Many people with Fibromyalgia struggle to understand why their doctors will not prescribe strong painkillers despite them being in considerable pain. This attitude is noticeable in the EULAR Guidelines for the Management of Fibromyalgia, which says that strong opioids are not recommended, although tramadol, simple analgesics and weak opoids are. This attitude has little to do with doctors not believing in the pain of Fibromyalgia, although it can cause a lot of confusion. Opoids do not work efficiently with Fibromyalgia and the stronger they are, the worse the side effects get.

Researchers from the University of Michigan have published an article in the Journal of Neuroscience suggesting that this is due to changes in regions of the brain that process and dampen pain signals. PET scans were used to assess the differences in the amount of opioid receptors available in the brain between a group of fibromyalgia patients and a group of healthy individuals. The team found that not only did the fibromyalgia patients have less opioid receptors available, they had significantly less availability in four areas of the brain that are known to be involved with pain transmission and modulation.

Opioid medications need to bind to the opioid receptors in order to have an effect. With significantly reduced availability of these receptors in the areas of the brain involved with pain, the pain killing properties of opioids in people with fibromyalgia is much reduced.

As suggested by the EULAR guidelines, strong painkillers should not be a long-term treatment plan for fibromyalgia. Side effects of medications such as Fentanyl (a very strong painkiller often given in controlled release patch form for other chronic conditions with lots of pain) include suppression of breathing, changes in blood pressure, hallucinations, being “knocked out” by the med and potentially severe gastrointestinal problems. If the med isn’t going to work well and if there are other options, then your doctor is unlikely to want to risk the side effects, especially as many of them would worsen symptoms you already have. Proper treatment of other conditions, (separate or related to the fibromyalgia), use of medications that affect sleep and neurotransmitter levels and complementary techniques such as pacing and heat therapy should all be used to bring pain levels down instead of simply increasing the strength of pain medications.