Long-Term Evaluation of Opioid Treatment in Fibromyalgia.



OBJECTIVES: In a 12-month observational study, we evaluated the effect of opioid use on outcomes in 1700 adult patients with fibromyalgia (FM).

METHODS: Data were evaluated using propensity-score-matching after patients were divided into cohorts based on their baseline medication use:(1) taking an opioid (concurrent use of tramadol was permitted); (2) taking tramadol (but no opioids); and (3) not taking opioids or tramadol. Changes in outcomes were assessed using the

  • Brief Pain Inventory for severity and pain-related interference (BPI-S, BPI-I),

  • Fibromyalgia Impact Questionnaire (FIQ),

  • Patient Health Questionnaire for depression (PHQ-8),

  • Insomnia Severity Index (ISI),

  • Sheehan Disability Scale (SDS),

  • 7-item Generalized Anxiety Disorder scale (GAD-7)

  • and economic factors.

Time to opioid or tramadol discontinuation was analyzed using Kaplan-Meier survival analyses.


  • Compared with the opioid cohort, the non-opioid cohort demonstrated significantly greater reductions (P<0.05) in BPI-I, FIQ, PHQ-8, SDS and ISI;

  • the tramadol cohort compared with the opioid group showed greater reductions on FIQ and ISI.

  • Reductions in BPI-S and GAD-7 did not differ significantly among cohorts.

  • Compared with the opioid cohort, patients in the tramadol cohort had fewer outpatient visits to healthcare providers.

  • Few significant differences were found between the tramadol and non-opioid cohorts across outcomes.

DISCUSSION: While pain severity was reduced over time in all cohorts, opioid users showed less improvement in pain-related interference with daily living, functioning, depression, and insomnia. Overall, the findings show little support for the long-term use of opioid medications in patients with FM given the poorer outcomes across multiple assessment domains associated with this cohort.

Source: The Clinical Journal of Pain, January 28, 2014. By Peng, Xiaomei MD, PhD; Robinson, Rebecca L. MS; Mease, Philip MD; Kroenke, Kurt MD; Williams, David A. PhD; Chen, Yi MS; Faries, Douglas PhD; Wohlreich, Madelaine MD; McCarberg, Bill MD; Hann, Danette PhD.

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