Fibromyalgia is a syndrome that may have a variety of causes and symptoms. Few cases of fibromyalgia are exactly alike. However, widespread pain is one thing that is common in almost all cases of fibromyalgia. This pain may vary from day to day or constant, mild or intense. For those who have more intense and constant pain, it can be extremely difficult to live with every day. Because the cause is unknown, doctors aren’t always sure how to treat this extreme pain. Some prescribe opiate painkillers as treatment, but is this the best option?
Who is Using Opiates and Why?
About 30 percent of fibromyalgia sufferers regularly take opiate painkiller medications, which is a similar percentage as those who take opiates for other pain disorders like multiple sclerosis and rheumatoid arthritis. In many cases, those who take opiates have previously tried other treatments to alleviate their pain or may currently be using other treatments, such as pregabalin (Lyrica).
Opiates May Make Fibromyalgia Pain Worse
It’s understandable why doctors would prescribe opiate painkillers to their patients with fibromyalgia. An estimated 80 percent of fibromyalgia sufferers reported being in pain in the past week, and the amount of pain they feel is greater than that of people with muscular dystrophy or multiple sclerosis. Doctors feel compassion when their patients are suffering, so it makes sense that many would try to alleviate it.
However, one study suggests that using opiates to treat fibromyalgia could actually make pain worse. In a condition called opioid-induced hyperalgesia, long term use of opiates changes the neural pathways in the brain that cause pain. Ironically, long term use of opiates can actually cause more sensitization to pain, which leads to a feedback loop in which you need to take higher dosages because of the tolerance you build to lower doses but you actually feel more pain as your medication dose increases.
Overall Outcomes for Opiate Use
Other research has shown that fibromyalgia sufferers who take opiates for pain relief have worse overall outcomes, including higher rates of disability, unemployment, unstable psychiatric symptoms and history of suicide attempts. Opiate use appears to be effective in lower dosages for short term courses of treatment.
Risks of Opiate Use
The question about whether fibromyalgia sufferers should be prescribed opiate pain relievers is a controversial one. Those who are suffering are understandably upset when public health advocates talk about restricting access to opiates, especially because the public health figures are generally not dealing with the pain of fibromyalgia themselves.
However, it can’t be denied that regular, long-term opiate use has its own risks. Such opiate use can cause the following serious side effects:
- Opiate pain relievers are addictive and many patients build up a tolerance to them, requiring greater amounts of the medication to get the same relief. This can lead to criminal activity to illegally obtain more drugs.
- Constipation
- Disordered breathing
- Risk of accidental overdose, especially when combined with other medications like anti-anxiety or anti-nausea drugs
- Greater risk of death from all causes
Making the decision to treat fibromyalgia with opiate medications is one that should be made by a doctor and patient together with careful consideration of all factors. Because it may have unintended side effects, it’s important to revisit the issue on occasion to make sure the treatment being used is the most appropriate one.
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