohort study. Postgraduate medicine, 132(1), 56–61. https://doi.org/10.1080/00325481.2019.1685298
- Shover CL, Vest NA, Chen D, et al. (2020, July 14). Association of State Policies Allowing Medical Cannabis for Opioid Use Disorder With Dispensary Marketing for This Indication. JAMA Netw Open, 3(7). https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2768239
- Elikkottil, J., Gupta, P., & Gupta, K. (2009). The analgesic potential of cannabinoids. Journal of opioid management, 5(6), 341–357. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3728280/
- Zhornitsky, S., & Potvin, S. (2012). Cannabidiol in humans-the quest for therapeutic targets. Pharmaceuticals (Basel, Switzerland), 5(5), 529–552. https://doi.org/10.3390/ph5050529
- Paudel, K. S., Hammell, D. C., Agu, R. U., Valiveti, S., & Stinchcomb, A. L. (2010). Cannabidiol bioavailability after nasal and transdermal application: effect of permeation enhancers. Drug development and industrial pharmacy, 36(9), 1088–1097. https://doi.org/10.3109/03639041003657295
- Muthumalage, T., Lucas, J., Wang, Q., Lamb, T., McGraw, M., & Rahman, I. (2020). Pulmonary toxicity and inflammatory response of e-cigarette vape cartridges containing medium-chain triglycerides oil and vitamin e acetate: Implications in the pathogenesis of EVALI. Toxics, 8(46). 10.3390/toxics8030046
- Hammell, D. C., Zhang, L. P., et. al. (2016). Op. cit.
- Clauw, D. J., Arnold, L. M., McCarberg, B. H., & FibroCollaborative (2011). The science of fibromyalgia. Mayo Clinic proceedings, 86(9), 907–911. https://doi.org/10.4065/mcp.2011.0206
- Inanici, F., & Yunus, M. B. (2004). History of fibromyalgia: past to present. Current pain and headache reports, 8(5), 369–378. https://doi.org/10.1007/s11916-996-0010-6
- National Fibromyalgia & Chronic Pain Association. Prevalence of fibromyalgia. Retrieved from https://fibroandpain.org/prevalence-2
- Vincent, A., Lahr, B. D., Wolfe, F., Clauw, D. J., Whipple, M. O., Oh, T. H., Barton, D. L., & St Sauver, J. (2013). Prevalence of fibromyalgia: a population-based study in Olmsted County, Minnesota, utilizing the Rochester Epidemiology Project. Arthritis care & research, 65(5), 786–792. https://doi.org/10.1002/acr.21896
- Arthritis Foundation. Fibro Fog. Retrieved from https://www.arthritis.org/diseases/more-about/fibro-fog
- U.S. Food and Drug Administration. (2014, Jan. 31). Living with fibromyalgia, drugs approved to manage pain. https://www.fda.gov/consumers/consumer-updates/living-fibromyalgia-drugs-approved-manage-pain
- American College of Rheumatology. (2019). Fibromyalgia. Retrieved from https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Fibromyalgia
- Rochfort, S., Isbel, A., Ezernieks, V., Elkins, A., Vincent, D., Deseo, M. A., & Spangenberg, G. C. (2020). Utilisation of Design of Experiments Approach to Optimise Supercritical Fluid Extraction of Medicinal Cannabis. Scientific reports, 10(1), 9124. https://doi.org/10.1038/s41598-020-66119-1
- National Conference of State Legislatures. (2020, Nov. 10). State Medical Marijuana Laws. Retrieved from https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx
- Boehnke, K. F., Gangopadhyay, S., Clauw, D. J., & Haffajee, R. L. (2019, Feb. 4). Qualifying Conditions of Medical Cannabis License Holders in the United States. Health affairs, 38(2). https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05266
- Sagy, I., Bar-Lev Schleider, L., Abu-Shakra, M., & Novack, V. (2019). Op. cit.
- Habib, G., & Artul, S. (2018). Medical Cannabis for the Treatment of Fibromyalgia. Op. cit.