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Opiates...are they a good choice for #Fibromyalgia?

There has been a study published in the Journal of Pain from Australian that might suggest opiates may cause increased sensitivity in some types of pain. The study had patients with chronic pain and hyperalgesia. They were taking methadone and morphine for the study.

Hyperalgesia is an increased pain response such that more pain is felt than dictated by the stimulus or injury would suggest. It can be specific to an area of the body or widespread. It can be seen with some inflammatory conditions, with some nerve damage situations and it is also a main feature of fibromyalgia. It is quite commonly associated with long term use of opiate medications so it is not surprising this study likewise had similar results.

"A second finding showed that similar nociceptive profiles are found in chronic pain patients treated with methadone. Third, the study showed that pain sensitivity associated with methadone administration also is found in morphine-treated patients. According to the authors, the study demonstrated that hyperalgesia but not allydonia is associated with the long-term administration of opioids."
In many cases opiate based medications, such as Percocet (oxycodone) are ineffective for people with fibromyalgia and a more effective treatment are the medications acting on the brain neurotransmitters themselves. Lyrica and Gabapentin are anticonvulsants which by affecting certain neurotransmitters try to dampen the pain signals and decrease pain where it is in fact starting. Fibromyalgia is brain pain and medications that focus on the brain have a better chance of treating that pain. Other medications that aim specifically at FM are Cymbalta and Savella which are antidepressants used to affect the serotonin neurotransmitter, often found to be lower in FM patients. However, some people do take opiates for pain management so this will be a concern if it in fact increases there sensitivity to pain over time. In the cases where pain medications are used it might be something to be used in moderation and careful consideration.

The question becomes how often does hyperalgesia occur with chronic pain patients, in particular with Fibromyalgia patients. And what is the normal response of doctors when it does? Do they generally switch to a different opiate? If it is a rare occurs that is resolved by switching to another medication it does not seem to be much of an issue at all.

That being said there are more than a few articles I have read that suggest in the case of FM opiates can increase the sensitivity of pain. So we do have to be careful of our treatments.
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