Narcotic

<p>From: Reviving the Broken Marionette: Treatments for CFS/ME and Fibromyalgia</p>

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Many people with CFS/ME and virtually everyone with fibromyalgia suffer from constant pain. For some of them the pain can be at a constant 10/10 level. Some do benefit from NSAIDs, acetaminophen (paracetamol) and other medications with analgesic properties, but for many these drugs do not provide enough relief. Opioids are also a safer alternative to NSAIDs in chronic use, as they do not cause ulcers, renal problems or increased cardiovascular mortality. Opioids can also help restless legs syndrome.

There are many different kinds of opioids with different receptor profiles and different half–lives. Some also have other modes of action not mediated through the opioid receptors. As with NSAIDs, some opioids work better for some patients, producing better analgesia and/or fewer side effects. Often two different opioid formulations are combined: a long–lasting product for maintenance and a short–lasting one for breakthrough pain. Sometimes different opioid painkillers are rotated, as that may afford the use of lower doses.

There are many unjustified prejudices associated with opioid treatment. There is no reason to categorically avoid them, as they are safe and effective. The risk of addiction when using opioids in the treatment of chronic pain has been shown to be extremely low, especially when therapy is based on long–acting drugs.23 Appropriate treatment of pain significantly improves quality of life and often reduces other symptoms (such as fatigue, depression and sleep disturbances) as well.

Side effects are more likely to pose problems than addiction or tolerance. Opioids can cause neuropsychiatric symptoms, itching, constipation and nausea. Often the nausea gets better after the first days of use, but on the other hand some people only begin to experience nausea after opioids have been used for a long time. Opioids have traditionally been associated with fatigue, but for some people they are activating. According to Dr. Jay Goldstein this happens particularly often in people with fibromyalgia.24

Constipation can be a serious problem, especially if the patient is bedbound (and often also dehydrated). Another medication or other strategies may be needed to alleviate this symptom. On the other hand some people with CFS/ME suffer from chronic diarrhea. Opioids can also cause urinary retention, which can be either beneficial or problematic depending on the patient.

Other central nervous system depressants increase the sedative effects of opioids. In some cases combinations with benzodiazepines or barbiturates have even led to death. Opioids should not be combined with MAO inhibitors or beta blockers. Strong opioids should not be prescribed to patients with severe asthma or another serious pulmonary illness. Opioids also decrease bone density25,26 and cause hormonal deficiencies in long–term use.27 Unlike NSAIDs, however, they are extremely unlikely to cause life–threatening side effects.</p>