07.26.2016

What the research really says about using opioids for fibromyalgia

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This story on using opioids for fibromyalgia first published on NationalPainReport.com. It is being reprinted here with permission from the editor. 

As fibromyalgia patients, our physicians often tell us that opioids won't decrease our pain, but what does the research REALLY say about using opioids for fibromyalgia? You might be surprised!

Using opioids for fibromyalgia

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.

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.”

Of course, it’s possible these patients were on opioids because their symptoms were more severe, and hence, they’d be more likely to be unemployed and on disability. There’s no way to know if opioids actually caused these patients to be more symptomatic and disabled.

Tramadol

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

A 1998 Italian study of 12 fibromyalgia patients found Tramadol relieved pain by 20 percent.
A 2000 University of Texas Health Sciences Center study involving about 100 fibromyalgia patients supported the efficacy of using Tramadol for pain relief.
• A 2003 multicenter, double-blind, placebo-controlled study found patients using a combination of Tramadol and acetaminophen (commonly sold as Tylenol) “had significantly less pain at the end of the [91-day] study.”

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 sizable portion will say opioids.

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

This post is part of Being Fibro Mom’s Chronic Friday Linkup!

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Comments

  1. Erica says:

    I am so frustrated with how things are going and this crack down on opioids. I was diagnosed with fibromyalgia five years ago. I tried tramadol, Percocet and Tylenol 3. Pain was still there. My doctor prescribed hydrocodone. Finally some relief. I have never abused my medication. I have been overwhelmed with anxiety lately because my doctor can no longer prescribe this to me. This is so unfair for us who actually take our medicine responsibly.

  2. Darlene says:

    The only thing that has helped my fibrpmyalgia pain, not interfered with my fatigue and allowed me to function with minimal side effects is a half tab of hydrocodone as needed. This has gotten me through for years. I check In with my pain management physician, of course, and a couple of close friends, to be sure to safeguard myself from the scary possibility of addiction. I had and occasionally continue to try many many other presented options. I also utilize the skills of an excellent homeopathic chiropractor, a fantastic massage therapist, etc.

  3. Thanks for the post.

  4. Jamie says:

    I was wondering what people with genuine, and medically validated chronic-pain issues can do to fight the system. With all the abuse, and addictions, to opioids, (and it is devastatingly high), my personal physician has informed me that once he retires in the couple of years, that “none of the new doctors will be prescribing me any opioids for pain.” My doctor has known me for 42 years, and knows that I have never abused my prescriptions. He is well aware that they have been the key reason that I was able to continue working in the healthcare field as a Mental Health Counselor, instead of applying for disability. (I eventually took an early retirement.) Though the opiates did not “heal” my chronic pain, which is related to a diagnosed auto-immune disorder, plus, two spinal-area surgeries where metal has been placed in my neck, and lower-back, they at least kept me functioning in my job. Now, I’ve been informed that prescriptions will no longer be forth coming after my doctor retires, and that I need to be preparing for that eventuality. So are there any groups that are organizing in the U.S. to fight this?
    (Thank you for your helpful site!)

    • Donna Gregory/FedUpwithFatigue.com says:

      Hi Jamie, I’m so sorry you’ve found yourself in this predicament. Unfortunately this scenario is way too common these days. You might ask your physician if he can refer you to a pain specialist. They may be more willing to prescribe opioids. Another option – if it’s available where you live – is to explore the use of medical marijuana. There’s a growing number of chronic pain sufferers who are transitioning from opioids to medical marijuana. You can use CBD-rich strains so that you don’t walk around stoned all the time. 🙂

      As for organizations, I know the U.S. Pain Foundation has been trying to represent the chronic pain community, but I don’t think the group has been very successful at this point. As a community, we just really don’t have the structure yet to come together and fight this.

  5. If it was not for my opioid, I would be disabled. No doubt in my mind. With it, I run my own business, working up to 60 hours+ per week. In no way do they make me feel “drugged”, “high”, “woozy”, or anything else. The ONLY thing my opioid does is decrease my pain. Of course I understand that they will never make me pain free.But I don’t have to be pain free to be functional. These “doctors” can go fly a kite. They made me jump through hoops for over a decade before I was finally permitted to use an opioid – over 10 years of needless suffering! We don’t allow our animals to suffer like that, but people are another matter. And one more thing: if your loved one died of an overdose, that is very sad, but it isn’t my fault!!

    • Donna Gregory/FedUpwithFatigue.com says:

      I agree … people who use opioids responsibly should not be punished for those who do not.

      • Absolutely !

