Dealing with Chronic Pain

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Fibromyalgia affects between 4 and 10 million and 60 million people suffer from > 3months of pain

Opioid, Cannabis, and Alcohol Use Is Particularly Risky Self-Medication in Pain

This Is Especially True in FM's nociplastic pain- brain pathways involved in FM are also involved in addiction

Fibromyalgia and chronic pain create a "fertile breeding ground" for self-medication and iatrogenic addiction. . Fibromyalgia involves abnormal pain processing; the brain struggles to turn off pain signals. Many brain pathways involved in fibromyalgia are also involved in addiction.

Addiction occurs through a cycle of central sensitization, inadequate relief, and the psychological burden of the condition. People with fibromyalgia (FM), like people with substance use disorders (SUDs), report suffering stigma during healthcare consultations, including feeling invalidated, discouraged, and judged by clinicians. Is FM a valid diagnosis? And do some with FM develop SUDs? Yes to both.

Approximately 3 to 6 % of people in the U.S. suffer fromfibromyalgia, many more women than men. Systematic reviews indicate that most physicians (≈ 84%) believe that FM is a clinical condition, not dismissing it entirely. But most find FM difficult to diagnose or treat, struggling to differentiate it from other conditions with overlapping symptoms. Physician uncertainty and diagnostic discomfort may confirm patient perceptions of being misunderstood.

Fibromyalgia is not malingering or hypochondriasis, and it is characterized by widespread musculoskeletal pain, nonrestorative sleep, debilitating fatigue, and cognitive dysfunction. Looking at the broader picture, chronic pain and substance use disorders co-occur frequently; about 40% of individuals experiencing chronic pain meet the criteria for SUDs.

When medications yield partial or inconsistent relief, FM patients may use self-medication strategies, such as alcohol or cannabis. Unfortunately, FM pain is daily and classified as nociplastic pain, a chronic pain arising from altered CNS function rather than tissue damage or inflammation. Unlike the pain of an injury or arthritis, FM pain is a whole-body, often unrelenting condition that increases the risks for SUDs.

Roland Staud, M.D., professor of medicine at the University of Florida, and colleagues have demonstrated that FM patients have (increased sensitivity to pain (hyperalgesia), yet modulate pain input as effectively as healthy controls, suggesting amplified pain in the central nervous system. It’s somewhat comparable to a “systems overload” situation. But unlike your laptop or phone running amok, you can't turn it off and then back on to reset it; you can’t turn the body off.

Recent functional MRI work demonstrated a persistent altered neural state in FM, heightened activity in anxiety and autonomic-related circuits, increased eye pupil size, and augmented pain sensitivity.

FM is also a diagnosis of exclusion. There are no confirmatory laboratory/imaging tests. Laboratory testing (complete blood count, erythrocyte sedimentation rate, C-reactive protein, thyroid function) with normal results excludes inflammatory, autoimmune, or endocrine disorders, but doesn’t define the underlying diagnosis when it’s FM.

The current American College of Rheumatology (ACR) criteria for FM diagnosis require the presence of chronic widespread pain for at least three months and assessment of patient symptom burden using the Widespread Pain Index (WPI) and Symptom Severity Scale (SSS). These instruments quantify pain........

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