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Opioid use in fibromyalgia is associated with negative health related measures in a prospective cohort study.
– Source: Pain Research and Treatment, Epub March 18, 2013
By Mary-Ann Fitzcharles, et al.
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.
Source: Pain Research and Treatment, Epub March 18, 2013. By Mary-Ann Fitzcharles, Neda Faregh, Peter A. Ste-Marie and Yoram Shir. Division of Rheumatology, McGill University, Montreal, QC, Canada H3G 1A4 ; Alan Edwards Pain Management Unit, Montreal General Hospital, McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, Canada H3G 1A4.
Editor’s Comment: In the full text of this study, the researchers noted, “Opioids are also perceived by patients to offer the best symptom relief according to an internet survey of persons with self-reported FM.” Despite that perception, the FM patients who were taking strong opioids (all opioids other than tramadol and codeine) scored worse for symptom severity, functional impairment and occupational status over time. It should be noted, however, that the group taking opioids also scored worse in measures of disease severity at the beginning of the study.
The point seems to be that while all of the patients showed improvement over time regardless of the treatments they received, those receiving opioids did not show greater improvement and in some cases, had less improvement than patients using other standard treatments. Given the dangers and negative effects associated with chronic opioid use, the study authors advise physicians to be vigilant regarding the continued use of opioids to treat fibromyalgia until more formal clinical trials on opioid use for FM are conducted.