What the Research Really Says About Opioids and Fibromyalgia

What the Research Really Says About Opioids and Fibromyalgia

By Donna Gregory Burch

donnasnowday

Donna Gregory Burch

My fibromyalgia and primary-care doctors have always been united when it comes to one thing: Opioids do not relieve fibromyalgia pain!

Early on, I believed them and didn’t question their treatment plans. I figured they must have formed their opinions based on actual clinical trials. Turns out, I was wrong.

The reality is there have been no sizable, randomized, double-blind, placebo-controlled studies to determine whether opioids are effective at reducing fibromyalgia pain or not.

What we do have are a few observational studies indicating opioids may not be helpful, and a couple of studies looking at the use of Tramadol, a weaker, synthetic opioid, for fibromyalgia.

Given the recent controversies regarding the use of opiates for chronic pain, I thought it would be helpful to actually review the available research on opioids as a treatment for fibromyalgia.

So here’s what we know based on current research…

The McGill studies

McGill University (Montreal, Canada) researcher Mary-Ann Fitzcharles completed two studies in 2011 and 2013 involving around 300 fibromyalgia patients being treated with opioids at the university’s Alan Edwards Pain Management Unit. Both studies essentially came to the same conclusion:

“Opioid-treated patients were more symptomatic and were more likely to be unemployed and to be receiving disability benefits,” reads the 2013 study. “While opioids remain a treatment choice for management of pain, we are concerned that our patients using opioids failed to show any advantage in overall health status. … We have no evidence that the addition of these agents … improved disease status or function.”

Tramadol

Tramadol is the only opioid that’s been extensively researched as a treatment for fibromyalgia.

Other studies

  • A 1995 Swedish study found no improvement when nine fibromyalgia patients were given intravenous morphine.
  • A four-year study from 2003 published in the “Arthritis & Rheumatology” journal found that “fibromyalgia patients taking opiates did not experience significant improvement in pain at the four-year follow-up compared with baseline, and reported increased depression in the last two years of the study,” according to a University of Cincinnati College of Medicine research review. (For some reason, I couldn’t find an online copy of the 2003 study.)

What this all means

As you can see, the available research on using opioids for fibromyalgia pain is pretty scant. It’s possible I may have missed some studies, but what’s listed above are the ones most often cited in the literature. You’ll notice there’s a definite lack of any studies looking at outcomes for fibromyalgia patients using stronger opioids, like hydrocodone.

And yet, if you ask fibromyalgia patients which treatment does the best job of relieving their pain, a sizeable portion will say opioids.

So when our physicians tell us opioids are a no-go, what are they really basing their opinions on? It’s obviously not the research!

Donna Gregory Burch was diagnosed with fibromyalgia in 2014 after several years of unexplained pain, fatigue and other symptoms. She covers news, treatments, research and practical tips for living better with fibromyalgia on her blog, FedUpwithFatigue.com. Donna is an award-winning journalist whose work has appeared online and in newspapers and magazines throughout Virginia, Delaware and Pennsylvania. She lives in Delaware with her husband and their many fur babies.

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Authored by: Donna Gregory Burch

There are 21 comments for this article
  1. Dan at 2:22 pm

    Im 43 yrs old and have been crippled by fibromyalgia since i was 24. It srarted after a year after i had my gallbladder out. For the first six years i tried every non opiod to mankind. Ssri’s, sleeping pills, antiinflammatorys, cymbalta, lyrica i mean everything. I did the physical therapy, chiropractor. Name it i did it. After i was ready to give up my pcp sent me to a pain doctor and different opiods were tried and finally she found a combination that worked. My neighbor is 70 has it and she couldnt get relief they tried oxycodone on her and she said she could function and do stuff with grandkids. So yes they do work. U need to find the right one and right dose. But it prob dont matter now thanks to the dea, surgeon general and everyone else thats destroying lives by taking meds away that gave a quality of life to people in chronic pain.

