Opioid Use in Fibromyalgia Is Associated with Negative Health Related Measures in a Prospective Cohort Study

Abstract

As pain is the cardinal symptom of fibromyalgia (FM), strategies directed towards pain relief are an integral component of treatment. Opioid medications comprise a category of pharmacologic treatments which have impact on pain in various conditions with best evidence for acute pain relief. Although opioid therapy other than tramadol has never been formally tested for treatment of pain in FM, these agents are commonly used by patients. We have examined the effect of opioid treatments in patients diagnosed with FM and followed longitudinally in a multidisciplinary pain center over a period of 2 years. In this first study reporting on health related measures and opioid use in FM, opioid users had poorer symptoms and functional and occupational status compared to nonusers. Although opioid users may originally have had more severe symptoms at the onset of disease, we have no evidence that these agents improved status beyond standard care and may even have contributed to a less favourable outcome. Only a formal study of opioid use in FM will clarify this issue, but until then physicians must be vigilant regarding the multiple adverse consequences of opioid therapy.

Another Nasty Effect of Opioids: Attenuating the Benefits of Motivational Interviewing in Fibromyalgia?

“…However the opioid users versus nonusers differed on other characteristics that could have influenced the results. Users had significantly less education, higher depression scores, and greater disease severity as measured by the Fibromyalgia Impact Questionnaire, findings that have been reported by others 13 .…”

Endogenous opioidergic dysregulation of pain in fibromyalgia: a PET and fMRI study

“…This may help explain why recent prospective long-term studies of opioid use in FM do not generally support their efficacy. 18; 50 …”

Evaluating increased resource use in fibromyalgia using electronic health records

“…The reason for this association was not determined, but it has been reported that FM patients taking opioids have poorer outcomes than nonopioid users,31 which may drive additional health care-seeking behavior. Recent studies have found improved scores for pain severity, pain interference, patient function, insomnia, disability severity, and depression severity in FM patients not taking opioids compared with those taking opioids 15,32. A recent observational study reported that the prescribing of opioids after FM diagnoses significantly reduced the likelihood of receiving a guideline-recommended medication 2.…”