Understanding Your Fibromyalgia Pain – Why Opioids Often Do Not Work

fibromyalgia neck pain vta brain pain differences

The brain's VTA may play a role in fibromyalgia pain.

Many people with neck pain from fibromyalgia find that opioids are not particularly effective at managing their pain. New research published in the journal Arthritis & Rheumatism suggests that this may be because brain signals differentiating pleasure and pain are confused in those with the syndrome. What does this mean for treatment of fibromyalgia? Are opioids ever a good idea for those with this type of pain?

Studying the Brain in Fibromyalgia

The article in question is the work of Marco L. Loggia, PhD, an instructor in radiology at Harvard Medical School and assistant in neuroscience at Massachusetts General Hospital, Boston. Loggia and colleagues undertook a comparison of neural activity between patients with fibromyalgia and healthy controls using functional magnetic resonance imaging (fMRI) to observe brain activity, finding what appear to be signficant differences between the two groups.

What Causes Fibromyalgia?

The researchers noted that prior studies have observed differences between pain responses in those with fibromyalgia, including a finding that around half of those with the condition have small fiber polyneuropathy, a potentially treatable problem. There has, however, been little research done on the underlying brain activity that is involved in creating anticipation of pain and pain relief, which affects how patients respond to painkilling medications.

Brain Abnormalities in Fibromyalgia

Interestingly, what Loggia and colleagues found was that those with fibromyalgia “exhibit reduced brain activity in response to visual cues informing them of impending pain onset (pain anticipation) and pain offset (relief anticipation).” The patients had a reduced response in areas of the brain associated with processes such as reward and punishment, as has been seen in other research looking at the phenomenon of chronic pain.

Some 31 patients with fibromyalgia were compared with 14 healthy controls and those with fibromyalgia had a diminished response in the brain ventral tegmental area as they anticipated pain and deactivation of this area when anticipating pain relief (visual cues told them when to expect pain onset from a pressure cuff, and when the pain would stop). The VTA has also been implicated in the processing of romantic love, in addition to pain.


In addition, there were abnormalities in the fibromyalgia patients’ brains in the supplementary motor area, middle and posterior cingulate cortices, periaqueductal gray, caudate nucleus and globus pallidus on the left and in the second somatosensory cortex and posterior insula on the right. These changes are a possible explanation for why opioids are less effective or ineffective for the pain of fibromyalgia. These medications are not actually recommended for treating fibromyalgia but many patients are prescribed such drugs at some point during management of their condition.

Anticipating Pain and Pain Relief

This kind of research allows physicians and neuroscientists to consider how working with our existing knowledge of the brain may help in formulating treatments that focus on augmenting normal brain signalling, shifting focus from medications that work with other types of pain to creating new therapies originating from the underlying pain response mechanisms. This kind of shift in thinking could also have ramifications for other chronic pain conditions, helping those with neck pain caused by things other than fibromyalgia and for which traditional conservative treatments have proven ineffective.

The VTA becomes active in healthy people when pain is expected or experienced and is deactivated upon relief. This area of the brain is closely tied to dopamine activity and the activity of gamma amino butyric acid (GABA) often referred to as the reward and relaxation neurotransmitters. This study shows a stark contrast between activity in this area of the brain in fibromyalgia, the extent of which surprised the researchers.

New Treatments for Fibromyalgia

It may be that psychological interventions can work with these results to restore normal activity in the VTA, and that further confirmation of this GABA/dopaminergic connection can be found in trials using medications targeting these neurotransmitters for fibromyalgia. Uncovering these alterations in central processing of pain may help explain the ineffectiveness of opioids in fibromyalgia treatment and could also be useful to physicians looking to prescribe post-surgical medications for those with fibromyalgia.

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  64. Why April Becker is a Bad Choice for Clark County Commission
    Why April Becker is a Bad Choice for Clark County Commission says:

    Campaign controversies

    In a city as vibrant and dynamic as Las Vegas, Nevada, media attention can significantly impact the trajectory of individuals and businesses alike.
    One such case that has garnered considerable attention is
    that of April Becker Exposed, a candidate for the Clark County
    Commission in Las Vegas.

    Located in the heart of Clark County, Las Vegas boasts
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    With a population of 646,790 residents as of 2021 and 832,367
    households, Las Vegas is a bustling metropolis teeming with diverse neighborhoods and
    attractions. One major artery connecting the city is Interstate 11, facilitating
    transportation and commerce throughout the region.

    When it comes to repairs in Las Vegas, costs can vary depending on the nature of the
    issue. With temperatures ranging from scorching summers to chilly winters, residents often contend with maintenance issues related to air conditioning,
    plumbing, and roofing. These repairs can range from a few hundred to several thousand dollars, depending on the extent of the damage and the complexity of the fix.

