Opiates and fibromyalgia- a treatment for severe pain but the brain works against us

It is like barbed wire is embedded in my flesh, ripping and grinding against my nerves.

Now no one in chronic pain wants to get to a point where they need painkillers to function. It isn’t an ideal choice or a pleasant one or one very acceptable by doctors even if it is clear you need it. When it comes to chronic migraines some people use opiates as a rescue medication for when their triptan fails or when they have maxed out triptan use, but opiates have the risk of rebound headaches so it isn’t something you would even want to take often. Yet it is an option some end up having because triptans do not work for them or have adverse effects and they are unable to take anti-inflammatories… whatever the reason, they end up on this option because they must even if it is by far the least favored by doctors.

What about for fibromyalgia? Is it being taken for something similar like a rescue med… for when the pain is bad and not for pain treatment altogether? If so, if it is monitored is this such an issue? I don’t take painkillers for FM so I’m not certain what it is being prescribed for but I can imagine it is like a rescue medication for migraines where you would not be using it all the time or even be having heavy duty opiates. I believe the one recommended by the Canadian Guidelines is Tramadol because it is more effective on pain.

But it depends on pain-levels doesn’t it as to when it is needed? Unfortunately, like with opiates causing rebound headaches in migraines, there are specific issues to opiates and FM. I don’t care about all the other reasons. I think all the other reasons are bull. If someone is in pain and other medications do not work then how the hell do you expect them to function and exercise and work if they have no way to manage that pain when it is severe?

And the Canadian Guidelines state that if a case requires its use then it is acceptable when monitored and I agree. Yet it is clear our brains are not wired the same way and opiates have less of an effect on us… I do remember that when I was on Percocet for a short-term when I had no migraine preventative (still don’t have an effective one but this particular doctor put me on them short- term while I was looking for a new job, since apparently shift work was not a good idea). Anyway, they worked fine for part of the day I needed to get through and it was the best painkiller I have ever been on because, yeah, it did help with FM pain as well, which I rather enjoyed, to be honest. But I didn’t think they were that strong and a co-worker was astonished I wasn’t knocked out by them and down for the count or groggy or hazy and whatnot.

I assumed when you were in a lot of pain you simply didn’t get any loopy side effects but I think they just don’t hit us that hard. I have been on tramacet and a slow release tramadol for rescue meds as well and they work fine as well, the slow release tramadol I prefer because it lasted longer for the migraine pain and worked better really, so you didn’t get this acute pain-dulled pain-acute pain sharp distinction in a short time frame, but honestly for migraines painkillers just sort of dull the pain when you are taking them for acute pain… sort of a crappy alternative but necessary to get you through work if you can’t take a triptan. I honestly don’t know how well they would work on an FM flare up but I suspect the tramacet would be insufficient given it was hardly sufficient for migraines.

Anyway, because I don’t need them to manage FM although it sure would be nice for flare-ups or when the pain is severe and I can’t sleep because of it… I am wary of using them just like with migraines. You use them if you happen to be granted them to manage severe pain but hesitate to do so because of how the brain is already mis-wired. Although to be honest way warier because of migraines and rebounding. But I don’t like the idea of my pain getting worse over time because of treatment choices. Although with chronic migraines… not much of a life if you can only use triptan three times a week and those don’t always work. Likewise for some people not much a life being crippled by FM pain. Pain management has to be considered as does the quality of life. Some of us like to live not just survive.

Opioid-induced hyperalgesia manifests as reduced nociceptive threshold and is primarily thought to be the result of central sensitization of pronociceptive pathways.[7] Opioid-induced hyperalgesia presents as heightened atypical pain sensations distinct from the original pain stimulus, with a separate location and altered distribution from the original complaint.[52] Opioid-induced hyperalgesia can be recognized clinically as persistent or increasing pain with increasing dose, pain worse on opioids than before, decreasing duration of analgesic effect, and pain becoming increasingly diffuse or poorly localized with ongoing opioid use. Both tolerance and opioid-induced hyperalgesia are concerns with any chronic pain condition; however, because of the pathophysiologic characteristics seen in FM, the use of opioids chronically in these patients deserves extra scrutiny. FM is a syndrome of central pain amplification that could be facilitated or augmented by opioid effects. Specifically, opioids are known to affect the activation state of spinal glia that supports a state of activation of pain transmission neurons.[12] There is reason to suspect that this property of opioids is particularly detrimental to FM and related disorders characterized by chronic neuronal activation.
Patients with FM may also have altered endogenous opioid activity that further complicates the evaluation of the utility of these drugs. A study utilizing positron emission tomography found that patients with FM exhibit decreased μ-opioid receptor availability in areas of the brain key to pain and nociception processing.[53] There are 2 possible explanations for the demonstrated reduced availability. First, endogenous enkephalin levels are elevated in patients with FM, even when compared with patients with chronic low-back pain.[54] Elevated endogenous ligands in these patients may explain the reduced availability of receptors to opioids, decreasing their effectiveness in FM patients. Another possible explanation is that the increased presence of endogenous ligands may lead to down-regulation of opioid receptors. Concerns Regarding Opioid Use in FM

see also Research may explain why common painkillers often don’t work on patients with fibromyalgia.htm


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