  2. criminally inpain at 2:31 am

    My pain started from a severe birth injury to both hips by a negligent doc. I was diag. w/ rheumatic fever at 13, RA at 14, OA at 18, FM at 24, & DDD at 31. Plus all the damage from treatments, epidurals, joint injections,surgeries, etc…I have basically been on opioids for about 20yrs.(I’m 45yr. now) & have done my own “studies”.
    I would wean off to try other things to find out what helped what & this is what I found.
    Nsaids helped my arthritis pain in my hands & feet, along w/ the bad tmj I developed. a week after starting Celebrex, I had even better arthritis relief & was not near as stiff & soar in the morning; but neither helped my FM, hip, tendonitis, nor back pain. However, Celebrex caused me to develop congestive heart failure & uncontrollable high bp. I also had to stop taking my vicoprofen as now, anytime I take ANY anti inflame. my bp skyrockets & has caused 6 mini strokes! I was then put on Norco & after 4yrs. my liver function had gone down by 60-70% due to the Tylenol. I was then put on oxycontin & after being on it for almost 5yrs. I wanted to stop it due to all the neg. news coming out about it.
    I stayed off ALL opioids for 2yrs. & tried about every alt. I could until the pain got so bad that I had to go back on it. It was great for 4 yrs. until they changed it! Not only did it not work hardly at all, it tore my digestive track up as it caused SEVERE constipation & blockages so bad that I was unable to pass anything for as much as a MONTH! This led to something called mega colon & the pain was unbearable. Morphine always knocked me out, so I opted to try methadone, but due to my doc not liking to use methadone as he said it was too dangerous, the most he would allow me to take was 10mg. X 3 per day which was to replace 60mg. oxycontin X 3 per day!!
    However to my surprise, not only did I not feel a decrease, it actually helped almost all my pain much better than the “new” oxy!
    We are all different and there are many types of pain which are helped by different things. Just because you have pain doesn’t mean that opioids are always the best treatment, nor does it mean they are not. medicine needs to stop generalizing instead of individualizing as we are all unique & should be treated as such!!

  3. linda at 6:12 am

    It’s so frustrating when Opoids work for me and yet I keep hearing the theory that they can produce more pain,which when I researched, is a rare phenomena,hyperalgia. I have had the problem of building a tolerance,so I rotate meds to avoid that. It’s hard to imagine being in chronic pain all the time,it is torture. We just want to function and the meds don’t get me high,they normalize me. I WISH I could feel euphoric,I’ve never got that from opoids. Usually I find I am undermedicated due to the opoidphobic docs. Today I am trying to figure out how to pay for my new prescription of bupenorphine films I’ve been prescribed.I am on disability and insurance won’t cover it.Its the new insanely expensive opoid used,but also used for addiction? An antagonist?I don’t get it.I think profit margins for pharmaceuticals are the motives,rather than helping people who suffer. It sucks.

  4. MaryAnn at 7:28 am

    I would just like to sat that I had a life with FM, DDD, arthritis etc., worked, took care of my 3 children, volunteered at our local shelter. Just taking Lortab 7.5. I took as prescribed, my doctor and I tried everything before he offered to try opiods. He moved away, I tried to explain to new doc and I was treated like a drug seeker. Went off in one week with no stint in rehab. But since then I am disabled, children grown, can’t do anything which leads to depression. To withhold a medication from me that works is harmful and I am in so much pain I wait to die. Got Grandchildren now, I want to live. I want a voice.

  5. marty at 2:03 am

    I have taken vicodin for my OA, RA and PA. My back does not work without using a walker. However in the many years I have had fibro, vicodin has never helped with the pain. It’s a different kind of pain that I live with daily. The muscles and ligaments that feel like they are being ripped out of my body daily and the fog cannot be helped with opioids . I have learned other ways to semi control the pain from fibro. Changed eating, meditations, lotions, moving no matter how I feel and recently have started CBD oils.