        • I am not totally pain free. But I can function closer to “Normal” when I take Oxycodone. I don’t feel drugged, high, or tired. I hate the fact that our government has made us look like drug addicts. I am more of an “I like feeling less pain addict”. I have lost many friendships because I really am not the “overachiever” I was before Fibro hit me like a ton of bricks. I can’t make plans ahead, and have learned to not make promises I can’t keep concerning things that require more than normal physical exertion on my part. I try to educate my friends and family close to me……..but they have to want to understand, and want to feel compassion. THIS ILLNESS DOESN’T GO AWAY! The pain (at least for me) is constant.

          • Sandra says:

            How do you get diagnoaed for fibromyalgia
            I have sciatic issues and get leg and back aches alot

    • Nobody’s saying it’s your fault. The issue here is that doctors have been prescribing highly addictive drugs to people who don’t need them at alarming rates. Sure, denying you the only medicine that helps is not a great way to fix this issue, but the reality of it is that somebody friending for another hit can sound just as convincingly fibro as you will.

  6. robin/lozen says:

    I know they helped me,n I do hear the”addiction factor”,i just want them(dr.s n nay-eayers) everybody Is different n if they report it helps give better quality of life to not be at max pain level all the time than each patient should have more than 1 choice.peace,i’m know judged on my cannabis use(tincture,oil,full plant,smoking) n I do not feel any 1 thing nor drug nor “food” is gonna cure me.peace n freedom from relentless chronic pain,
    I do meditate,sit with the pain,exercise,use other herbs,…ect

  7. First lines of defense or me are yoga, trigger point massage, topical pain relievers and careful diet with reduced wheat and dairy (from years of experimentation) BUT… since that still leaves me non-functional I gladly have taken Norco (hydrocodone) for the last 10 years. Tried Tramadol but too many side effects and did not help with pain, had to argue with rhuematologist that it was not working. Tried many other drugs with wacky to dangerous effects and no help with pain. No more designer drugs for me! I use a topical pain lotion or a roll on all natural, (if it has arnica montanna and illex and aloe it seems to really work), there are several out there. It is a 3-4 hour effect of course but worth it to not have to up my drug usage.

  8. Melanie Dowdy says:

    After reading more of the comments, some sound almost guilty and apologetic for having to use opioids. Others sound judgmental…even if not intentionally so… just eat a healthy diet and exercise. Good advice for everyone. I remember when I followed up with the rheumatologist and complained the tramadol was not helping and her telling me I would just have to learn to “live” with it. At that point I could see why so many Fibro sufferers “end it all.” Thank God I found a pain specialist who prescribed opiates. I had to quit working after trying vacation time off, then cutting to 3 days a week. The longer I worked, the more the intensity of the pain increased. I am sure the pain levels differ from person to person. I had one woman say “Fibromyalgia, I have that. Sometimes I have to take Tylenol!” I became bedbound and housebound, even on the morphine. Only leaving the house to go to doctors visits. I only took enough morphine to keep the pain level around a “4” but with any activity the level would rise to 7 or 8. No one could tell I was on narcotics. I drove myself with no difficulty. I did not experience a “high” or euphoric state. Just myself with a manageable pain level. So if opioids are what you need to survive and function, go for it! No one should have to suffer extreme pain.

  9. Melanie Dowdy says:

    Opioids…specifically morphine…are the only medication that would touch my pain. And they only made it tolerable. Oxycodone and even Fentanyl patches were no help, telling me that a very person specific solution is needed. Of course over the 14 years since my diagnosis, my dosage needed to be increased. Tis is when we would try other options, but always back to the morphine until Cymbalta helped and I was able to cut my morphine by a third. Then after realizing Xanax helped my pain when prescribed for panic attacks, I cut my morphine by another third. After 13 years on morphine and 8 years on Xanax (the same original dosage) I found a doctor who was willing to treat my low cortisol levels. After starting hydrocortisone a year ago, my pain levels dropped low enough that I was able to stop the morphine and Xanax in Nov 2015. Although I was not psychologically addicted (I would sometimes even forget to take it until the pain exploded again!) I did have to go through physical detox. I stopped the Xanax and morphine at the same time and I have to say it was a rough 2 weeks. But I am so grateful to have had the morphine to get me through until alternatives were found. Crying at work and being bedridden due to the horrible pain no one should have to endure so I heartily support anyone with a genuine need for opiates to get the relief they need!

