@Gingergrrl beat me to linking to the lengthy thread on opioids and their effectiveness for many PWME — it's well worth a read, though I've always been surprised at how little discussion there is in that thread on the role of vasodilation.
I'm among those who have found a curious improvement in my global ME/CFS symptoms 2-4 days after opioid use, in addition to pain relief. At the moment, thanks to the current media hysteria and typical CDC mismanagement of it, my doctor and I have felt compelled to begin tapering my dose in advance of my health insurance potentially forcing us to do so on a much more abrupt time-table, with far more potential suffering. I've been surprised to find that my pain level has not especially increased as it did when I requested a decline in my dose 3 years ago, but my ME/CFS symptoms (sensory sensitivities, profound weakness, muscle twitching/jerking, "lead legs," flu-like feeling) sky-rocketed 3 days after reducing my dose. I have a supplement called "
Nitric Balance" which is mostly herbal vasodilators (niacin, vinpocetine, huperzine) and has a similar effect on me as the opioid (in my case, morphine), though not quite as potent (and of which I am imbibing at a greater rate since decreasing my opioid dose). While the way opioids interact with the vascular system is not especially well understood (at least from my admittedly superficial examination of the literature), it does appear to include interacting with nitric oxide (as well as histamine), which I've found of particular interest given
Fluge and Mella's work with nitric oxide donors ME/CFS treatment. (Actually, couldn't see how your experiment with nitric oxide donors worked for you
@alex3619 ?)
As for the Vancouver Clinic's policy along with the current nearly mendacious national discourse on opioids,
the BPS folks are doing to chronic pain patients what they've been doing to ME/CFS patients for the last 30 years: tell patients that what they're feeling is real but isn't, using CBT and GET. But for chronic pain, they've got the added ally of organizations like the DEA, a group of modern-day teetotalers which exists to make people suffer for having the disease of addiction. I'm guessing that since cannabis is being increasingly legalized, DEA is looking around for a new whipping boy to take its place and have found it in prescription opioids. While there are so many things wrong with the media discussion of this so-called "opioid epidemic," what I find most troubling with regard to the Vancouver Clinic's guidelines is the way it — and many FMS researchers — ignore what fibromyalgia patients have long been saying: opioids work in treating FMS pain. It's the same sort of thing as ME/CFS and GET. Patients overwhelming say one thing while researchers insist the "evidence" says patients are "mis-interpreting" what their bodies are telling them.
The primary answer to the "opioid crisis" is straightforward: provide adequate treatment for substance abuse. But that costs money, and it's far easier and preferable to blame overworked doctors who prescribe opioids (seriously, the head of CDC said "this is a doctor-driven epidemic") and pain patients who persist in believing that the pain relief they receive from such drugs is not really real. To say nothing of how happy insurance companies are to remove or reduce a whole class of drugs from their formularies while being under no obligation to increase access to other treatments for pain (as if most of us haven't already tried them anyway!). And I'm sure companies like Pfizer are not unhappy to have their ineffectual anti-depressants and anti-seizure drugs forced on patients either. Most importantly, the "mind-body" folks think that meditation and CBT will work just as well as Vicodin. And it's not that meditation and CBT don't help — they very much do. But they are ADJUNCTIVE treatments, gawddamnit, not primary treatment.
As for everything you've read or heard about what opioids do to the body — short-term or long-term, it's almost all bullshit. There is very little evidence for or against any such claims. There is very little evidence about anything pertaining to opioids period. See the P2P report on opioids in chronic pain (held just 8 months after our own P2P workshop). At the end of the day, they're playing the same game they've been with ME/CFS using the whole "there is no evidence to suggest X works long-term" when, in fact, there's no evidence to say it does not either.