  6. Steve Ariens at 5:53 pm

    Until the last decade or so.. the medical community referred to what we know as today as Fibromyalgia (FM)… was referred to as a “whining woman’s syndrome” because there was no test that confirmed that was outside the “acceptable values”… Pts – mostly women – would see a physician.. complaining a aching all over, fatigue and dozen or so other symptoms. Eventually, there was discovered that these – mostly women – had up to 18 “hot” to trigger points over their body… and the disease – or syndrome – was being diagnosed by a pt having a multitude of same/similar symptoms… the more symptoms they experienced.. the higher the probability that they were diagnosed as a FM pt.
    What I have observed is that many physicians were forced by the proponderous of Anecdotal evidence that these pts were actually suffering from a disease and/or syndrome.
    It would seem that many of these same physicians shifted their denial of the existence of FM to a denial that opiates worked in helping the quality of life of these pts. Now with the DEA breathing down their necks about prescribing opiates for non-cancerous pain… they were not about to try and justify the prescribing of opiates to pts with a “disease” that there was no lab tests that confirmed that the disease – in fact – did exist.

  7. Yvetta Barbee-Miles at 5:47 pm

    The problem is the pain scale I’m not on that scale. However on meds a bad day is maybe a ten. but a normal day is than a 8 or 9.,a good day is a 7 .but those numbers happens with meds.

  8. MichaelL at 5:29 pm

    Funny thing that I see, in the McGill study, the patients that were the worst, seemed to be on opiates! All that tells me is that those were the patients with the worst manifestations of the disease, need the opiates. That seems like putting the horse before the cart! Making assumptions that the opiates were the cause of the increased disability does not seem really scientific, at all!

  9. Debra Oliver at 3:59 pm

    Great article! I am also a Fibromyalgia patient and was diagnosed well over 20 years ago. I have taken every type of arthritis medications out there, i.e, Cymbalta, Lyrica, Celebrex, Prednisone, Medrol, along with opiods and antidepressants. I never got any relief from from the meds for arthritis. I did however get substantial relief from a combination of opiod therapy and passive exercise & water therapy. Opiods give me quality of life that I don’t get from other medications. I don’t feel euphoria from opiods. I do believe that Fibromyalgia and chronic pain patients are trying to maintain a “quality of life” – we are NOT trying to get high. We are just trying to manage our pain. Without opiod therapy I am unable to take a shower and have difficulty getting dressed or going to the grocery store without assistance that most people not in chronic pain are able to do. So I do believe that opiods do help Fibromyalgia patients & are truly a necessary part of pain management.

  10. Helen at 12:50 pm

    I have had fibromyalgia for 5yrs and I’m on a 7day, 20mg bupermorphine transdermal patch, slow release and bupamorphine sublinguals 20mg x2 up to 2a day and I have to say I could not function without them, I also take duloxatine which can have pain properties as well as for depression (but I take for BPD)
    My GP hate prescribing my pain meds and has caused massive headaches but I have a pain consultant who is very good with it all and take a whole person approach. Iv tried other meds like tramadol but nothing made a difference like my current meds.

  11. Kristil at 10:30 am

    Adding to the above when I was born the Dr told my mom that I was “loosely put together ” . Was also diagnosed at 23 with “joint hypermobility syndrome”. I was born this way., I am in pain every day of my life, and it is so tiring. My muscles don’t relax- ever. My shoulders are 2 1/2 inches off and my neck& shoulders have felt hard as rocks for 25 yrs . Opioids are a Godsend to me. They don’t ever take it away completely but I know I would be bedridden without them. I am a small majority of people actually born with pain. 3rd generation “Fibromyalgia”. I prove that Fibro is in the”genes” and is hereditary . I never had a chance…

  12. Sara Batchelder at 10:00 am

    I wonder if any of the studies take into account that people taking opioids are at the worst in their disease and the fact that opioids didn’t help them feel better over all is because their conditions are getting worse behind the scenes. I’m guessing those patients would feel even worse without the opioids but I’m not sure. Do these studies have a control group of people whose condition are getting worse without the opioids?

  13. Angel at 9:54 am

    It’s my opinion and that of my doctors, that many fibro patients are in the early stages of autoimmune disease or other serious ailments. Since the direct cause of fibro hasn’t been discovered, we cannot expect each patient to respond accordingly to various treatment methods. Many people given fibro diagnosis have very serious underlying disease where fibro diagnosis becomes a handicap instead of a treatment plan. Example I was told it was fibro when I had leukemia. Any fibro patient who believes that opiods would help them should be allowed to give them a try. Each patient is different and deserves the opportunity to try when other medications have failed.