  10. Jason says:

    My wife was introduced to tramadol to manage her pain about 5 years ago. It takes the edge off. At least it does something. Before using the tramadol she could barely get out of bed. Then we moved to Florida and now we have to pay money every time we need a refill…annoying. North Carolina would be able to give us a refill or be able to just pick a prescription up without an appointment….but alas Florida is not like that. Primarys can’t even prescribe it you need to see a pain specialist which is that much more money. So thankfully I stumbled across a product that has helped so many with fibro and other ailments. Our diet is a major key in helping us get better…which is so hard. This product has been such a blessing and has a thirty day money back so no risk. I am not trying to be spamy just want to share the blessing. I just want everyone in pain to find relief. Watching my wife gong through this has been heartbreaking. Here is the site: http://regen.basicreset.com/

  11. Sandy says:

    I go mostly the holistic methods including what I eat but the best pain relief has been when I taken opiates for post surgery pain. I actually feel normal before I developed CFS then fibromyalgia. Instead the low hum of pain (1 to 3 pain level) 24/7. Yep..Tramadol doesn’t do anything for pain unless you take large amount of it. Tramadol is great for restless leg syndrome.

  12. J Poulin says:

    Frankly, I think people are too quick to reach for pharmaceuticals and opioids. Having a determined position to get well, reducing stress, limiting activities and demands in life, clean eating, reducing pharmaceuticals, sugar and wheat, and adding supplements have been a huge help in minimizing pain (although not totally eliminating) for me. It refuse to lay down and submit to having Fibro control my life. Emphasis on getting well and eliminating chemicals in my body. I am only using Cymbalta and weening myself off that as well.

    Certainly my life is not Like it used to be (pre-Fibro) but discipline has greatly improved my quality of life.

    • Donna Gregory/FedUpwithFatigue.com says:

      I’ve been taking a mostly natural approach, too, and I think diet and other lifestyle factors are very, very important in managing fibro. That being said, I don’t judge anyone who uses opioids as part of their treatment plan. Some people find them very helpful and rely on them to have any semblance of life. I felt it was important to actually delve into the fibro/opioid research given the recent controversy over the use of opioids. More and more of our fibro warriors are having their doctors take their opioids away from them due to the recent adoption of the new opioid prescribing guidelines. It’s equivalent to having their lifeline cut and is unnecessarily cruel if they are using their opioids responsibly. My opinion is the U.S. government needs to stay out of the doctor/patient relationship and not punish chronic pain patients who are using their medicines as prescribed.

      • Tammy Carlson says:

        Amen to that!
        At the age of 29 I was diagnosed with arthritis in my spine, degenerative disc disease, and fibromyalgia. I have been through the ringer having to try so many different things. A series of steroid injections, burning of nerve endings, different kinds of patches, physical therapy, occupational therapy, gabapentin, cymbalta, celebrex, muscle relaxers, heat, ice, 2 spinalcord stimulators, and on and on. Finally found a medication to get some pain relief, Opana ER, along with a couple fast acting pain meds. I finally felt like I could live life again and enjoy doing activities with my daughters. Then BAM!! Now my doctors have to pull me off the same medication that I finally got relief from because of new hospital guidelines. So let me just say thank you for not allowing me the physical ability to play with my kids and to work, having to file disability. There is nothing like being in so much pain that you cry yourself to sleep each night, but when addressing the issue with your doctor you basically get the “tough shit” reply.

        • Donna Gregory/FedUpwithFatigue.com says:

          It’s inhumane what they are doing to pain patients, especially the millions who are using these drugs responsibly. 🙁

        • Michelle says:

          I’m so sorry to hear this. I hope you find a doctor that can help you. Good luck on your journey xx

    • Donna, I get what you are saying and I try to minimize my Rx or OTC intake myself. Each of us, unfortunately are at a different level of pain or tolerance to it. That is the worst thing about FM. I try to eat right, move some, and get what I call my Rx level of sleep each night, as well as remain as stressfree as possible. I am learning to say NO to certain activities and trying not to overdo anything. A while back I had a flare up and had some Lortab from a dental procedure that I did not finish. It helped! Before that, I had a back issue, and saw my doctor who prescribed Tramadol. It too helped! I was just in Colorado, and wanted so badly to go into one of the shops to buy some CBD oil (not hemp based) to see if it would help, but I was with others and feared their judgement, so I didn’t go. I have no interest in smoking the stuff, as I have never smoked in my life [aside from trying to smoke a tobacco cigarette in 3rd grade, YUK] and now I have Sarcoidosis in my lungs and do not wish to complicate things. All in all, I manage with Ibuprofen, at least keep it down to a dull roar. There are those times that I wish for something more. I typically come home and have a couple martinis, they relax me. I tried Cymbalta in the early years. I am struggling to lose weight again, and I know that adds pressure on my joints. Thanks for your input. I wish you the best.

    • milly says:

      yeah!!! i just need to eat healthy and exercise and take some vitamins, yes That will take away the horrible debilitating pains, yeah….not at all insulting….

