To the Editor:
Fitzcharles and Shir1 emphasize the “negative effects of opioids in chronic pain conditions.” Kim, et al2 attribute detrimental effects of opioids to compromise of adherence to therapeutic regimens, but Fitzcharles and Shir1 suggest an important role for other factors, including substance or psychoactive drug use, and disease duration and severity as compromising therapeutic responsiveness. Kim, et al2 suggest that opioids compromise motivation (suggesting a relationship to cannabinoid induction of “amotivational” disorders) and enhance fatigue. These may certainly be factors in the final common pathway of opioid interference and physiologic compromise, but a simpler primary factor may be even more significant in patients with fibromyalgia (FM).
If loss of motivation is also a manifestation of the mental “dulling” characteristic of opioid usage, perhaps there is another operative factor. One of the major characteristics of FM is sleep compromise3,4,5,6. Indeed, restoring stage IV/ rapid eye movement sleep appears to mollify that disorder6,7,8. Because opioids interfere with reaching those sleep states3,9,10, is it any surprise that they are not only ineffective in treating FM, but that they actually compromise the benefit of any other interventions?
