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