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Can Opioid Withdrawal/Abuse Be Misdiagnosed as Fibromyalgia?

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Fibromyalgia and Opioid Use

Although current literature does not clearly document the misdiagnosis of opioid withdrawal/abuse as fibromyalgia, it does address related issues. One example is the Fitzcharles et al. article “Opioid use, misuse, and abuse in patients labeled as fibromyalgia.” The article raises concerns about the long-term effects of the use of opioid therapy. The article also notes there is limited information about opioid treatment for patients suffering from fibromyalgia.
Fitzcharles et al. also noted that drug therapy is traditionally used for pain conditions, including fibromyalgia. Furthermore, there has been a large increase of opioid use in the last 20 years, with tragic consequences. The authors conclude there are significant concerns about the risk-benefit ratio of opioid therapy for the treatment of pain related conditions. The authors further note that for patients diagnosed with fibromyalgia and being treated with opioids, the observation is of a “negative health and psychosocial status.”
In another article related to fibromyalgia and opioid use, Cunningham et al. addressed the topic of  “Opioid tapering in fibromyalgia patients: Experience from an interdisciplinary pain rehabilitation program.” In this specific study, authors observe that while current recommendations are not in favor of the use of opioids in the treatment of fibromyalgia, there are nearly 30% of the patient population still using opioids for pain management .” Cunningham et al. also includes  methods for opioid tapering and observation of withdrawal symptoms for  patients being treated with opioids.
Cunningham et al. also observed that although patients on high doses of opioids had to endure a more extended taper, there was no difference relevant to the withdrawal symptoms Furthermore, the length of opioid use did not affect withdrawal symptoms or the time to complete the taper. The positive results of the study show that   “pain-related measures improved” despite the tapering of opioids.
Another article related to fibromyalgia and the use/abuse of opioids comes from Ballantyne who notes that fibromyalgia is a poorly understood condition that can be debilitating, and the most predominant symptom is muscle pain. Ballantyne notes that in one study patients suffering from the condition,  took small doses of naltrexone, a drug commonly used after detoxification to block cravings for opioid drugs.
Ballantyne states, “Naltrexone works by latching onto nerve cell receptors where heroin and other opioid drugs would dock, thus blocking their ability to act on the cells and induce a feeling of being high.” The findings show reduced feeling of  pain for those taking naltrexone versus placebo. A conclusion is that this medication may stimulate nerve cells and release pain-alleviating endorphins.
Another study by Johnson et al. in “Fibromyalgia, autism, and opioid addiction as natural and induced disorders of the endogenous opioid hormonal system” also addresses the same subject
In this specific study, authors observed individuals after opioid detoxification and  fibromyalgia patients. One of the findings show that “fibromyalgia patients have difficulty participating in human relationships, as if they lack an ability to respond interpersonally, as do post-detoxification patients.” The authors also observed a response of  improved pain tolerance in patients treated with low-dose naltrexone (LDN).
The conclusion of this study was that  “low opioid tone caused by opioid maintenance or fibromyalgia can usually be reversed with low-dose naltrexone.”
These articles give some insight on what appears in the literature and studies regarding opioid use and fibromyalgia. It also shows that we need more research to fully answer the question of “Can opioid withdrawal/abuse be misdiagnosed as fibromyalgia?” There are several available options of treatment to reduce the feeling of pain related to fibromyalgia, and decrease the risks of long term opioid therapy.
Fibromyalgia vector illustration

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