Opioids Recommended for Fibromyalgia With PTSD

Nighttime Opioid Combination to Treat Fibromyalgia With PTSDBrandon May – September 07, 2017

Patients with PTSD may present with underlying and undiagnosed fibromyalgia, which contributes to poor sleep and further pain amplification.

Persisting fibromyalgia can intensify associated fibrocytic symptoms resulting in worsening of the underlying primary condition, even if that primary condition is not pain associated”

Dr Figueroa recommends a nighttime administration of 50 mg tramadol and 4 to 8 mg tizanidine at 7 pm for patients with fibromyalgia and PTSD.

What? He’s recommending not only an opioid but also a muscle relaxant – together! 

Tramadol, sold under the brand name Ultram among others,[2] is an opioid pain medication used to treat moderate to moderately severe pain.
Tizanidine (trade names Zanaflex (Acorda Therapeutics), Sirdalud (Novartis), Relentus(Beximco Pharma) Is a centrally acting α2adrenergic agonist used as a muscle relaxant.

But if any other pain patient without both PTSD and fibromyalgia takes this drug combination for painful spasms it’s considered “opioid misuse”.

The addition of duloxetine, milnacipran, or pregabalin, if used, should be maintained if there is a clinical benefit.

He also recommends the addition of 50 mg tapentadol for 2 nights in patients with PTSD to observe potential benefit.

Tapentadol (brand names: Nucynta, Palexiaand Tapal) is a centrally acting opioid analgesic of the benzenoid class with a dual mode of action as an agonist of the μ-opioid receptor and as a norepinephrine reuptake inhibitor (NRI).[1] Analgesia occurs within 32 minutes of oral administration, and lasts for 4–6 hours

Treatment effectiveness, according to Dr Figueroa, is reached when patients achieve no less than 6 hours of uninterrupted, restorative sleep each night.

In >40 women with PTSD treated within the last 5 years, the majority of which had been exposed to domestic violence, Dr Figueroa’s treatment resulted in a return to “normalcy” in the lives of the patients and an increase in sleep duration.

It’s no surprise that when he treats fibromyalgia patients with opioids he finds that they return to “normalcy”. This is true for many of us pain patients.

He never checks if the same would be true if these patients didn’t also suffer from PTSD (though having your pain doctor suddenly stop prescribing your pain medication can definitely induce PTSD).

This implies that if patients only have fibromyalgia without coexisting PTSD, then their “fibromyalgia-related symptoms” should not be treated with the opioids this doctor is recommending.

In addition, the rates of

  • fatigue
  • tender point pain,
  • stiffness, and
  • headache

were reduced in this population.

  • Goal accomplishment,
  • employment maintenance, and
  • higher-quality personal relationships

were also observed among the patient cohort.

In patients in which treatment failed to alleviate fibromyalgia-related symptoms [i.e. pain was not relieved], no improvements in PTSD were observed.

“Fibromyalgia can be intermittently and variably present with the primary clinical entity and can together be looked upon as a singular pathological entity,” concluded Dr Figueroa.

“Fibromyalgia can be intermittently and variably present with the primary clinical entity and can together be looked upon as a singular pathological entity,” concluded Dr Figueroa.

These “fibromyalgia plus PTSD” patients are encouraged to return to the “normalcy” achieved by using opioids, while other fibromyalgia patients are not allowed to relieve their equal “Fibromyalgia related symptoms” with the same medications.

It seems that “Fibromyalgia related symptoms” in this study is clearly a euphemism for “pain”. In this way, the researchers can avoid admitting that opioids are being used to alleviate chronic pain, which is no longer “justified” in our medical system.

Instead, their study focuses only the use of opioids to alleviate “fibromyalgia-related-symptoms”. Since the vast majority of these symptoms can be traced back to the incessant pain it causes, this phrase is essentially a code-word for pain.

What they found says that if the “symptoms”(pains) of Fibromyalgia are not alleviated by these medications(opioids), then there’s no improvement in either the fibromyalgia or the PSTD.

That doesn’t surprise me.

Pain is the ultimate physical alarm and, when it’s unrelenting as part of “fibromyalgia related symptoms” or other chronic pain, it will naturally make people prone to symptoms of PTSD.


Figueroa J. Pain, Opioid therapy, Fibromyalgia and PTSD (Post Traumatic Stress Disorder) – A Singular Disease Entity – A Fundamental Concept in Disease Treatment. Presented at: PainWeek 2017; September 5-9, 2017; Las Vegas, NV. Poster 39
Häuser W, Galek A, Erbslöh-Möller B, et al. Posttraumatic stress disorder in fibromyalgia syndrome: prevalence, temporal relationship between posttraumatic stress and fibromyalgia symptoms, and impact on clinical outcome. Pain. 2013;154(8):1216-1223.

Original article: Nighttime Opioid Combination to Treat Fibromyalgia With PTSD


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