Is There a Role for Opioids in the Treatment of Fibromyalgia?

Littlejohn, Geoffrey; Guymer, Emma Kathryn; Ngian, Gene Siew

doi:10.2217/pmt-2016-0012

Cited by 20 publications

(15 citation statements)

References 54 publications

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“…There is little role for the use of pure opioids in fibromyalgia as intrinsic brain opioid activity is already optimized and this, together with the significant medical issues associated with long-term opioid use, limits consideration of the usual form of this drug for its NMDAR antagonist properties in fibromyalgia [47]. This drug should only be considered in special circumstances in fibromyalgia, for instance as part of an opioid withdrawal program.…”

Section: Resultsmentioning

confidence: 99%

Modulation of NMDA Receptor Activity in Fibromyalgia

Littlejohn

Guymer

2017

Biomedicines

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Activation of the N-methyl-d-aspartate receptor (NMDAR) results in increased sensitivity of spinal cord and brain pathways that process sensory information, particularly those which relate to pain. The NMDAR shows increased activity in fibromyalgia and hence modulation of the NMDAR is a target for therapeutic intervention. A literature review of interventions impacting on the NMDAR shows a number of drugs to be active on the NMDAR mechanism in fibromyalgia patients, with variable clinical effects. Low-dose intravenous ketamine and oral memantine both show clinically useful benefit in fibromyalgia. However, consideration of side-effects, logistics and cost need to be factored into management decisions regarding use of these drugs in this clinical setting. Overall benefits with current NMDAR antagonists appear modest and there is a need for better strategy trials to clarify optimal dose schedules and to delineate potential longer–term adverse events. Further investigation of the role of the NMDAR in fibromyalgia and the effect of other molecules that modulate this receptor appear important to enhance treatment targets in fibromyalgia.

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Section: Resultsmentioning

confidence: 99%

Modulation of NMDA Receptor Activity in Fibromyalgia

Littlejohn

Guymer

2017

Biomedicines

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“…It should be noted that opioids are not necessarily appropriate for all pain syndromes, including the severe pain associated with migraine and fibromyalgia. 52 …”

Section: Methodsmentioning

confidence: 99%

Managing severe pain and abuse potential: the potential impact of a new abuse-deterrent formulation oxycodone/naltrexone extended-release product

Pergolizzi

Taylor

LeQuang

et al. 2018

JPR

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Proper management of severe pain represents one of the most challenging clinical dilemmas. Two equally important goals must be attained: the humanitarian/medical goal to relieve suffering and the societal/legal goal to not contribute to the drug abuse problem. This is an age-old problem, and the prevailing emphasis placed on one or the other goal has resulted in pendulum swings that have resulted in either undertreatment of pain or the current epidemic of misuse and abuse. In an effort to provide efficacious strong pain relievers (opioids) that are more difficult to abuse by the most dangerous routes of administration, pharmaceutical companies are developing products in which the opioid is manufactured in a formulation that is designed to be tamper resistant. Such a product is known as an abuse-deterrent formulation (ADF). ADF opioid products are designed to deter or resist abuse by making it difficult to tamper with the product and extracting the opioid for inhalation or injection. To date, less than a dozen opioid formulations have been approved by the US Food and Drug Administration to carry specific ADF labeling, but this number will likely increase in the coming years. Most of these products are extended-release formulations.

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“…Evidence to recommendation. The panel agrees that the use of analgesics is not sufficiently supported by the literature; even for new molecules, such as tapentadol, which seemed to show an acceptable safety profile (34), there is a lack of robust evidence about the efficacy in FMS (35). Therefore, also for their side effects, it is advisable to avoid using analgesics, especially if there is not any improvement.…”

Section: Summary Of Guidelinesmentioning

confidence: 99%

The Italian Society for Rheumatology clinical practice guidelines for the diagnosis and management of fibromyalgia. Best practices based on current scientific evidence

et al. 2021

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Fibromyalgia or fibromyalgia syndrome (FMS) is defined as a central sensitization syndrome characterized by the dysfunction of neurocircuits detecting, transmitting and processing nociceptive stimuli; the prevalent manifestation is musculoskeletal pain. In addition to pain, there are multiple accompanying symptoms, in common with other algo-dysfunctional syndromes, which are reflected in a broad spectrum of somatic, neurocognitive and neuro-vegetative manifestations. An evidence-based approach is essential in FMS management, in order to improve patient health and to reduce its social burden. Since in the last ten years new international guidelines for clinical practice (Clinical Practice Guidelines or CPGs) concerning FMS diagnosis and pharmacological/ non-pharmacological management have been published, the Italian Society of Rheumatology (SIR) has decided to adapt them to the Italian national setting. The framework of the Guidelines International Network Adaptation Working Group was adopted to identify, appraise (AGREE II), synthesize, and customize the most recent CPGs on FMS to the needs of the Italian healthcare context. A working group of rheumatologists from SIR epidemiology unit and FMS experts identified relevant clinical questions to guide the systematic review of the literature. The target audience of these CPGs included physicians and healthcare professionals who manage FMS. The adapted recommendations were finally assessed by an external multidisciplinary panel. From the systematic search in databases (Pubmed/Medline, Embase) and grey literature, 6 CPGs were selected and appraised by two independent raters. The combination of the scientific evidence underlying the original CPGs with expert opinion lead to the development of 17 recommendations. The quality of evidence for each recommendation was reported and their potential impact on clinical practice was assessed. These SIR recommendations are expected to be a valuable aid in the diagnosis and treatment of FMS, as they will contribute to disseminate the best practice on the basis of the current scientific evidence.

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Is There a Role for Opioids in the Treatment of Fibromyalgia?

Cited by 20 publications

References 54 publications

Modulation of NMDA Receptor Activity in Fibromyalgia

Modulation of NMDA Receptor Activity in Fibromyalgia

Managing severe pain and abuse potential: the potential impact of a new abuse-deterrent formulation oxycodone/naltrexone extended-release product

The Italian Society for Rheumatology clinical practice guidelines for the diagnosis and management of fibromyalgia. Best practices based on current scientific evidence

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