Fibromyalgia Support Group
You're not alone in your pain. Fibromyalgia is a condition that can be difficult to diagnose and manage. If you're trying to cope with pain throughout your body, sleep problems, general fatigue, or other common fibromyalgia symptoms, you're in the right place. The community is here for you to talk about therapies and share your challenges.
I just heard a talk from a MD giving a talk in the NIH that opiates make fibro pain worse. Does anyone know anything about that?
(I remember after I had surgery, I was given both a high dose ibuprofen and oxycodone. When I took the oxycodone, it made me felt depressed so I stopped. I only took the high dose ibuprofen.)
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We're all troubled.WSo, to remind ourselves we're not at rock bottom (this is a reverse optimism thing I learned as a kid):We are not living on the island of Krakatoa when the volcano goes boom!Yeah, okay, that sucks.***Toay in 1942, Pierre Laval announced that the way to free France was for Germany to win WW2. Pierre did not win a lot of friends. When the war ended, quite quickly he was tried...
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Another day, another ouchie?My bruised achilles tendon (don't ask) makes my foot numb. Wonky on meds, whacked it.Now, as to fibro:A lot of reports are going around some parts of social media that fibro (and dang near anything else) are caused by post-Covid, post-flu, post-vaccinations, post-pick-something.1. Your risk of death or serious complications beyond "ow, that shot hurt!" are typically...
For some people with fibro opiate medications are the only thing that works.
I take Tylenol arthritis strength 650. and it helps.
There is a current heroin epidemic in this country and part of the plan to
address it, includes limiting distribution of opiates among other things.
Since you had an adverse affect you might want to try something else like Lyrica, which is recommended for fibro. Good luck
Why Fibromyalgia Patients Can’t Regulate Their Pain
Exhausting the body’s pain management system can leave those with chronic conditions unable to find relief — either naturally or via opioids.
By triggering its opioid receptors, the brain is naturally hardwired to shut down or dampen physical discomfort.
But for those with pain from chronic conditions such as fibromyalgia, a continued reliance on that process can be overtaxing — and ultimately ineffective.
“It’s sort of like trying to run a marathon … for months and years,” says Daniel Harper, Ph.D., a research investigator at the Chronic Pain and Fatigue Research Center at the University of Michigan. “If a person’s brain is constantly releasing endogenous opioids over a long period of time, the system gets worse and worse about being able to do that.”
Beyond a reduced capacity to self-regulate, such gradual dysfunction also hinders the brain’s ability to process and translate the effects of prescription opioids which, in a typical patient, could offer relief.
Harper co-authored a recent study examining how the brains of 18 adult females with fibromyalgia respond when subjected to experimental pain (in this case, varying levels of intensity applied to the left thumb).
Published in May of 2016 in the journal Pain, it is the first research of its kind to evaluate a chronic pain population via a combination of positron emission tomography and functional magnetic resonance imaging (fMRI).
Using the technology to conduct blood oxygenation-level-dependent (BOLD) imaging and observe opioid receptors during the pain sequence, the research team found reduced binding ability of the opioid receptors, which could mean fewer receptor molecules present in the brains of fibromyalgia patients.
As hypothesized, such dysregulation affected the brain’s innate ability to relieve pain.
Says Andrew Schrepf, Ph.D., a research fellow at the U-M pain center and a co-author of the study: “We’ve been able to complete the picture — their brains are doing a fairly bad job controlling pain.”
"These patients are quite different in the way they experience and process pain."
Andrew Schrepf, Ph.D.
Wider implications for treatment
The results ought to help incentivize doctors who might otherwise combat fibromyalgia pain with opioids — which, in addition to not working, can be dangerous.
Beyond the potential of addiction due to higher or extended dosage, opioid use in chronic pain patients, Harper says, could also trigger opioid-induced hyperalgesia, a condition that further disrupts a person’s pain-regulating receptors and heightens their sensitivity to pain.
Which is why a need to continue the dialogue outside of academic circles exists.
“Physicians that aren’t really trained in pain might reach for opioids more frequently,” says Richard Harris, Ph.D., a U-M associate professor of anesthesiology and the study’s senior author.
Alternate drugs that he says could be considered in lieu of opioids are pregabalin, duloxetine or milnacipran. These drugs are thought to work independently from opioid receptors.
The new research, though, might warrant a greater focus on finding other ways to help fibromyalgia patients manage a condition that some medical experts have previously dismissed as psychosomatic.
