Opioids are the most potent analgesics available and are well established for the treatment of severe acute, surgical, and cancer pain. However, their use to ameliorate chronic noncancer pain (CNCP) is still controversial because of the side effects, such as tolerance, somnolence, confusion, constipation, addiction, withdrawal, and anxiety about disapproval by regulatory bodies. Chronic rheumatic diseases along with low-back pain and arthritis are among the leading causes of CNCP. This article will focus on the role of opioids in chronic rheumatic diseases. Furthermore, the peripheral effects of opioids on pain and inflammation in rheumatic diseases will be outlined.