Opioids have long been part of the chronic pain conversation. But when the pain comes from fibromyalgia, the answer is far from simple. New real-world data presented by Tonix Pharmaceuticals at the 2026 American Society of Clinical Psychopharmacology Annual Meeting are putting that issue back in the spotlight. The analysis looked at opioid prescribing among more than 261,000 U.S. adults diagnosed with fibromyalgia.
The findings reveal something important: opioid prescribing remains common among people with fibromyalgia, even though major clinical guidance does not recommend opioids as routine treatment for this condition.
So, what does the new data actually show? And does it change the question of the best opioid for fibromyalgia?
Let’s take a closer look.
What Did Tonix’s New Analysis Find?
Tonix presented a retrospective analysis using Symphony Health’s closed claims database. Researchers examined medical and pharmacy claims collected between April 2021 and April 2024, with the latest study year covering April 2023 through March 2024.
The Year 3 cohort included 261,776 adults with fibromyalgia. The average age was 52.3 years, and 92.1% of the group was female.
Among patients with commercial or Medicare Advantage insurance, 40.2% received at least one opioid prescription during the period studied.
Among Medicaid patients, the figure was 38.8%.
The most common opioids differed slightly between the groups. Commercial and Medicare Advantage claims most often involved tramadol, followed by oxycodone. Medicaid claims most often involved oxycodone, followed by tramadol.
These numbers do not prove that the medications were prescribed specifically for fibromyalgia. Claims data can show that a patient received a medication after a diagnosis, but they cannot always establish the exact reason for the prescription.
That distinction matters.
Why Are Opioids Still Used in Fibromyalgia?
Fibromyalgia can cause widespread, persistent pain. It can also bring fatigue, sleep problems, stiffness, and cognitive symptoms.
When pain continues for months or years, patients and clinicians may try several treatments.
Some people have already tried multiple medications before opioids enter the conversation.
This creates a difficult situation. Patients want relief. Clinicians want to reduce suffering. Yet opioids carry serious risks when used over the long term.
The new Tonix data highlights this treatment gap. The company says the findings demonstrate substantial and persistent opioid use among adults with fibromyalgia.
Is There a Best Opioid for Fibromyalgia?
The short answer is no single opioid is considered the best opioid for fibromyalgia.
In fact, current guidance takes a different approach.
The CDC recommends nonopioid therapies for subacute and chronic pain and specifically states that, for fibromyalgia, the expected benefits of starting opioids are unlikely to outweigh their risks.
That does not mean every person taking an opioid should suddenly stop.
Stopping an opioid abruptly can cause withdrawal and other problems. Anyone currently taking one should discuss changes with their prescribing clinician.
The bigger point is that opioids are not considered a routine first-line treatment for fibromyalgia.
Fibromyalgia and Opioid Treatment: Why the Evidence Is Complicated
The relationship between fibromyalgia and opioid treatment has been debated for years.
Fibromyalgia is not simply an injured muscle or damaged joint. It involves altered processing of pain signals within the nervous system.
That difference matters.
Opioids primarily act on opioid receptors and can reduce certain types of pain. But fibromyalgia involves a broader pain-processing problem.
Over time, some patients may also develop increased sensitivity to pain while using opioids. This phenomenon is known as opioid-induced hyperalgesia.
The American College of Rheumatology notes that opioid use can potentially make chronic pain worse through opioid-induced hyperalgesia, while also highlighting risks such as overdose and death.
Differential Opioid Hyperalgesia vs Fibromyalgia
It can be difficult to separate differential opioid hyperalgesia vs fibromyalgia when someone has persistent pain.
Fibromyalgia can cause widespread pain and sensitivity without tissue damage explaining the intensity of symptoms.
Opioid-induced hyperalgesia, meanwhile, refers to increased sensitivity to pain associated with opioid exposure.
The two can look similar.
That is why a person whose pain continues or worsens while taking opioid medication needs a careful clinical review rather than simply assuming that they need a stronger dose.
A clinician may consider the original diagnosis, medication history, dose, duration, new symptoms, and overall function.
What About Opioid Pain Meds for Fibromyalgia?
People searching for fibromyalgia opioid pain meds may find lists of medications such as tramadol, oxycodone, or hydrocodone.
But a medication appearing in prescribing data does not mean it is recommended as a standard fibromyalgia treatment.
The latest Tonix analysis found substantial use of opioids, but the study was observational. It describes real-world prescribing patterns rather than proving that opioids improved fibromyalgia symptoms.
This is an important difference between what happens in clinical practice and what guidelines recommend.
What Are the Risks of Long-Term Opioid Use?
Opioids can cause side effects and serious complications.
Potential risks include:
- Physical dependence
- Opioid use disorder
- Overdose
- Constipation
- Drowsiness
- Dizziness
- Falls
- Drug interactions
The CDC notes that evidence for long-term opioid benefits in chronic pain is limited, while serious risks increase with continued exposure.
The risk can become even more concerning when opioids are combined with other medications that depress the central nervous system.
Tonix’s analysis also found substantial concurrent opioid and benzodiazepine use. Among commercial or Medicare Advantage patients, 19.1% had both; the figure was 20.4% among Medicaid patients.
That does not mean every combination is inappropriate. It does show why medication reviews matter.
What About Fibromyalgia Opioid Medication Already in Use?
If someone is already taking fibromyalgia opioid medication, the next step should not be an abrupt change.