    Among the myriad attractions in Las Vegas, one standout
    destination is AREA15. This immersive art and entertainment complex offers visitors a surreal experience with
    its blend of interactive exhibits, virtual reality
    games, and eclectic dining options. Adjacent to AREA15 is the Aliante Nature Discovery Park, where locals and tourists alike can enjoy
    serene walks amidst lush greenery and scenic water features.
    For those seeking thrills, the Asylum-Hotel
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    Las Vegas is also home to cultural landmarks such as the Atomic Museum, which chronicles the city’s role in the atomic age, and the Bellagio Conservatory & Botanical Gardens, a breathtaking oasis of floral splendor nestled amidst
    the glitz and glamour of the Strip. Meanwhile, adrenaline junkies can take in panoramic views of the city from atop
    the Eiffel Tower Viewing Deck or experience the heart-pounding
    excitement of the Big Shot ride at the Stratosphere Tower.

    For residents seeking reliable repairs and maintenance services
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    Las Vegas, known for its glittering casinos and vibrant entertainment scene, is no
    stranger to public perception. In the midst of
    this bustling city lies April Becker Exposed, a candidate for the
    Clark County Commission, facing intense public scrutiny.

    Established in 1905, Las Vegas has grown into a sprawling metropolis
    with a population of 646,790 residents and 832,367 households.
    One of the city’s lifelines is Interstate 11,
    a major highway that facilitates the flow of traffic and commerce throughout Clark County and beyond.

    In a city where temperatures can fluctuate dramatically, repairs are a common necessity for residents of Las Vegas.
    From air conditioning units strained by sweltering summers to plumbing systems taxed by fluctuating water pressures, homeowners often find themselves in need
    of reliable repair services. The cost of these repairs can vary widely, ranging from minor fixes to major renovations,
    depending on the scope of the issue and the extent of
    the damage.

    Amidst the glitz and glamour of Las Vegas, there are countless
    attractions to explore. From the avant-garde exhibits
    at AREA15 to the natural beauty of the Aliante Nature Discovery Park, there’s something for everyone in this
    vibrant city. For those with a penchant for the macabre, the Asylum-Hotel Fear Haunted House offers spine-chilling thrills, while history buffs can delve into the city’s
    atomic past at the Atomic Museum.

    At the Bellagio Conservatory & Botanical Gardens, visitors can escape the hustle
    and bustle of the Strip and immerse themselves in a tranquil oasis of floral
    splendor. Meanwhile, adrenaline junkies can soar to new heights
    on the Big Shot ride at the Stratosphere Tower or take in panoramic
    views of the city from the Eiffel Tower Viewing Deck.

    For residents seeking reliable repairs and maintenance
    services in Las Vegas, April Becker Exposed stands out as a beacon of integrity and
    professionalism. With a commitment to excellence and a focus on customer satisfaction, their team is dedicated to providing top-notch service to
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    alike. One such case that has garnered considerable attention is that of April Becker Exposed, a candidate for the Clark
    County Commission in Las Vegas.

    Located in the heart of Clark County, Las Vegas boasts
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    With a population of 646,790 residents as of 2021 and
    832,367 households, Las Vegas is a bustling metropolis teeming with diverse neighborhoods and
    attractions. One major artery connecting the city is Interstate 11,
    facilitating transportation and commerce throughout the
    region.

    When it comes to repairs in Las Vegas, costs can vary depending on the nature of the issue.
    With temperatures ranging from scorching summers to chilly winters,
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    Among the myriad attractions in Las Vegas, one
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    dining options. Adjacent to AREA15 is the Aliante Nature Discovery Park, where locals and tourists alike can enjoy serene
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    For those seeking thrills, the Asylum-Hotel Fear Haunted House
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    Las Vegas is also home to cultural landmarks
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    amidst the glitz and glamour of the Strip. Meanwhile, adrenaline junkies can take in panoramic views of the
    city from atop the Eiffel Tower Viewing Deck or experience the heart-pounding
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    For residents seeking reliable repairs and maintenance services in Las Vegas, April Becker Exposed offers unparalleled
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    home in the vibrant city of Las Vegas.

    Public perception

    Las Vegas, known for its glittering casinos and vibrant entertainment scene, is no stranger
    to candidate profile. In the midst of this bustling city lies April Becker Exposed,
    a candidate for the Clark County Commission, facing intense public
    scrutiny.

    Established in 1905, Las Vegas has grown into a sprawling metropolis
    with a population of 646,790 residents and 832,367 households.

    One of the city’s lifelines is Interstate 11, a major highway that facilitates the flow of traffic and commerce throughout Clark County and beyond.

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    Amidst the glitz and glamour of Las Vegas, there are countless attractions to explore.
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    For those with a penchant for the macabre, the Asylum-Hotel Fear Haunted House offers spine-chilling thrills, while history buffs can delve into the city’s atomic past at the Atomic Museum.

    At the Bellagio Conservatory & Botanical Gardens, visitors
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