Prescriptions for painkillers have increased dramatically in the past decade, as more patients with chronic pain are becoming reliant on opioid drugs like Vicodin and Percocet. Despite the growing use of opioids to treat chronic pain like fibromyalgia, little research has examined the long-terms effects of such drugs on patients with fibromyalgia syndrome (FM).
“Given the profound lack of controlled or anecdotal efficacy evidence supporting the use of opioids in FM, their prevalence as a treatment option is of great concern,” stated Jacob T. Painter, PharmD, MBA, PhD of the University of Arkansas for Medical Sciences.
Dr. Painter and Leslie Crofford, MD, analyzed the existing literature on opioid treatments for FM in a new study published in the Journal of Clinical Rheumatology. Earlier studies have shown fibromyalgia patients suffer from more adverse events and a greater intolerance to opioid drugs compared to people without FM. The review adds to this research by revealing several risks involved in the long-term use of opioids for FM.
They emphasized that regularly taking opioids has been linked to hyperalgesia, a process of over-sensitization of the central nervous system that causes heightened pain sensitivity and diffuse, non-localized pain. This is particularly concerning for fibromyalgia patients since FM already causes widespread pain and increased pain sensitivity. Opioid drugs could activate spinal glia that are responsible for pain transmission neurons, further amplifying the pain of an over-stimulated central nervous system.
The brains of people with FM also function in a way that could decrease the efficacy of opioids. Opioid drugs work by acting on opioid receptors in the brain which process pain. In studies involving PET scans of people with FM, researchers discovered that FM decreases the availability of ?-opioid receptors in the brain. With less receptors available to process opioids, the drugs become less effective in FM patients, Dr. Painter and Dr.Crofford suggested.
The authors also pointed out that fibromyalgia patients often suffer from depression, anxiety, and mood disorders. These psychological factors could increase their risk of drug dependency and misuse. Opioid drugs could also exacerbate sleep disturbances, fatigue, and symptoms of irritable bowel syndrome experienced by many fibromyalgia patients.
These concerns, coupled with the lack of sufficient evidence for opioids and FM, led researchers to conclude that “the use of opioids in this condition ill advised.”
This study comes at the heels of another new study showing that opioid prescriptions may lead to worse outcomes for patients with musculoskeletal conditions like back pain.
Instead of relying on drugs, patients managing chronic pain can benefit from non-pharmaceutical approaches to reducing symptoms like exercise therapy and chiropractic care.
Painter JT, and Crowfford LJ. Chronic opioid use in fibromyalgia syndrome. Journal of Clinical Rheumatology 2013; ;19(2):72-77.