Duke and Stanford Opioid and Fibromyalgia Study Published

Duke and Stanford Opioid and Fibromyalgia Study Published

When I saw this tweet from Stanford University Pain this week, I was intrigued.

Stanford and @Duke Anesthesia researchers find brain data to explain why fibromyalgia patients may feel benefit from opioids even though opioids may not work better to reduce chronic pain.

They referred to this article, which I suggest you read.

While the use of long-term opioid medications might not be beneficial for chronic pain per se (i.e., in terms of not improving physical function and not reducing pain interference for example), it is possible that opioid medications could be benefiting brain reward processing and associated reward behavior in patients with chronic pain.

Because the piece was specifically about fibromyalgia, it prompted me to ask Dr. Ginevra Liptan in Oregon what she thought of the study and its conclusion. Her comment was characteristically direct.

“Although it seems you hear nothing but bad news about opioids these days, a new study reports a beneficial effect of opioids on the fibromyalgia brain! Scans demonstrated that those patients taking chronic opioids had normal neural reward responses compared to abnormal responses in those not taking opioids.”

She continued, “This supports what I see in the clinic every day, with patients reporting less pain, improved function and quality of life due to opioids. However, since opioids are so controversial the researchers end the article by saying “We therefore encourage readers not to extrapolate these findings to suggest that opioids may, or may not, be of value in the treatment of fibromyalgia”.”

Fibromyalgia is one of the most common chronic pain conditions. The disorder affects an estimated 10 million people in the U.S. and an estimated 3-6% of the world population. While it is most prevalent in women —75-90 percent of the people who have it are women —it also occurs in men and children of all ethnic groups.

Among those 10 million people who have fibromyalgia is Dr. Liptan. Her Frida Center for Fibromyalgia is believed to be the first practice in the U.S. devoted to the treatment of fibromyalgia.

By the way, if you are on Twitter and not following @StanfordPain, you’re missing something. It is one of the most active Twitter accounts on chronic pain—and almost always interesting.

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Authored by: Ed Coghlan

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Tell me about what research doesn’t know about pain and opioid treatment for chronic pain, or acute pain. I am a redhead. It was only recently “discovered” that red hair is caused by a mutation with many major consequences pertaining to medicine. Pain experience is one of them. Response to medication of all kinds is another. I have gone into shock due to medical mismanagement of my pain. I lost my hearing, then my eyesight, then my consciousness. When aroused by the nurse she said ‘its just a little shocking’. in other words: don’t worry, you are okay. You merely went into shock from pain due to the mismanagement of your pain by our resident. No apologies. Also no awareness of my condition. I had upon the occasion of that hospitalization, to be moved to a different floor. Because I am intelligent. No kidding. The staff had “trouble realizing I was ill”, despite being on an antibiotic so strong a glucose IV was needed 24-7 (they kept letting it dry out) and a temp of 106. I spoke rationally so I was ok.
A dentist did not feel like using the anesthesia I normally use. I was cordial about the malpractice. I said nothing after he griped. I made no noise, I kept my entire body perfectly still while he tortured me; like the dog described by Darwin, licking the hand of the man who did the vivisection to learn how his body worked. The only thing I did not control was the radiation coming out of my body: I changed color and temperature. I glowed, as if I was radioactive. By the time the dentist was finished his procedure he was in tears, begging me to forgive him. I was so gracious. I even forget myself that my pain is legitimate. I am so accustomed to being treated like a normal person; i.e., a brunette, blond or person with black hair. I have provided a ton of research to my physiatrist “for my chart”, to provide him with all the legitimation he could possibly need should the DEA challenge my dose…HINT HINT: my pain is not covered! As it was perfectly before the CDC.


There is this myth that long term opioid therapy doesn’t help chronic pain patients. Said patients will tell you otherwise. The truth is a study has never been done because there is no ethical way to design such a study. You would have to give high dose opioids to an opioid naive control group who dont have chronic pain. They would of course become addicted right away as they dont have the over sensitised central nervous systems of pain patients which mop up any “high” from opioids. In a chronic pain patient the “high” of the opioid isn’t experienced as it just serves to calm the CNS to a more normal level ie a less painful level, so could everyone please stop claiming that long term opioids don’t help chronic pain patients there is absolutely no theoretical or factual scientific evidence for this and never will be. .


