Chronic Opioid Analgesic Therapy (COAT)

Opioids have been used to treat pain symptoms for decades. They are also occasionally used to treat cases of severe cough or diarrhea. Some opioids come from natural sources- specifically, the opium poppy plant that grows in Asia. Other opioids are manufactured with chemicals that mimic the effects of the opium poppy plant. For many fibromyalgia sufferes, opioids are helpful means of chronic pain relief. In particular, many fibromyalgia sufferers look to chronic opioid analgesic therapy to help treat their pain.

What is Chronic Opioid Analgesic Therapy?

Chronic opioid analgesic therapy, or COAT, is a treatment technique that uses opioids to reduce symptoms of chronic pain. Opioids belong to a class of drug that is usually used to reduce pain symptoms in cancer or post-operative patients. However, recent research has shown that opioids are also highly effective at reducing chronic pain symptoms in sufferers of long-term illnesses. Referred to as chronic opioid analgesic therapy, this treatment has proven to be very successful in fibromyalgia sufferers. However, it is available by prescription only.

How do Opioids Work?

Opioids work to relieve pain by blocking messages that your body sends to your brain. When your body senses pain, special pain messages are sent by your nerve cells to certain receptors in the body. Opioids attach to opioid receptors in the brain, gastrointestinal tract, and spinal cord, which are responsible for receiving some of these pain messages. Here, opioids block the opioid receptors from picking up the pain messages, thereby reducing your pain sensations.

How do COATs Help People with Fibromyalgia?

Opioids have been used successfully to treat chronic fibromyalgia pain. Those sufferers who experience moderate to severe muscle pain have reported relief in their pain symptoms after using opioid drugs. They also report a reduction in the number of pain flare-ups. Fibromyalgia sufferers also report an increase in their ability to function after using opioids. However, opioids are not a long-term solution to the chronic muscle pain of fibromyalgia. Because they often cause addiction, opioids are only recommended for short-term use.

Types of Opioids

There are a variety of types of opioids, categorized according to which types of receptors in the brain they attach to, and how they work there. There are three categories of opioids:

Full Agonists

Full agonist opioids do not have a ceiling; that means that they will continue increasing in efficacy over time and work fully on the receptors in your brain. Also, full agonists will not interfere with the effects of other opioids you may be taking. Types of full agonist opiates include morphine, codeine, oxycodone, methadone, and fentanyl.

Partial Agonists

Partial agonist opioids will eventually reach a ceiling and stop being effective. Unlike the full agonists, they are not as efficient at blocking pain messages at brain receptors. A common partial agonist is buprenorphine.

Mixed Agonists-Antagonists

Mixed agonists-antagonists are opioids that will also reach an eventual ceiling to their efficacy. They only work on one receptor site in your brain, called the "mu" receptor. They should never be combined with a full agonist. Mixed agonists-antagonists include pentazocine and dezocine.

Side Effects of Opioids

Though opioids work efficiently to reduce pain, they often cause unwanted side effects, especially when used in large doses or for extended periods of time. Possible side effects include:

  • drowsiness
  • nausea
  • vomiting
  • loss of appetite
  • blurry vision or constricted pupils
  • sweating
  • constipation
  • euphoria

The Debate about Opioid Use

Opioids have been used successfully to relieve pain in all sorts of patients, including cancer patients, accident victims, and chronic pain sufferers. However, the use of opioids as a treatment for pain has come under intense scrutiny for a number of reasons.


Opioid use is often frowned upon as it can sometimes lead to dependency and addiction. Because of the euphoria that opioid drugs can produce, some patients begin taking opioids for reasons other than the reduction of pain. This can lead to severe side effects, including long-term dependency on the drug. Opioids should never be used for anything other than a prescribed purpose. Drug dosages should never be increased except by a certified health professional.


Opioid use has also been debated because of the withdrawal symptoms that they often cause. Even patients that are not addicted to an opioid will likely experience disturbing withdrawal symptoms when they stop taking the drug. To avoid serious withdrawal symptoms, opioid use should always be tapered off gradually.

Symptoms of opioid withdrawal include:

  • yawning
  • diarrhea
  • goosebumps
  • runny nose
  • drug cravings
  • anxiety
  • insomnia

Most withdrawal symptoms should disappear within a week. However, symptoms of anxiety, insomnia, and craving may persist for a longer period of time. For those who have trouble withdrawing, understand that inpatient opioid treatment can be private.


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