By Dr Ananya Mandal, MD
Chronic widespread pain is one of the most important symptoms of fibromyalgia. According to the 2010 diagnostic criteria for fibromyalgia from the American College of Rheumatology, the pain forms around two thirds of the symptoms along with others including fatigue, sleep disturbance, cognitive changes, and physical symptoms including irritable bowel syndrome, headaches etc. These represent the remaining one third of the symptoms for diagnosis. Thus pain relief becomes much more important in fibromyalgia treatment and coping with fibromyalgia than management of any other symptom.
Opioids and fibromyalgia
Traditional pain relievers in fibromyalgia include non steroidal anti-inflammatory drugs, and the opioids like Morphine.
Due to their liability of abuse and dependency especially over long term use, opioids are not recommended by any current guidelines for the treatment of fibromyalgia. This is mainly because fibromyalgia is a chronic pain disease where the pain persists for life and the diseases in itself is not fatal or terminal.
Opioid medications at best can only provide short-term pain relief from any type of pain and in clinical trials with opioids, there is little evidence of sustained pain relief or benefit.
Opioids are preferred in patients with severe terminal cancer pain. Despite the absence of recommendations and studies that prove the benefit of opioids in fibromyalgia, currently around 30% of Canadian and American patients with fibromyalgia report to using opioids for pain relief.
When opioid users are surveyed they are found to have several negative factors including psychiatric disorders, unemployment, history of substance abuse etc. and of these 66% were confirmed as having fibromyalgia.
Only Tramadol, a synthetic opioid has been formally studied in fibromyalgia for short term pain relief. Along with opioid use, there is also evidence of high uses of benzodiazepines or sleeping pills.
Use and abuse of opioids
Studies have shown that patients who use and abuse opioids tend to have more severe pain, a more severe impairment in daily functioning and presence of mood disorders compared to those who did not use opioids.
Furthermore opioid use and abuse leads to several symptoms that overlap with fibromyalgia itself including fatigue, cognitive function loss, poor physical and mental well being and increasing pain despite medications.
The negative effects of opioids are complicated by concomitant use of tranquillizers.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)