Are Opiates Right for Fibromyalgia?

Why Opiates Don't Work for Fibromyalgia

Fibromyalgia involves central sensitization—your nervous system amplifies pain signals and processes pain abnormally. It's not inflammation or tissue damage causing your pain. It's a problem with how your brain and spinal cord process pain information.

Opiates work well for nociceptive pain—pain from actual tissue damage. They're less effective for neuropathic pain—pain from nerve dysfunction. Fibromyalgia falls into the category of centralized pain, where the pain processing system itself is malfunctioning.

The Evidence Against Opiates for Fibromyalgia

Multiple studies have failed to show that opiates provide significant benefit for fibromyalgia. In fact, some research suggests they might make symptoms worse. Opiates can increase pain sensitivity over time through a process called opioid-induced hyperalgesia—your pain system becomes even more reactive.

Additionally, opiates don't address the other core symptoms of fibromyalgia like fatigue, cognitive dysfunction, and sleep problems. They may actually worsen sleep quality and contribute to the fog and fatigue many patients experience.

What Medical Guidelines Say

Three major medical organizations—the American Pain Society, the European League Against Rheumatism, and the Canadian Pain Society—specifically recommend against using opiates for fibromyalgia. This consensus is based on the lack of evidence for benefit and the known risks.

The 2016 CDC guidelines on opioid prescribing also caution against opioid use for conditions like fibromyalgia where effectiveness is not well-established and where other treatments are available.