Skip to main content

Fibromyalgia and Opiates for pain: Helpful or hindering?



Fibromyalgia and Opiates for pain: Helpful or hindering?





There has been a study published in the Journal of Pain from Australia that might suggest opiates may cause increased sensitivity in some types of pain.  The study had the patients who have chronic pain and hyperalgesia, which is that intense response to pain, we also see in fibromyalgia.  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." Source





In many cases, opiate based medications, such as Percocet (oxycodone) are not as effective 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 them for pain management so this will be a concern if it, in fact, increases their 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.

It should be noted this risk factor occurs with all chronic pain and is a low risk. When it occurs the patient is switched to another opiate. It should also be noted Tramadol is in the guidelines for treatment as it is one that has been studied as effective for fibromyalgia pain. 

This is a reprint of the study I had published on a site that is gone, so putting it up again. As I said, this is a risk factor for all people using opiates. It does run the risk of causing hyperalgesia and this study doesn't indicate if the risk is greater with FM. However, my previous research into this effect suggests it isn't a common reaction at all. Typically the patient is simply switched medication. There have been little studies on FM and opiates and the studies Minimal to make any conclusions about. Mostly on Tramadol, which is seen as acceptable and is in the guidelines for treatment. 



Here’s the problem with this type of blanket statements: these recommendations are based on the results of only a few small studies showing they were ineffective for fibromyalgia pain. Since no large trials have been done, the recommendations against opiate use for fibromyalgia are based on data from less than 100 subjects! Also, these small studies only looked at patients taking opiates every day for pain, and we know that daily, long term use of opiates does result in negative side effects and diminishing medication benefit over time. None of these small studies assessed the most successful use of pain medications, which is when they are taken just as needed for flares. National Pain Report

So take it with a grain of salt. But know doctors will resist the idea based on these very little studies.
Post a Comment

Popular posts from this blog

Signs the pain is getting the best of you

100 Symptoms of Fibromyalgia

There was a site that had this and I had linked to it on Tumblr but it is gone. So I had to hunt down someone who found my post and posted the whole thing in a forum. Anyway it is around but I'm posting it here so I will not have to hunt it down to reference it. Now we all know the major symptoms are the wide-spread pain, but our pain isn't just muscle pain... it can be nerve types of pain as well, and the fatigue and the insomnia. And even among symptoms there are some far more frequent than others, but it should be said we have categories... like the cognitive dysfunction, which is a broad one that has more than one symptom and we often just say fibrofog. The insomnia... more than one sleeping disorder. So the list is interesting.




GENERAL
__ Fatigue, made worse by physical exertion or stress
__ Activity level decreased to less than 50% of pre-illness activity level
__ Recurrent flu-like illness
__ Sore throat
__ Hoarseness
__ Tender or swollen lymph nodes (glands), especiall…

When I say I am good

When people ask me how I am feeling 99% of the time I am lying. I often say 'not bad', because I feel it is slightly more honest than 'good' or 'fine'. Got sick of fine. Anyway, I lie for many reasons. 



I'm having a good pain day: They happen and I'll say that I'm good, fine, not bad. I even feel like I can accomplish great things... in moderation. In which case, relatively speaking, for Me I am not actually lying. This is a Good pain day, it is Not Bad for me and I am Fine with it. I just don't want to explain: I just don't want to explain how crappy I feel and in which way I mean. Because I am tired of it. I just want to deal with it, without having to discuss it, mention it or have any sympathy expressed about it. Because it can be complicated. It may be a migraine with specific symptoms. Maybe it is a FM flare though. Or both. And then I have to explain what it is because most people think my migraines are the main issue but I could be FM…