Instead, the patient and clinician can review three questions:
Is the medication actually improving function?
Pain reduction matters, but so does the ability to sleep, work, move, and participate in daily activities.
Are the benefits lasting?
A medication that once helped may provide less benefit over time.
Do the risks still make sense?
The answer can change as health conditions, medications, age, and dosage change.
The CDC recommends regular reassessment of benefits and risks for people receiving ongoing opioid therapy.
Fibromyalgia Treatment: Non-Opioid Options
The good news is that opioids are not the only option.
A fibromyalgia treatment non opioid approach can combine several strategies.
Depending on the person, options may include:
- Regular, appropriately paced physical activity
- Cognitive behavioral therapy
- Sleep-focused strategies
- Mindfulness or relaxation techniques
- Certain antidepressants
- Pregabalin or gabapentin
- Other individualized therapies
The CDC specifically lists exercise and several nonopioid medications among approaches used for fibromyalgia.
Treatment works best when it targets more than pain alone.
Sleep, fatigue, mood, physical function, and cognitive symptoms can all affect quality of life.
Opioid Alternatives for Fibromyalgia
The growing interest in opioid alternatives for fibromyalgia reflects a broader shift toward multimodal pain management.
Rather than relying on one powerful medication, clinicians may combine different tools.
For example, someone might work on sleep while gradually increasing physical activity and using a medication that targets pain processing.
There is no universal formula.
The right combination depends on symptoms, medical history, other medications, and individual goals.
What Does Tonix Say About Non-Opioid Treatment?
Tonix presented the opioid-use findings alongside its focus on TONMYA, a sublingual formulation of cyclobenzaprine.
The FDA approved TONMYA in August 2025 for adults with fibromyalgia, and Tonix says it launched commercially in November 2025.
The company describes TONMYA as a non-opioid treatment designed for bedtime use.
It is important to separate company claims from independent clinical guidance. Tonix is the sponsor of the product and the claims analysis discussed here.
For patients, the practical question remains the same: which treatment offers a reasonable balance of benefit, safety, tolerability, and long-term usefulness?
Could Fibromyalgia and Opioid Abuse Be Connected?
The phrase fibromyalgia and opioid abuse can sound alarming, but it is important not to label patients simply because they receive opioid medication.
Physical dependence, tolerance, and opioid use disorder are different concepts.
A person can take an opioid exactly as prescribed and still develop physical dependence.
Opioid use disorder is a medical condition involving problematic opioid use and specific symptoms.
The answer is not to shame patients. It is to provide appropriate monitoring, clear communication, and access to safer pain-management strategies when possible.
What About Intrathecal Opioids?
You may also encounter the term fibromyalgia intrathecal opioid when researching advanced pain treatments.
Intrathecal therapy delivers medication into the fluid surrounding the spinal cord. It is used for selected severe pain conditions.
However, fibromyalgia is not typically treated with intrathecal opioids. The condition involves widespread pain processing rather than a single damaged area that can simply be targeted with local drug delivery.
This is another reason why treatment should begin with an accurate diagnosis and an understanding of the underlying pain mechanism.
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What Does This Mean for Patients?
The new Tonix analysis does not establish that opioids work for fibromyalgia.
Instead, it highlights how often they are still prescribed in real-world practice.
That distinction is crucial.
The data may encourage more discussion about whether patients have access to effective nonopioid treatments and whether clinicians have enough options to manage complex chronic pain.
It also reinforces the importance of individualized care.
If you are already taking opioids, do not stop them suddenly without medical advice. Talk with your healthcare professional about your current dose, benefits, side effects, and long-term plan.
If you are exploring other approaches, you can also read our guide on whether fibromyalgia is an autoimmune disease.
Final Word
The question of the best opioid for fibromyalgia may actually point toward a more important question: Do opioids offer enough benefit for this type of pain to justify their risks? Tonix’s 2026 real-world analysis shows that opioid prescribing remains common among U.S. adults with fibromyalgia. More than 261,000 patients were included in the latest cohort, and roughly four in ten insured patients in the reported groups received at least one opioid prescription. Yet current CDC guidance does not recommend opioids as routine treatment for fibromyalgia. The future of fibromyalgia care may therefore depend less on finding a stronger opioid and more on expanding effective, personalized, nonopioid options.
For patients, the goal should not simply be fewer pain points on a chart. It should be better function, better sleep, safer treatment, and a better quality of life.
Frequently Asked Questions
1. What did Tonix report about opioid use in fibromyalgia?
Tonix reported substantial opioid use among U.S. adults with fibromyalgia in its retrospective analysis of healthcare claims data.
2. What is the best opioid for fibromyalgia?
There is no opioid considered the best routine treatment for fibromyalgia. Current guidance generally favors nonopioid approaches for managing chronic fibromyalgia pain.
3. Can opioids make fibromyalgia pain worse?
Long-term opioid use can contribute to opioid-induced hyperalgesia in some people, which can increase sensitivity to pain.
4. What are opioid alternatives for fibromyalgia?
Nonopioid options can include physical activity, psychological therapies, sleep management, and certain prescription medications used to manage fibromyalgia symptoms.
5. Should I stop taking opioid medication for fibromyalgia?
Do not stop opioid medication suddenly without medical guidance. Speak with your healthcare professional about the benefits, risks, and safest treatment plan.
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