Thank God there’s a pain specialist advocating opiates for Fibromyalgia.

Until I was taken off of successful pain management with small amounts of Methadone and Ativan, I was able to be independent from assisted care. I could run a business. And have a romantic relationship. Those are the major losses. Nevermind the simple normal pleasures that are almost non existent due to the removal of my treatment.

Opiates don’t work for every case of FMS. But…for heaven’s sake, make 2nd class drug scripts available for those who benefit from these medications.

Kathy C

Stanford Pain has been full of alternate facts lately. If they had a positive response to opioids, in one of their studies, they might lose out on millions in NIH funding. The NIH does not want objective research, that is why they chose to fund Stanford’s research. One of their pain psychologists spoke at the world economic forum, telling the billionaires, that all of the economic damage they cause, is really a mindset problem for the afflicted. They love things like that.

They even have a pain and addiction researcher whose only experience of pain, is when his GF married another guy! He dated her for 6 years and did not want to marry her. It is weird how many guys do that and never forget that they did the rejection. At Stanford Pain they don’t see any difference between intractable chronic pain and something like that.

Do not print my name

I have been on opioid treatment for ten years. The chief result of my exposure to it is to absolutely abominate the medical profession. They are ignorant, misleading, self-protective, and backboneless they are the worst in treating you as an addict. The whole mess is filled with conflicting information; it turns you from a patient to a prisoner of the country. I am a Britishl, EU, and American citizen, but I can’t go there because I have to be here every 28th day for my physical exam, which is a joke and, with one doctor I had, a constant badgering to get more expensive procedures. One doctor gave me virtually no information when I began, but when he apparently got the idea that he had done something wrong, he gathered all the people who worked in the office, nurses, secretaries, file clerks, cleaning people, arranged them in a semi-circle around the door of my examination room and when they were all set, opened the doors and in a stentorian tone, began giving the instructions he should have given a year before.
The medical profession functions on two levels: the miracle-cure and wonder-machine level and the everyday by-rote and basically thoughtless everyday level. Even the most obvious things are not being done: the patient should sign a release, stating they will not sue the doctor, then be able to govern his own level of medication. I am 78 and I’m treated like a teenager who might get addicted. OF COURSE IM ADDICTED. THAT’S THE NATURE OF WHAT YOU, DOCTOR, ARE DOING TO ME. These monthly examination are a joke. You still have the same disease you had a month before. There should be ID cards that would allow you to travel and be legit, even internationally, as a pain patient. Any doctor can cut you off any time he wants. (just to watch you suffer?). I had the experience of seeking out the very best doctor in the whole northeast. He was arrested in this new sex thing, even though he was the best doctor I had had.


Finally some good news.

Debbie Nickels Heck, MD

Sounds like something Medscape would report. Starts out with positive conclusions based on objective findings then says “but don’t pay attention to these obvious benefits the patients receive from opioids.” Why was that last statement written which essentially ignored the positive findings? That’s what Medscape does so frequently & why I’ve ignored most of their articles the past several years. Waste of time to read when they contradict themselves by the end.


I see good in this attempt but we know opioids do work on receptors in brain and another researcher could conclude that is why people continue use them
What is more the issue is the inability to treat the condition that causes the pain in first place often rare sometimes not
Cancer can cause severe pain and like one reply pointed out it can cause from treatment ongoing pain that will need quality pain management Noncancer chronic pain from other illnesses the same . Advil and Tylenol does not work for moderate to severe pain that is 24/7 7 days a week Why would I want to not be able drive, work , walk but even package on Tylenol state for mild and not for more then so many days same as Advil.
No one wants be sick and loose independence but scanning brains could back fire depending on duration the dose of medicine , person , the type illness or just known effects of opiates on pain receptors. It is also not decided state by state treatment for heart lung bone or cancer etc Why is pain control not left to doctors and it should not matter where you live in the United States We all should have right to quality medical care including pain control as a human being.


“While the use of long-term opioid medications might not be beneficial for chronic pain per se…”

The study findings are great & no surprise, but why the heck did they think it necessary to parrot a false narrative? There’s no actual evidence to back this up -just sociopolitical BS & PROPaganda.

