Is cannabidiol (CBD) effective for treating fibromyalgia?

Treatment of Fibromyalgia with CBD

CBD is not recommended for the treatment of fibromyalgia as the most recent high-quality evidence shows it is inferior to placebo for pain reduction. 1

Evidence Against CBD for Fibromyalgia

The most recent and highest quality evidence on this topic comes from a 2025 randomized, double-blind, placebo-controlled trial that specifically evaluated CBD for fibromyalgia. This study found that:

• CBD 50 mg daily was actually inferior to placebo for pain reduction at 24 weeks
• The placebo group showed a mean pain reduction of 1.1 points compared to only 0.4 points in the CBD group
• The between-group difference of 0.7 points favored placebo (p=0.0028) 1

This finding directly contradicts the common belief that CBD provides benefit for fibromyalgia symptoms. While adverse events were generally mild and similar between groups, the lack of efficacy makes CBD an inappropriate treatment choice.

Current Guideline Recommendations

The 2017 EULAR (European League Against Rheumatism) guidelines for fibromyalgia management do not include CBD or cannabis products among their recommended treatments 2. Instead, they provide strong recommendations for:

• Exercise therapy (100% agreement) - particularly aerobic exercise
• Cognitive behavioral therapies (100% agreement) 2

And weak recommendations for:

• Amitriptyline (100% agreement)
• Duloxetine or milnacipran (100% agreement)
• Pregabalin (94% agreement)
• Tramadol (100% agreement) 3

Patient Usage Patterns Despite Lack of Evidence

Despite the lack of supporting evidence, surveys indicate that CBD use is common among fibromyalgia patients:

• Approximately 32.4% of fibromyalgia patients report current CBD use 4
• Many users report subjective improvements in pain and other symptoms 4
• Some patients report substituting CBD for conventional pain medications, including NSAIDs (59%), opioids (53.3%), and gabapentanoids (35%) 5

However, these self-reported benefits must be interpreted with caution given the strong placebo response seen in the controlled trial and the potential for reporting bias in surveys.

Recommended Treatment Approach for Fibromyalgia

Based on the current evidence, the following treatments should be prioritized for fibromyalgia:

1. First-line (strong evidence):

   • Prescribed aerobic and strengthening exercise program
   • Cognitive behavioral therapy 2, 3

2. Second-line (moderate evidence):

   • Amitriptyline (10-25mg at bedtime) for pain, sleep disturbance, and fatigue
   • Duloxetine (60mg daily) particularly when pain is accompanied by depression
   • Pregabalin (300-450mg/day) particularly for pain and sleep disturbance 3

3. Third-line (weaker evidence):

   • Tramadol (with caution due to dependence potential)
   • Cyclobenzaprine
   • Multicomponent therapies (including acupuncture or hydrotherapy) 3

Important Considerations

• Treatment should be tailored based on predominant symptoms (e.g., pain with depression vs. pain with sleep disturbance)
• Medications should be started at low doses and titrated gradually
• Strong opioids and corticosteroids should be avoided 3
• Regular monitoring for side effects and periodic reassessment of treatment efficacy is essential

Conclusion on CBD for Fibromyalgia

Despite growing interest and anecdotal reports, the current highest quality evidence does not support the use of CBD for fibromyalgia. Clinicians should instead focus on evidence-based treatments with demonstrated efficacy, particularly exercise therapy and cognitive behavioral approaches, supplemented by appropriate pharmacological options when necessary.