It's All Connected

I realized after some calming (done on my own, no one noticed how pissed off I was for days) that using opioids in treating fibromyalgia is typically not done, and as Dr. Sean Mackey says, "controversial," so could I really blame my GP for not prescribing it?

I thought a long time about what was best for my health, regardless of whatever the GP might think or do. There are some risks with using opioids that goes beyond just abuse and addiction. They can affect hormone levels, and cause a decrease in libido for men and women, and also they can cause hyperalgesia, which is when the opioids actually make the pain worse. Long term use, like years, can cause changes in features of the brain, drastic enough to be shown on an fMRI. Most people, doctors and the public alike, are so concerned about the addiction aspect that they haven't spend time and editorials calling out the other negative consequences that can happen when using opioids for chronic, noncancer pain (I find it interesting that within the doctor community, using opioids for cancer pain is given a green light, for reasons which I don't understand--is it because opioids work better for cancer pain or because people with cancer are likely to die off anyway, so who cares if they become addicted the last three months of their life?).

So, I wrote a letter to the GP, outlining why I was at low risk for becoming addicted, and also that I recognized the other risks involved in taking the medication. However, I implored him that one pill a day was not enough to manage my pain, and I outlined how pain affected my daily life. During our last visit, I read the letter outloud to him, and my GP upped my dose to two pills per day.

What's ironic about all this is that the Neurologist is against me taking opioids, the psychiatrists at Stanford are definitely against me taking opioids, and the doctor at UCLA didn't mention anything specfically about opioids but told me that medications in general didn't help very many people with fibromyalgia. There are some people in the medical community who hint that fibromyalgia might just be a psychiatric disease, but they said that about chronic fatigue syndrome (a related disorder), and then changed their minds. At the very least, fibromyalgia has psychiatric symptoms, including anxiety and depression and sleep disturbances. What everyone seems to agree on is that while people with fibromyalgia have a decrease in pain threshold, they do feel legitimate pain. They're not making it up for attention or for whatever deluded reasons might come to anyone's mind. We just feel physical pain more intensely, which for me solves the puzzle of why I experienced moderate-to-severe lower abdominal pain right before I started having severe lower back pain. It's all connected.