The few studies that support this false narrative are so bad as to be utterly, laughably nonsensical at best, criminally bad at worst. I spent many years in basic research & science & have read literally thousands of medical/scientific journal articles. I’ve read & evaluated the “studies” that the members of the Church of Opiophobia trot out to back up their BS. The studies are worse than useless; poorly designed, wildly biased, badly written, etc. The fact that major journals published them actually makes me glad that decades of chronic pain finally forced me out of the lab; journals clearly have NO integrity any more & I’d hate to be associated with science in this state.

James McCay

I’m a PERFECT study subject for Multiple Chronic Intractable Pain diseases & opioid use. I definitely have Advanced General Myasthenia Gravis with the extremely rare Hyperthymusism (XL Hyperactive Thymus Gland), Degenerative Disc Disease (six discs), and Fibromyalgia (that’s TWO Autoimmune diseases at the same time!).
I’ve been putting my name & info “out there” in every NYC Hospital and with every NYC Neurologist I’ve seen (well over a dozen of them) once I was fully correctly diagnosed in 2006 and no one has ever contacted me??? I also added my info to every Internet study related to any/all of my diseases and I never was contacted for any study. WHY?


Like it was already mentioned; leave it to the United States to use “MONEY” as an incentive. Money is NO INCENTIVE to me as I’ve been doing charity work donating sports cards and autographs (and cash) to hospitalized & terminally ill children (every penny profit I could have made from this hobby) from 1989-2015 (over 3-Million cards donated), while I was always living on the absolute minimum a human can live on my entire life. Ironically this worked out in my favor, as NY State couldn’t care less about the homebound disabled or elderly & most suffer everyday literally starving to death. But since I’m used to living on the absolute bare minimum; that wasn’t much of a change for me. 🙂

The rent in NYC for a one room apartment is $2,400+ a month. I can’t move, I can barely walk! Plus I’ve had Multiple Sclerosis symptoms and Muscular Dystrophy since my Myasthenia Gravis became advanced 10-years ago. I lost more than 50% of the muscle mass in my legs (that used to be quite muscular). I’m on a very strict diet which keeps my weight in normal limits- as most bedridden people become obese. NO PAIN MEDS WORK ON ME ANYMORE EXCEPT HIGH DOSE METHADONE.

So how much credence can I give to such “studies”?


It is just not proven that opioids don’t benefit chronic pain patients. Where is the research saying so? THERE ISN’T ANY AS IT IS NOT POSSIBLE TO DESIGN AN ETHICAL STUDY: you would have to give opioids to opioid naive patients at a standard fixed dose for all participants, the opioid tolerant ones too.
Therefore you would have a group of patients starting on too high a dose for their pain levels. Therefore they feel high. Feeling high numbs emotional pain and that is how those who are vulnerable ie in Emotional Pain for whatever reason (eg child abuse, poverty, unemployment, H/O Child Emotional Neglect ) are at risk of addiction.
The opioid crisis manufacturers knew this and pushed their false claims re. so called “non addictive” opioids eg OxyContin , on populations they knew to be in emotional pain from poverty & unemployment.
Properly introduced by correct individualised dose titration pain patients yes like myself, have never been high. Our high pain is produced by a very over activated CNS. Opioids calm the CNS and that is how they work for pain, they operate directly on the mechanism that causes the majority of pain states : central sensitisation. Let’s have some common sense instead of anti opioid hysteria now infecting even these pages.The opioid epidemic is a political crisis not a medIcal one.
I’m writing from the UK where the opioid addiction rate for genuine Chronic Pain Patients is 0.03% & multidisciplinary approaches are the gold standard for pain management

Terry Ott

I have been paying close attention to articles/studies/bulletins about pain and opioids for several years now. Usually I understand what I am reading, at least in a general sense. The article linked in the body of Ed’s note is clearly beyond my capacity to understand. Are others having a similar problem?

Denise Bault

I’ve had fibromyalgia for at least 15 years. Tried EVERYTHING. Finally tried opioids and they have helped immensely! One of the few things that actually does…

Hayden Hamby Jr.

Now, with science it appears that again the “experts” are using machines (MRI) to tell us that opioids do not improve functionality.

My wife of 41 years was an energetic, wife, Mother, and friend to all. She was always attentive to our two sons, was employed full time as an independent licensed realtor, involved in all school activities with both sons both in sports and academic achievements, was involved in my business as a licensed building contractor, cook, maid, and chief bottle washer in our home.

