The use of opioids in fibromyalgia

  title={The use of opioids in fibromyalgia},
  author={G. S. Ngian and Emma K. Guymer and Geoffrey Owen Littlejohn},
  journal={International Journal of Rheumatic Diseases},
Fibromyalgia syndrome (FMS) is a chronic disorder of widespread pain with high personal and societal burdens. Although targeted pharmacotherapies have become available in recent years, it remains a challenging condition to treat. Despite no randomized controlled trials addressing the short‐ or long‐term use of opioids in FMS, their use remains prevalent. In this article we discuss the role of opioids and other analgesics in the management of FMS, with particular focus on problems associated… 
Chronic opioid use in fibromyalgia syndrome: a clinical review.
  • J. Painter, L. Crofford
  • Medicine
    Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases
  • 2013
The case is made that chronic opioid use is inappropriate in the treatment of fibromyalgia (FM) syndrome because of the interaction of unique pathophysiologic characteristics of the patients and effects associated with chronic opioids use.
Opioid Use in Fibromyalgia: A Cautionary Tale.
Is there a role for opioids in the treatment of fibromyalgia?
There is no evidence that pure opioids are effective in fibromyalgia but there is some evidence that opioids with additional actions on the norepinephrine-related pain modulatory pathways, such as tramadol, can be clinically useful in some patients.
Update on Treatment Guideline in Fibromyalgia Syndrome with Focus on Pharmacology
Amitriptyline, Pregabalin and Duloxetine are used most commonly in FMS and though modestly effective, are useful adjunctive treatment to non-pharmaceutical measures.
The impact of the interaction of chronic opioid use with fibromyalgia, despite control for myriad regressors, is significant both statistically and clinically.
Management of Fibromyalgia Syndrome: Review of Evidence
Treatment options for managing fibromyalgia symptoms are reviewed, including FDA-approved medications and other pharmacologic agents, and non-pharmacologic treatments that have shown promising effects.
Fibromyalgia: Treating Pain in the Juvenile Patient
More stringent randomized, controlled trials with longer follow-up periods are needed in order to determine the long-term efficacy and safety of medications in the treatment of JFMS.
Opioid Use in Fibromyalgia Continues Despite Guidelines That Do Not Support Its Efficacy or Risk
Greater burden of illness appeared to be associated with the prescription and use of opioids in this population of fibromyalgia patients, suggesting that some providers may not be aware of current recommendations that have been found to be effective in the management of FM that are contained in guidelines.
The current treatment of fibromyalgia O tratamento atual da fibromialgia
Fibromyalgia therapy should be individualized, and it does not aim the cure; its objective is to reduce the subject’s suffering; provide function improvement and, as much as possible, the individual's autonomy and quality of life.
Healthcare Costs Associated With Chronic Opioid Use and Fibromayalgia Syndrome.
While the differences seen in FM patients and controls are marginal, those attributed to chronic opioid use in these patients are significantly higher.


Adverse effects of chronic opioid therapy for chronic musculoskeletal pain
Patients with chronic musculoskeletal pain should avoid the long-term use of opioids unless the benefits are determined to outweigh risks, in which case, the use of chronic opioids should be regularly re-evaluated.
Understanding fibromyalgia: lessons from the broader pain research community.
Fibromyalgia symptoms are reduced by low-dose naltrexone: a pilot study.
It is concluded that low-dose naltrexone may be an effective, highly tolerable, and inexpensive treatment for fibromyalgia.
Fibromyalgia: an overview.
  • D. Clauw
  • Medicine, Psychology
    The American journal of medicine
  • 2009
Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial.
Pregabalin at 450 mg/day was efficacious for the treatment of FMS, reducing symptoms of pain, disturbed sleep, and fatigue compared with placebo and was well tolerated and improved global measures and health-related quality of life.
Decreased Central μ-Opioid Receptor Availability in Fibromyalgia
It is demonstrated that FM patients display reduced MOR binding potential within several regions known to play a role in pain modulation, including the nucleus accumbens, the amygdala, and the dorsal cingulate, which indicates altered endogenous opioid analgesic activity in FM.
Opioid-induced Hyperalgesia in Humans: Molecular Mechanisms and Clinical Considerations
Clinicians should suspect expression of OIH when opioid treatment effect seems to wane in the absence of disease progression, particularly if found in the context of unexplained pain reports or diffuse allodynia unassociated with the pain as previously observed.
Tramadol in the fibromyalgia syndrome: a controlled clinical trial versus placebo.
The contrasting results found in the present study could be a stimulus for the organization of new projects, which may lead to the identification of an optimal therapeutic approach for fibromyalgic patients, also using tramadol for long periods.
Gabapentin in the treatment of fibromyalgia: a randomized, double-blind, placebo-controlled, multicenter trial.
Gabapentin (1,200-2,400 mg/day) is safe and efficacious for the treatment of pain and other symptoms associated with fibromyalgia and was generally well tolerated.
Cerebrospinal fluid levels of opioid peptides in fibromyalgia and chronic low back pain
Fibromyalgia was distinguished by higher cerebrospinal fluid MEAP, systemic complaints, and manual tender points; intermediate SF-36 scores; and lower pain thresholds compared to the low back pain and normal groups; and central nervous system opioid dysfunction may contribute to pain in fibromyalgia.