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Opiates for Fibromyalgia & Chronic Fatigue Syndrome

What You Need to Know About Narcotics

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Updated June 27, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

People with fibromyalgia (FMS) and chronic fatigue syndrome (ME/CFS) can have dozens of symptoms, including pain, and it often takes a combination of several medications to make you feel substantially better. Because each medication carries its own risk, and those risks can increase when taken with other drugs, it pays to know your medications well.

Opiate drugs, also known as opioids or narcotics, are commonly prescribed for chronic pain. They work by mimicking a natural pain-reliving chemical, called an opioid peptide, that occurs in your body. Like their natural counterparts, opiate drugs bind to specific receptors in your brain and and spinal cord and activate pain the pain-relief system.

Several opiates have been on the market for a long time, are generally inexpensive, and are available in generic form. Common opiates include:

  • Hydrocodone
  • Codeine
  • Oxycodone
  • Fentanyl
  • Oxymorphone
  • Hydromorphone
  • Tramadol
  • Morphine

Additionally, some commonly prescribed opiates also include the drug acetaminophen, which is also in Tylenol and many other over-the-counter medications. They include:

  • Percocet (oxycodone/acetaminophen)
  • Ultracet (tramadol/acetaminophen)
  • Vicodin (hydrocodone/acetaminophen)

If you're taking a combination drug, you should make sure to learn the risks of both components. Learn more about acetaminophen.

The effectiveness of opiates for ME/CFS pain has not been rigorously tested. Doctors have long observed that opiates are generally less effective against FMS pain than other types of pain and current recommendations discourage them.

However, anecdotal evidence is mixed, with some people reporting that they work and others saying they don't. A survey of opiate use in FMS concluded that opiate use requires evaluation due to possible negative effects on health and psychosocial status.

Some researchers hypothesize that opiates are less effective in FMS because of abnormalities in the way the opioid receptors in our brains function.

It's also possible that, over time, opiates may heighten pain. Some research suggests that opioid medications may lead to an increased sensitivity of some types of pain.

Opiate Risks: Overdose, Addiction, Victimization

Opiates come with multiple risks – some medical, some not.

Overdose can be fatal. It's sometimes the result of people taking an extra dose because the first one didn't relieve their pain satisfactorily. The cognitive dysfunction (fibro fog) associated with FMS and ME/CFS may also make it hard for you to keep track of when you took medication and lead you to take more too soon.

Also contributing to overdose risk is drug tolerance. Many people who take opiates long term develop a tolerance, meaning the drug is not as effective for them as it once was. It's common for doctors to gradually increase the dosage. However, just because it takes more for you to feel the effect doesn't mean your body can actually handle more. It's important to always take opiates as directed.

Symptoms of opiate overdose include:

  • Dizziness and/or fainting
  • Nausea
  • Vomiting
  • Slow heart rate
  • Difficulty breathing
  • Cold, clammy skin
  • Convulsions

If you suspect you or someone else has overdosed on opiates, it's important to get emergency medical help right away.

Addiction is also a risk with opiates. This has gotten a lot of attention from law enforcement and media in recent years, which has made some doctors reluctant to prescribe opiates and makes some people worry about taking them.

However, some studies show that the risk of addiction is lower than commonly thought, and the greatest risk appears to be in people with a history of drug abuse and addiction.

To address doctors' fears over prescribing potentially addictive drugs, the American Pain Society in 2009 published this paper: Guideline for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain.

Because some people take opiates recreationally, they can be a target for thieves. The more people who are aware that you possess these drugs, the more you may be at risk for victimization.

Opiate Side Effects & Interactions

You can have side effects to opiates (or other drugs) even while taking them as directed. Some side effects are the same as overdose symptoms. Common opiate side effects include:

  • Nausea and/or vomiting
  • Drowsiness
  • Dry mouth
  • Dizziness upon standing (due to drops in blood pressure)
  • Problems urinating
  • Constipation

Side effects can vary by drug, so for lists specific to your medication, see About.com's Drugs A-Z.

Taking opiates with certain types of drugs can cause negative interactions, including death. Actor Heath Ledger's death was attributed to a mixture of opiates and sleep aids.

Drugs that can be dangerous when combined with opiates include:

  • Other pain medications
  • Sleep medications
  • Antihistamines (allergy medicine)
  • Muscle relaxants
  • Medications for depression, anxiety or other mental-health problems
  • Alcohol

Again, these may vary by drug, so you can check specific ones at Drugs A-Z. It's important for you to notify your doctor and pharmacist about all drugs you're taking, including over-the-counter drugs, so they can help you avoid dangerous interactions.

Reducing Your Risk

The best way to take these drugs safely is to follow the instructions to the letter and double check to make sure the things you combine are safe together. You may want to keep a list of medications in your phone or wallet so they're available to emergency personnel in case of an overdose.

It can also help to have a family member or friend help you monitor your medications, or to keep a log of the times you take them to help you avoid taking more too early.

Your doctor is an important resource for drug information, but also don't forget your pharmacist. It's in your best interest to ask about possible negative interactions any time you add something new to your treatment regimen.

Are Opiates Right for You?

Only you and your doctor can decide whether opiates are a good choice for you, based on your diagnoses, symptoms, overall health, and lifestyle factors.

If you don't feel that opiates are effective at relieving your pain, talk to your doctor about possible alternatives.

Sources:

American Pain Society and American Academy of Pain Medicine. Guideline for the Use of chronic Opioid Therapy in chronic Noncancer Pain: Evidence Review. Accessed March 2012.

Baraniuk JN, et al. BMC musculoskeletal disorders. 2004 Dec 9;5:48. Cerebrospinal fluid levels of opioid peptides in fibromyalgia and chronic low back pain.

Fitzcharles MA, et al. The American journal of medicine. 2011 Oct;124(10):955-60. Opioid use, misuse, and abuse in patients labeled as fibromyalgia.

Gracely RH, Ambrose KR. Best practice & research. Clinical rheumatology. 2011 Apr;25(2):271-84. Neuroimaging of fibromyalgia.

Ngian GS, Guymer EK, Littlejohn GO. International journal of rheumatic diseases. 2011 Feb;14(1):6-11. doi: 10.1111/j.1756-185X.2010.01567.x. The use of opioids in fibromyalgia.

"Pathogenesis of fibromyalgia." UpToDate. Accessed: March 2009. (Subscription required.)

Lee M, et al. Pain physician. 2011 Mar-Apr;14(2):145-61. A comprehensive review of opioid-induced hyperalgesia.

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