The [[National Institute of Arthritis and Musculoskeletal and Skin Diseases]] (NIAMS) in 2014 stated that there was a lack of evidence for opioids for most people.<ref name="NIH2014Tx" /> The [[Association of the Scientific Medical Societies in Germany]] in 2012 made no recommendation either for or against the use of weak [[opioid]]s because of the limited amount of scientific research addressing their use in the treatment of FM. They strongly advise against using strong opioids.<ref name="German" /> The [[Canadian Pain Society]] in 2012 said that opioids, starting with a weak opioid like tramadol, can be tried but only for people with moderate to severe pain that is not well-controlled by non-opioid painkillers. They discourage the use of strong opioids and only recommend using them while they continue to provide improved pain and functioning. Healthcare providers should monitor people on opioids for ongoing effectiveness, side effects and possible unwanted drug behaviors.<ref name="Canadian" />
TheSmernice [[EuropeanEvropska Leagueliga Againstza Rheumatismboj proti revmatizmu|Evropske lige za boj proti revmatizmu]] in(EULAR) iz leta 2008 recommendsso priporočile uporabo [[tramadol]]a andin otherdrugih weakšibkih opioidsopioidov mayza belajšanje usedbolečine, forne painpriporoča butpa notuporabe strongmočnih opioidsopioidov.<ref name="EULAR" /> AV 2015pregledu reviewraziskav foundiz fairleta evidence2015 toso supportdokazali, tramadolda useje ifuporaba tramadola smiselna, otherče medicationsdruga dozdravila notne workučinkujejo.<ref name="Mac2015">{{cite journal |last1=MacLean |first1=AJ |last2=Schwartz |first2=TL |title=Tramadol for the treatment of fibromyalgia. |journal=Expert Review of Neurotherapeutics |date=May 2015 |volume=15 |issue=5 |pages=469–75469–475 |pmid=25896486 |doi=10.1586/14737175.2015.1034693}}</ref> AIzsledki pregleda raziskav iz leta 2018 reviewso foundnašli littlele evidencemalo todokazov supportza thekorist combinationkombiniranja oftramadola s [[paracetamol]]om (acetaminophen)v andprimerjavi tramadolz overzdravljenjem asamo singles medicationtramadolom.<ref>{{cite journal|last1=Thorpe|first1=J|last2=Shum|first2=B|last3=Moore|first3=RA|last4=Wiffen|first4=PJ|last5=Gilron|first5=I|title=Combination pharmacotherapy for the treatment of fibromyalgia in adults.|journal=The Cochrane Database of Systematic Reviews|date=19. February2. 2018|volume=2|pages=CD010585|doi=10.1002/14651858.CD010585.pub2|pmid=29457627|pmc=6491103}}</ref> GoldenbergGlede ''etna al''teorijo suggestGoldenberga thatin sodelavcev naj bi tramadol workspri viafibromialgiji itsizkazoval serotoninučinek andzaradi norepinephrinezaviranja reuptakeponovnega inhibition,privzema ratherserotonina thanin vianoradrenalina itsin actionne aszaradi asiceršnjega agonističnega weakdelovanja opioidna receptoropioidne agonistreceptorje.<ref name="Don2016" />
AVelika largeraziskava studyna ofbolnikih USiz peopleZDA withmed fibromyalgialetoma found2005 thatin between2007 2005je andpokazala, 2007da je 37.,4 % werebolnikov prescribeduporabljalo short-actingkratkodelujoče opioidsopioide andin 8.,3 % werebolnikov prescribeddolgodelujoče long-acting opioids,opioide.<ref name="Ngian">{{cite journal |vauthors=Ngian GS, Guymer EK, Littlejohn GO |title=The use of opioids in fibromyalgia |journal=Int J Rheum Dis |volume=14 |issue=1 |pages=6–11 |date=Februaryfebruar 2011 |pmid=21303476 |doi=10.1111/j.1756-185X.2010.01567.x |url=}}</ref> withOd aroundtistih, 10%ki ofso thosejim prescribedpredpisali short-actingkratkodelujoče opioidsopioide, usingjih je 10 % uporabljalo tramadol;.<ref name="Berger">Berger A. [https://web.archive.org/web/20130606030416/http://abstract.mci-group.com/cgi-bin/mc/printabs.pl?APP=EULAR2009SCIE-abstract&TEMPLATE=&keyf=2307&showHide=show&client= Patterns of use of opioids in patients with fibromyalgia] In: EULAR; 2009:SAT0461</ref> andKanadska araziskava 2011iz Canadianleta study2011 ofna 457 peoplebolnikih withs FMfibromialgijo foundje pokazala, da so 32 % usedbolnikom opioidspredpisali andopioide, twood thirdstega ofdvema thosetretjinama usedmočne strong opioidsopioide.<ref name="Canadian" />
