Table 4.

Key information regarding systematic reviews assessing the efficacy/effectiveness of CBPMs in patients with fibromyalgia syndrome.

Reference (year)	Objective; articles, and number of participants (n) included	Cannabis-based medicinal products (dose)	Main efficacy/effectiveness results	Main conclusions
16 (2016)	To assess the efficacy, tolerability and safety of cannabinoids for fibromyalgia symptoms in adults; 2 (72)	Any formulation of cannabis products; however, only Nabilone was identified (1 mg/day)	•There was no relevant study with herbal cannabis, plant-based cannabinoids or synthetic cannabinoids other than nabilone in fibromyalgia •There were no significant differences for fatigue, depression, pain, mood, and health-related quality of life	There is no convincing, unbiased, high-quality evidence suggesting that nabilone is of value in treating people with fibromyalgia.
32 (2021)	To analyze the role of the cannabinoid system in fibromyalgia syndrome (FMS); 22 (1326)	Nabilone (0.5–1 mg/day); Dronabinol (7.5 mg/day); Bedrocan (22.4 mg THC, <1 mg CBD), Bediol (13.4 mg THC, 17.8 mg CBD), and Bedrolite (18.4 mg CBD, <1 mg THC)	•Cannabis group presented a significant decrease in Fibromyalgia Impact Questionnaire (FIQ) score in comparison with the placebo group •Nabilone is superior to placebo and showed significant reductions in visual analog scale (VAS) for pain •Nabilone and dronabinol showed improvement in pain and anxiety in several randomized controlled trials and meta-analyses •Cannabinoids could be safe, effective, and potentially alleviate some of the symptoms associated with FMS	Data suggest that medical cannabis is a safe and effective treatment for fibromyalgia pain; however, several limitations regarding dosage, length of treatment, adverse effects, long-term follow-up, and dependence needs further investigation.
33 (2023)	To examine and discuss current clinical evidence regarding the use of cannabis for the treatment of fibromyalgia; 9 (564)	Nabilone (0.5–1 mg/day) and cannabis in various forms, administered as a pill, oil smoke, or vapor (no specified)	•Nabilone is an effective treatment option for pain reduction in patients with fibromyalgia •Cannabinoids improved quality of life and alleviated pain, in patients with fibromyalgia. •Only one randomized controlled trial demonstrated that cannabinoids did not have a different effect than placebo on pain responses •Low-quality evidence to support reduced pain in fibromyalgia with cannabinoid treatments using Fibromyalgia Impact Questionnaire (FIQ)	The use of cannabis in fibromyalgia treatment is still an area of ongoing study. Although, some studies show promising results effective in reducing pain and improving sleep) others have been inconclusive. Therefore, the effectiveness of these cannabinoids in treating fibromyalgia remains uncertain and more research is needed to verify the efficacy.
34 (2021)	To assess current evidence on medicinal cannabis for FMS to evaluate safety and efficacy in patients with fibromyalgia syndrome (FMS); 10 (1136)	Nabilone (0.5–1 mg/day); Dronabinol (2.5–15 mg/day); Bedrocan (22.4 mg THC, <1 mg CBD), Bediol (13.4 mg THC, 17.8 mg CBD), and Bedrolite (18.4 mg CBD, <1 mg THC)	•The visual analog scale (VAS) was the most common pain assessment tool used. Others tools utilized were the 5-point Likert scale, Fibromyalgia Impact Questionnaire (FIQ), Numeric Rating Scale (NRS), Verbal Rating Scale (VRS), an online questionnaire, and the McGill pain questionnaire •Reduction in pain was of 30 % and 50 % in patients with FMS •In the medical cannabis groups, there were significant decreases in the visual analog scale, VRS and in the FIQ	Medical cannabis may be beneficial for some patients with FMS; however, more studies are required to confirm the possible impact of cannabis on pain. Also, it is important to identify what chemovar types, THC to CBD ratios, dosage regimen, or form of administration are appropriate for various symptomology, and what assessment tools are required to quantify and interpret outcomes
35 (2022)	To evaluate the efficacy and safety of cannabinoid administration in chronic primary pain (CPP); 8 (Total = 240, of them 115 with FMS).	Sublingual cannabis THC-rich oil, dronabinol oral capsules, oral nabilone, CBD gums, inhaled vaporized pharmaceutical grade medicinal cannabis (Bedrocan, Bediol, Bediol), different doses of delta-9-THC pharmaceutical-grade medicinal cannabis smoked cigarettes	•The sensitive analysis with FMS patients concludes a reduction in pain compared with placebo using the visual analog pain scale, and when the study has a duration of more than 4 weeks •Reduction in Fibromyalgia Impact Questionnaire (FIQ), indicating improving in quality of life	Cannabinoids in chronic primary pain has limited benefit in pain reduction, but cannabinoids might improve pain and FIQ in FMS with long-term administration

CBD: Cannabidiol; THC: Tetrahydrocannabinol, FMS: fibromyalgia syndrome.