In her “spare” time, she got interested in body sculpting while NEVER lapsing on her priorities as the above mentioned. She got so interested in body sculpting ( body building) that she entered into a competition. When she, we, arrived at the local competition it turned out it was a much more “significant” competition than we both realized. It was the 1987 Western North Carolina Bodybuilding Championship. She won the lightweight class and should have won the entire competition however being an unknown competitor and not representing a well know gym, bias entered into the competition. She did this AFTER giving me two sons!

The 1987 reigning “Mr. America” offered to take her under his wing so to speak and help her train to become a professional bodybuilder. With two small sons, a husband, and more important priorities, she graciously refused. She knew that she could do very well in further competition but, she had proved herself already and that was sufficient.

Years go by and she was diagnosed in 2009 with fibromyalgia after a year of multiple physician visits to determine why, she was feeling like she did. It was determined AFTER several different non opioid medications was prescribed, to prescribe her a small dosage of an opioid. Prescribed opioid medication ….brought her back to the woman I have known for so long. For “science” to tell us, a damn machine (MRI) that opioid medication does NOT help with physical function is COMPLETELY asinine.


As an RN who developed fibromyalgia after cancer for 7 years of treatment I have noted this same consenses. I have been on multiple non Opoids medication finally found one that is helping.
I take hydrocodone for debilitating intracable chronic pancreatitis. When I take my hydrocodone for pancreatitis it relieves my fibromyalgia pain tremendously.
There is a tremendous difference daily in doing my ADL. I don’t use it for my chronic irretractable fibromyalgia but it would be so easy to give in. I am only given so many pain medication so I use it Judiciously.
I am so thankful for this study since there are medically necessary diseases for opoids.
So many patients have been profiled and stripped of there Opoids only to be labeled drug addict. This withdrawl is from the benefits of relieving intracable chronic pain and being able to live productive lives. A drug addicts withdrawal is caused by the fix of feeling high non productive lives.
Thousand’s of Patient’s have been profiled and labeled then stripped of all Opoids medication in one single office visit. Drug addictions definition needs a defining definition for Compliant Intracable Chronic Pain Patient’s.


I barely understood what that study was meant to accomplish. My takeaway was that opiates pretty much normalized the brains of chronic pain patients.
Leave it to the US to incentivize with *money*.
I’d like a study with Functional MRI to see what my brains does WITHOUT opiods…which is coming soon.
Talk about “reward stimulus”!
Does a dog respond to a bell for treat? Hello!

Gail Honadle

Having had FMS 30+ yrs, I’ve been on most of the Crap that is recommend. Some resulted in A Fib trips to the ER, others side effects that were bad, or the least Hives. Predisone is not normally in the cards for me as I have Osteoporosis. The absolute worse were Lyrica and Neurotin or the generic for it. Those Addictive drugs were A Fib Trips as was Cymbalta, I’d rather deal with Fibro Fog than the PEA SOUP fog of Cymbalta. Nor did any of them work. There simply is NO effective treatment for FMS. It was a Syndrome when I was first diagnosed, now it’s a Autoimmune. Shows you science is fickle. Best they can manage is controlling the FMS Fog and some of the pain, but it has to compete with Gastro, and 3 other Autoimmunes. They all clash. Who ever recommended Savella is a IDIOT who didn’t do even a Goggle search, which brings up the Lawsuits, and horror stories on this drug. A sleeping pill is not going to help replace the natural healing sleep you need. Plus every one of these drugs will get you labeled as a DRUG SEEKER.

Brett H

Exactly how I feel. I have had to quit on several occasions and every time I experienced withdrawl but I did not run out and purchase illegal drugs and I changed to Methadone(takes 2 weeks with no meds to switch, one of the weeks spent wiating for the meds to take effect (sadly this is where people OD, you dont take extra)) for the long lasting pain instead of Oxy because of the constant need to up dosage. That isn’t beneficial to our Insurances and only inflated the Pharma industry. The 90 MME chart isn’t about addiction its about money, because the addiction medications are controlled to the point of almost being unusable. I am sure they wanted us all to go through addiction services (rewarding owners of these clinics) and thus causing anyone having to go through this to pay cash for your pain management.