Cannabidiol Use, Substitution for Medications, and Perceptions of Effectiveness in Women with Chronic Pelvic Pain

Study Objective To describe the prevalence and patterns of cannabidiol (CBD) use in women with co-existing chronic pelvic pain (CPP) and fibromyalgia, and to evaluate characteristics associated with pain improvement. Design Cross-sectional, anonymous survey. Setting Web-based survey distributed by National Fibromyalgia Association in April-May 2020. Patients or Participants Female respondents with fibromyalgia who also self-reported diagnosis of CPP due to endometriosis, vulvodynia, interstitial cystitis or urinary chronic pelvic pain (IC/UCPP), and/or irritable bowel syndrome (IBS). Interventions Participants completed survey including self-reported CBD use patterns, substitution of CBD for medications, and self-reported improvement in pain due to CBD. Measurements and Main Results Our sample included 1382 women with ≥1 CPP diagnosis: 26.0% with endometriosis, 4.2% with vulvodynia, 14.0% with IC/UCPP, and 84.4% with IBS. Participants were classified by CBD use: current (n=477, 34.5%), past (n=404, 29.2%), or never (n=501, 36.3%). Of those who discontinued CBD, 61.6% did so because it did not improve symptoms. Participants who used CBD most commonly did so for pain (96.4%), sleep (48.8%) and anxiety (46.1%), with 80.9% reporting that CBD improved their pain. Side effects were minimal, with patients reporting an average of 1.0±1.3 side effects. The majority of participants (75.9%) reported substituting CBD for pain medications, including NSAIDs (45.3%), opioids (39.8%), gabapentinoids (27.7%), and benzodiazepines (19.3%). Compared to those who did not report pain improvement (n=91, 19.1%), those who reported improved pain had a higher proportion of substituting CBD for pain medications (p=0.003), reported greater improvements in other symptom domains (sleep, anxiety, depression, fatigue, and overall health, all p≤0.001). Conclusion Among women with FM and co-morbid CPP, over 60% reported past or current use of CBD. About half of participants who ever used CBD for pain reported improved pain, and many substitute CBD for pain medications including opioids and benzodiazepines.