  14. Jeremy Goodwin, MS, MD at 9:36 am

    Many of my patients suffer the pain and associated signs and symptoms of fibromyalgia syndrome ( FMS) in addition to other neurological, orthopedic and rheumatic disorders, one example of which is spinal pain. Many types of pain can trigger fibromyalgia flare-ups. This is but one example of opioid responsiveness where FMS is concerned.
    I have successfully treated with oral, transdermal snd intrathecal opioids the near constant misery and pain of FMS brought on by discogenic and other forms of spinal pain, a miserable state of suffering that has often failed to respond to PT, manual manipulation, surgery, therapeutic injections, medications, Pilates, pool therapy, tai chi, yoga and time. In effect, two conditions were controlled best by one class of medication: opioids ( often in conjunction with other medications and modalities of care).

    Whether by mouth, transdermal patch or by intrathecal pain pump (when appropriate), the control of persistent spinal pain minimized both reactive myofascial pain ( peripheral in origin) and the more centralized, reactive yet coincident in time FMS-related pain.

    Opioids can be used intelligently for co-existing problems which worsen the intensity and frequency of FMS pain. This is often ignored because there are sometimes too many cooks in the kitchen. A person in overall charge of the patient’s pain has to coordinate the various specialists involved. Both spinal and FMS-related pains occur commonly, alone as well as separately. It isn’t rocket science.

    I don’t buy this ‘opioid epidemic’ movement in its present form. It is politically driven and based upon poor science, misuse of statistics and, worse, because it allows many clinicians an excuse to not take pain seriously. I was shocked at how many jumped on the bandwagon and how few spoke up for their patients. Sadly, it is a minority of clinicians who spend the time required for their patients’ much needed validation and support.

    And ‘pure’ fibromyalgia? I have tried opioids and used it with mixed results, but when combined with other modalities in an integrative and / or interdisciplinary, multi-modal program, opioids can often provide a useful adjunct especially where a limited amount of breakthrough medication is the way by which they are used. Sometimes one requires a ‘real’ pain killer. It may provide the necessary amount of sleep to minimize daytime, activity related pain.

    This obviously needs to be assessed on a case by case basis with level of function and compliance always being kept in mind. Syndromes may appear similar but they often have very different causes and therefore different avenues by which pain is generated. Opioids do have a role to play in fibromyalgia, along with other approaches to care in selected patients. Each person must be assessed carefully, individually and without prejudice. Generalizations about the appropriateness of opioid use cannot be routinely applied to each individual. Cure may not, indeed, be always possible but there is never an excuse for lack of care.

  15. Sandy at 9:23 am

    I’m fortunate enough to have tramadol work for me as treatment for my fibromyalgia. I’m very grateful for a Dr. that will prescribe it for me.

  16. Kristil at 9:04 am

    I have been in some kind of pain since I was12. I am turning 50 this year. I am a pain patient whose mother and her mother , and her 2 sisters ( mom grandma, and 2 aunts) all had Fibro. My mother is still here at 79 but she is in bad shape. I was diagnosed with Raynauds at 12 , severe endometriosis at 23, Fibro and myofascial pain syndrome at 25 with degenerative disc disease. Had 2 surgeries at 29 and 31 for the endometriosis. After 10 yrs of trying for a child, I had my one and only at 33. I never went back to work. My pregnancy took a major toll on my body and I was never the same. I missed out on a lot of my sons childhood because of my pain. He is now 16 and has never had a normal Mom. I now have 13 co existing conditions related to Fibro including thyroid disease, which right now can’t decide whether it’s hypo or hyper. I have osteopenia in my hips with bursitis. Arthritis, etc. I could literally write a book on here, but refraining lol. So a very very painful and long story short, I have tried many many different kinds of meds and combinations of meds, and my medicine of choice is Norco 7.5/325 and Flexeril along with Naproxen . Thank God I have a Dr who helps me to get through each day by prescribing me the meds that work well enough to get through most days, and there are some days when I have to stay in bed all day. Life without my medicine would be no life at all. I am a chronic pain patient and a Fibro warrior. And I could not be that warrior without my meds. Thank you 💪

  17. Carla Cheshire at 8:12 am

    I amazes me that there seem to be so few studies on the use/efficacy of opioids to relieve pain. The studies you cite are limited because of the small amounts of participants. Aren’t there studies after a drug has been approved to see if it is truly effective and how well it works in the general population? Are there studies of long-term opioid use (5-10 years) for chronic pain? If not, why?

