By Ginevra Liptan, M.D.
Many people with fibromyalgia have gone to their doctors to ask for help with pain management, only to be told that opiate pain medications like Vicodin or oxycodone are not a recommended treatment option for fibromyalgia. This is confusing and frustrating for patients who wonder why their doctors are so hesitant to prescribe them this form of pain relief.
It boils down to this: In published studies, daily use of opiates hasn’t been shown to work very well for fibromyalgia over the long run. This leads to medical journal articles stating such things as “opioid use for the management of pain in fibromyalgia is strongly discouraged and is not recommended by any current practice guideline.”
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.
In my fibromyalgia practice, I have found that patients do better when not taking opiates daily, but rather taking them just as needed for severe pain flares, ideally less than 10 days out of the month. This schedule limits the development of most of the negative side effects of opiates and allows medications to maintain effectiveness over time, while still providing relief during the worst pain episodes.
I suspect in 20 years we will be using primarily cannabis-based prescriptions to manage fibromyalgia pain and look back at a time when we only had opiates as the “dark ages” of pain management. But currently we really have very limited medication treatment options for fibromyalgia pain. And until we have better tools, we need to utilize those tools we do have–and right now that is opiate-based pain medications. Most doctors grudgingly acknowledge this, and knowing they don’t have much else to offer their fibromyalgia patients, end up reluctantly prescribing them opiates (Berger 2010). In a recent study, 57% of almost 100,000 fibromyalgia patients had been prescribed opiate pain medications.
Until we have better options, opiates have an important role to play in managing fibromyalgia pain. The key is in using them correctly for the maximum benefit and minimum harm. Now is not the time to make blanket proclamations against using opiates for fibromyalgia, instead we should be studying which opiates and dosing regimens work best for fibromyalgia.
Editor’s Note: Ginevra Liptan, MD is both a fibromyalgia patient and physician specialist. Her new book The FibroManual: A Complete Fibromyalgia Treatment Guide for You…And Your Doctor releases May 3, 2016.