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.

In a remarkable July 2026 Nature Medicine study of over 2.56 million individuals, the researchers found that heritability was exclusively enriched in brain tissues and neuronal cell types, providing strong evidence that fibromyalgia is primarily a central nervous system disorder and the long-standing concept of central sensitization or nociplastic pain.. identical in men and women, suggesting the sex difference is not due to different inherited risk variants. Importantly, the inherited risk was concentrated almost entirely in brain tissues and neuronal cell types, providing powerful support for

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.

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.

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.

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 distribution, fatigue, unrefreshing sleep, cognitive dysfunction, and associated complaints.

Patients with FM commonly report flu-like aching—“I hurt all over”—accompanied by fragmented sleep, exhaustion, impaired concentration, and fluctuating pain levels. Functional capacity is often substantially compromised. Depression and anxiety affect up to half of FM patients; bipolar and trauma-related symptoms are also overrepresented. The clinical picture is chronic pain and distress. I created a figure (left) to illustrate the problem.

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.

Some patients turn to substances to cope with pain and accompanying emotional distress, such as depression and anxiety. Self-medication often occurs; it isn’t driven by drug experimentation or seeking euphoria. It is caused by the need for pain relief.

When substances rapidly remove pain “noise” and affective distress, a self-sustaining cycle of use is created.

FM and Substance Use Disorders

Persistent distress increases the appeal of substances providing even transient relief. Drugs of abuse are addictive enough, but repeated pairing of rapid symptom reduction with substances further strengthens drug reinforcement learning.

Opioids illustrate this dynamic. There is no convincing evidence that opioids effectively treat FM pain, and chronic use may increase pain through opioid-induced heightened sensitivity to pain (hyperalgesia). Nonetheless, opioids transiently blunt distress and provide brief pain relief. Reinforcement occurs through short-term dampening of suffering, not disease modification.

Clinically, FM may magnify patient-perceived value of opioids or sedatives, alcohol, and cannabis, because they reduce pain arousal and emotional distress—especially in patients with co-occurring mood or trauma-related disorders. For patients, temporary pain relief is better than nothing. Note that chronic pain conditions in general are associated with higher substance use rates, including polysubstance use. Pain increases exposure and reinforcement; polysubstance use elevates substance use disorder risk, in an unhappy cycle.

Depression, anxiety, trauma-related symptoms, and sleep disturbance are core components of FM and are independent SUD risk factors. Using alcohol, “weed,” or other substances for pain relief creates a self-perpetuating loop: short-lived relief reinforces repeated use, while underlying symptom generators persist. Over time, escalation in dose, frequency, or polysubstance combinations may follow.

Opioids, Marijuana, and Alcohol

Opioid use disorder (OUD) is the most frequent SUD with CP. Patients with FM are 50% more likely to use opioids on a regular or high-dose basis compared to those with other pain conditions. Long-term opioid therapy in FM is linked with increased depression, sleep disorders, and suicidal ideation. Among individuals with opioid use disorder, FM apparently accelerates pain-related addiction and relapse.

Cannabis use is highly prevalent in the FM community; nearly 50% of patients report use since diagnosis. “Medical” and recreational cannabis in the U.S. have become alternative pain therapeutics. In population-based and veteran samples, adults with chronic pain were significantly more likely to have cannabis use disorder (CUD) than their non-pain counterparts. One study found that three in 10 individuals experiencing CP reported using cannabis for pain.

Alcohol misuse remains a recognized risk in chronic pain populations. A study utilizing the U.S. National Inpatient Sample showed that while AUD-related hospitalizations increased across several musculoskeletal conditions (gout, rheumatoid arthritis, osteoarthritis, low-back pain), the rate of increase was highest in fibromyalgia patients.

Evidence-Based Management

First-line treatment for FM emphasizes nonpharmacologic strategies: aerobic exercise, yoga, sleep optimization, cognitive-behavioral approaches, and education. FDA-approved pharmacologic options include duloxetine, milnacipran, and pregabalin. In addition, recently approved (2025) sublingual drug Tonmya was the first new fibromyalgia treatment approved in 15 years. Phase-3 clinical trials involving nearly 1,000 adults demonstrated that Tonmya led to significant improvements in chronic pain and other core FM symptoms by specifically targeting nonrestorative sleep. A new study, led by Kathleen Sluka, PT, PhD, published on March 27 in the journal JAMA Network Open, shows that TENS is a safe, effective, inexpensive, and readily available treatment for fibromyalgia. When TENS (transcutaneous electrical nerve stimulation) was added to standard physical therapy, patients saw a significant reduction in movement-evoked pain and—most notably—fatigue. The study, involving 384 participants across 28 clinics, proved that TENS is as effective as FDA-approved medications but with a “dose-dependent” benefit that doesn’t fade over time. After the trial, 80% of participants found TENS helpful, and 70% reported feeling better overall, leading to high long-term adherence.

Emerging Hope: GLP-1 Receptor Agonists

A 2025 preclinical study and a 2026 Mayo Clinic study suggest that GLP-1 medications such as Ozempic may offer hope for future pain relief for FM patients.

Roland Staud, author of Fibromyalgia for Dummies, told me, “There is increasing evidence for benefits of GLP-1 agonists for fibromyalgia. They have mechanistic plausibility via their effects on central sensitization and neuroinflammation. However, GLP-1 receptor agonists for fibromyalgia have not yet been sufficiently studied.” Interestingly, new studies indicate that GLP-1s may also help treat SUDs.

Conclusion

Since this article was first published, two of the largest genetic studies ever conducted on fibromyalgia have strengthened the evidence that fibromyalgia is a disorder of altered nervous system function rather than of psychological origin. Using genetic data from more than 2.5 million individuals, investigators identified 26 genetic risk loci associated with fibromyalgia. The investigators found extensive genetic overlap with chronic pain syndromes, PTSD, depression, and irritable bowel syndrome- conditions that commonly coexist with fibromyalgia.