“Clinicians can think about nondrug therapies,” says Harper. “Certainly, exercise has been shown to be effective, as long as you don’t overdo it … cognitive behavioral therapy, getting better sleep.”
Although the researchers focused exclusively on subjects with fibromyalgia, ties that also were probed in a 2007 U-M study, the takeaways could be applied to other types of chronic pain, they say.
All this underscores the value of a personalized approach.
“It’s a newer line of thinking, for sure,” Schrepf says. “These patients are quite different in the way they experience and process pain.”
When patients arrive in the emergency room, nearly all but those with the most minor complaints get an IV.
To draw blood, give medications or administer fluids, the IV is the way doctors and nurses gain access to the body. Putting one in is quick and simple, and it's no more painful than a mild bee sting.
Yet for some patients, this routine procedure becomes excruciating. On my shifts as an emergency physician, I began to notice a strange pattern. These hypersensitive patients often had a history of using opioids.
Shouldn't these patients be less susceptible to pain, instead of more so?
As I looked into it, I found that I was far from the first to notice the paradox of heightened pain sensitivity with opioid use. An English physician in 1870 reported on morphine's tendency to "encourage the very pain it pretends to relieve." In 1880, a German doctor named Rossbach described a similar hypersensitivity to pain with opioid dependence.
A century passed before the phenomenon received serious scientific attention. That is when American scientists showed that rats exhibited increased sensitivity to pain after exposure to morphine, a phenomenon that became known as opioid-induced hyperalgesia.
By the 1990s, the evidence of this unusual reaction in animals was strong, but whether it occurred in humans wasn't clear.
A hint came in 1994, when researchers found that active heroin users were more sensitive to pain than expected. Other investigators took note, and by decade's end, a half-dozen studies had demonstrated similar results among heroin users as well as among recovering users on methadone.
But had these people used heroin because they had always been more sensitive to pain, perhaps from birth? The studies couldn't say.
In 2006, a group of Stanford researchers attempted to tease apart this question. The scientists measured pain thresholds in patients with back pain before and after four months of oral morphine. The researchers found that the patients had become significantly more sensitive to pain by the study's end.
Another way that scientists have tried to approach the problem is by studying opioids used during surgery. Several studies have shown that patients randomized to receive higher doses of opioids during operations have worse pain afterward than patients who received smaller doses or a placebo. Similarly, giving short-acting opioids to healthy volunteers has been found to heighten their sensitivity to pain.
Taken together, these findings do seem to suggest that exposure to opioids can paradoxically increase pain, but Martin Angst, a Stanford anesthesiologist, points out a problem common to all of these studies: Were these patients just becoming tolerant to the painkillers?
"Is this hyperalgesia? Is this tolerance?" he told me. "Nobody can say."
The questions have plagued much of the research. In pharmacology, tolerance refers to decreasing efficacy of a drug with repeated use. Not all medications are subject to this effect, but opioids certainly are. Over time, they simply don't work as well, and the original pain returns.
Doctors often increase the dose to counteract this effect, which works until the patient becomes tolerant to the increased amount of medicine. The result can be an upward spiral, with no clear end in sight.
But there is a drawback to this approach. If worsening pain is due to opioid-induced hyperalgesia rather than tolerance, then "increasing the dose will only make the pain worse," explains Caroline Arout, a scientist at the New York State Psychiatric Institute. While tolerance is characterized by desensitization of neural pain pathways, which can be overcome by higher doses, opioid-induced hyperalgesia is the result of hypersensitization of those pathways, she says.
"This could be a major factor in the opioid crisis," Arout says. "People have worsening pain, and so their dose is often increased because they are thought to be tolerant." But the result is that some patients may find themselves taking dangerously high doses while their pain continues to intensify.
So how common is opioid-induced hyperalgesia? "This is the million-dollar question," Stanford's Angst answers. "We just don't know."
Although the current research isn't definitive, Angst says opioid-induced hyperalgesia strikes him as a serious problem. Addressing it may require adopting a new perspective on pain.
Pain is a critical adaptation for survival, even in the era of modern medicine. "Think of pain in a different way, as a very useful thing to the body," he says. Pain in the abdomen can sometimes herald appendicitis, or some other dangerous infection. And chest pain is a cardinal symptom of heart attacks.
"When we overwhelm the system with large doses of opioids — does the system fight back?" Angst asks.
"We have to accept that there are limitations to any biological system, and if you exceed them, then bad things will happen," he says. "And one of those things may be opioid-induced hyperalgesia."