      • Jamie says:

        Agreed! I just recently was told I likely have FM (just got blood tests done checking for other possible causes of my symptoms/waiting on results), but have been in pain for over a decade. I have had opioid medications temporarily prescribed after surgery, for infections, etc, but have never gotten them regularly. The times I have taken them, I did notice that my all over pain was reduced dramatically and I was actually much more productive than usual. Since I don’t regularly take medication for pain, I have tried many things to reduce pain, reduce fatigue, etc. I eat fairly healthy, I’ve seen a sleep specialist that gave me tips on ways to help me sleep without medication, I exercise as much as my body will allow, use heated flax seed pillows often, and other natural remedies. Despite my efforts, I have only gotten worse. I’m always tired and the pain keeps increasing. I feel like taking pain medication, at least on my worst days, would likely improve my productivity and overall quality of life. I haven’t even mentioned this to my doctor, though, out of fear of being labeled an addict or someone just seeking meds for recreational use.

  13. Linda Williams says:

    Over the long term, daily opiates did keep me more active but I’m not sureif it was just helping the arthritis pain or the fibro. Now I take opiate pain meds PRN. They do help taking them like this. There are some days that nothing else helps and I don’t have the luxury of staying in bed…mostly weekends when my kids expect and need more from me.

  14. Gayle MacDonald says:

    I agree that it is likely that the people studied had more severe symptoms, and that was causing their inability to work. After having fibromyalgia for over 30 years, and having tried many medications, I would have to say that narcotics, (I’m on Codeine), are truly a life-saver. It’s the difference between being bed-ridden without it, to being able to do self-care, use the computer, and take small walks for exercise with it. I’m also on Gabapentin, Amityrptiline, 5-HTP, magnesium, and vitamins D and B12, and they are not enough to make me functional without the addition of the codeine. It is truly infuriating that the narcotic medications are being withheld from those who really need them, because some people abuse them.

  15. Tired mom says:

    Thank you for this article. Since I was diagnosed in 2012 with Fibro & then RA a few months afterward, the ONLY thing that keeps me from absolutely losing my mind is opioids. The dose I have barely dose it at that & I have to be so very careful at times. I do not enjoy the fact that I actually have to take them to survive & i do not get high which people without chronic pain do NOT “get”. I am not an addict either & my body will build a tolerance to it like any other drug for blood pressure, seizures, etc. I take topamax for migraines but no one called me an addict because I’m on that- so I wish people would get educated. I’m tired & hurt so much. I’m afraid to even ask for “more” because of the stigma & that is what is wrong with our health care system. I have to suffer because of what OTHER people do not know. Tramadol – though it may somehow work for someone, never did one bit of good for my pain or any kind of pain my dad had. Was like taking an M&M. Just our experience. I would love not to have any pain at all every minute of every day & not have to take anything. I can’t remember what that is like. The fact that chronic pain patients can’t get adequate relief in US is pitiful. When the resources are available, we should be allowed to choose what works for us. Even if it’s marijuana. I would rather use that in some form (it’s grown) than some man made drug that’s forced on me by big Pharm that causes unlimited, unknown side effects & still have the unknown with how all these man made “fibro drugs” will effect us LONG TERM. It’s amazing to me how many dr.’s still prescribe & people are still taking cymbalta & Lyrica even after the warnings. There is not enough education out there. They are plenty happy to shove lots of those upon us & of lots of muscle relaxers, which if we have fibro (a symptom is fatigue, do we need a drug to make us sleepy?) Just sounds like some big plot by someone to keep pushing their agenda- (big pharm) & their drugs (dangerous & not helpful) onto the public willing to take a chance on anything they think will make them better – and trying to keep away what actually works because they will lo$e out big time. Since opioids have been around for years & they don’t cost much. They got a bad rap from some idiots but as we all know if people are going to use something, they will just choose something else – i.e. The heroine abuse epidemic in America.

    • Julie says:

      I agree! I have been taking opioids for 20 years for back issues and fibro. I have tried everything and I have experienced allergic reaction to them all. Norco is the only drug so far that keeps me moving and living s half normal life. Thank you for your post.

  16. Thank you for this, I’m so tired of hearing opioids don’t work for Fibro. They are the only thing that work for me. I’m saving this to bring out next time someone tries to convince me my lived experience is wrong.

    • Donna Gregory/FedUpwithFatigue.com says:

      I haven’t used opioids except Tramadol, but I don’t judge anyone who does. I know a lot of us w/ fibro depend on them just to get through the day. I think it’s a shame that people have this all or nothing mentality – they think if you’re using opioids, then you MUST be addicted to them and abusing them. Most people use them responsibly, and we shouldn’t be punished for the actions of a few. I felt it was important to highlight the research b/c it is definitely lacking.

    • Julie says:

      I am with you. I have been taking them for 20 years and it is the only drug that works for me. I have tried all the others but have allergies to them. I am thankful I have a physician whose wife, also an MD had to quit her practice due to fibro & chronic fatigue so he understands.

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