Is There a Role for Opioids in the Treatment of Fibromyalgia?

Abstract

The use of opioids for chronic pain has increased significantly due to a combination of the high patient burden of pain and the more widespread availability of a range of long-acting opioid preparations. This increased opioid use has translated into the care of many patients with fibromyalgia. The pain mechanism in fibromyalgia is complex but does not seem to involve disturbance of opioid analgesic functions. Hence, there is general concern about the harms in the absence of benefits of opioids in this setting. 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. Novel actions of low-dose opioid antagonists may lead to better understanding of the role of opioid function in fibromyalgia.

KEYWORDS:

• codeine
• fibromyalgia
• morphine
• naltrexone
• opioids
• oxycodone
• tapentadol
• tramadol

Financial & competing interests disclosure

E Guymer reports consultancy work, clinical trials or presentations involving Pfizer, Eli Lilly, Daiichi Sankyo and Pierre Fabre Medicament; G Littlejohn reports consultancy work, clinical trials or presentations involving Pfizer, Pierre Fabre Medicament, Eli Lilly, Daiichi Sankyo, Mundipharma and Seqirus. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Additional information

Funding

E Guymer reports consultancy work, clinical trials or presentations involving Pfizer, Eli Lilly, Daiichi Sankyo and Pierre Fabre Medicament; G Littlejohn reports consultancy work, clinical trials or presentations involving Pfizer, Pierre Fabre Medicament, Eli Lilly, Daiichi Sankyo, Mundipharma and Seqirus. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.