Are Opiates Right for Fibromyalgia?

FDA-Approved Alternatives

While opiates aren't recommended, there are three FDA-approved medications specifically for fibromyalgia that actually target the underlying pain processing dysfunction:

Pregabalin (Lyrica)

Approved in 2007, pregabalin works by reducing the overactivity of nerve cells. It's been shown in clinical trials to reduce fibromyalgia pain, improve sleep, and reduce fatigue. Common side effects include dizziness, drowsiness, and weight gain.

Duloxetine (Cymbalta)

This medication, approved for fibromyalgia in 2008, is a serotonin-norepinephrine reuptake inhibitor (SNRI). It works on neurotransmitters involved in both pain and mood regulation. It can help with pain, mood, and overall function.

Milnacipran (Savella)

Another SNRI approved in 2009, milnacipran works similarly to duloxetine but with a different balance of effects on serotonin and norepinephrine. Some patients respond better to one SNRI than the other.

Non-Medication Approaches

Beyond FDA-approved medications, several non-drug treatments have evidence supporting their use for fibromyalgia:

Exercise, particularly low-impact aerobic activity and strength training, has strong evidence for reducing fibromyalgia symptoms. Start slow and increase gradually to avoid flares.

Cognitive behavioral therapy helps patients develop coping strategies and can reduce pain and improve function. It addresses the psychological impact of chronic pain without suggesting the pain is "all in your head."

Sleep management is crucial since poor sleep worsens all fibromyalgia symptoms. Good sleep hygiene and sometimes sleep medications can help.