  18. Richard Dobsonn at 7:40 am

    Nope there is no good evidence, but an article in American Family Physician recommended opioids when other things don’t work, used in carefully selected patients with appropriate education of patients. However, it seems to me that there are just no medical research programs that are looking at the real and measurable impact the disease. First of all, pain and flare ups of pain are triggered by activity. For Fibromyalgia, as with other chronic pain conditions there is a “pay for it” effect that is well known to all pain patients: If you do too much, you will “Pay For It!” None of the research that I have read even refer to this phenomenon. Meaningful research would have to look at issues such as:
    1. Does the medication limit the intensity and duration of “Pay For It”?
    2. Does medication enhance the recovery from “Pay For It”?
    3. Does the medication limit the decline in function during “Pay For It”?

    And then there is the limited awareness of the fact that pain causes falls and those falls do cause injury. The real question is whether medications including opioids help to limit the frequency f falls and/or the extent of injury from falls. Leveille published an article a decade ago in the Journal of the American Geriatric Society (I believe) that indicated use of a daily analgesic showed some protection against falls in elderly community dwelling women with pain.

    Bottom line is that there is “NO evidence” but that is because the researchers are simply ignoring or ignorant of the true nature of the disease. God knows, there are enough willing people out there with fibromyalgia who would be very willing to participate in meaningful research.

  19. Jeannah Haber at 7:16 am

    Opioids worked for me. I’ve lived with pain every single day since 1998 from fibromyalgia, for 12 of those years I took low dose (5mg) hydrocodone 2 x a day every day. It allowed me to hold down full time employment, get my housework done, do a little gardening and yard work, be a semi active productive individual. It was very affordable ($15 for a months supply) and while it didn’t take all my pain away, it kept it down to a 3-4 for the part of the day I needed to be most active. I did not develop a tolerance to it, I had no negative side effects and never “wanted more” (unless I I over did it on the yard work or too many activities in one day then a third one would have helped yes but I didn’t take any more than I was supposed to.)

    My family physician prescribed it. I haven’t had insurance for the last 8 years, I cannot afford more expensive meds, treatments, pain management or obamacare. I didn’t know how good I had it with a semi normal life. I panicked and took myself off medicine that humanely relieved a good bit of my pain when the new opioid regs went in to effect in Oct. 2014. I couldn’t take going to my Dr. and having her tell me she couldn’t/wouldn’t prescribe them any longer and had to send me to pain mgmnt. I don’t even know if she would have done that but I couldn’t take the prospect so stubborn woman that I am, I stopped the pain meds and stopped seeing my dr. I found an herb (not mj) that helps take the edge of but doesn’t help anywhere near enough, doesn’t allow me to be active and I didn’t think it would happen but the pain and neuro symptoms are getting worse and worse. Yes I did this to myself but it was out of fear of the humiliation I was witnessing chronic pain patients go through. A very sorry state of affairs. Something has to change, what’s happening is not sane or humane.

  20. Nancy at 6:11 am

    Maybe the patients using opioids are the ones that had worse pain. I take opioids for pain from fibromyalgia DDD myofascial pain osteoarthritis…and more..
    Most of the time it keeps me functional..much more functional than without opioids. Its a bit of a rollercoaster ride. Sometimes they work and sometimes they work less. Constipation and anxiety are still issues and the process of obtaining opioid meds is dehumanizing once a month. Urine test, pill counting, long drive, psych assessment, pharmacy judgements…etc.
    I wish there was a better solution…I’ve tried most and still keep trying.

  21. maureen at 5:56 am

    Donna, Thank YOU! for all that you do and for keeping us updated! Maureen