Long-term Opioids for Fibromyalgia Linked to Depression, Sleep Issues

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Patients with fibromyalgia who continue opioid use beyond 90 days are at significantly greater risk of developing depression or a sleep disorder, according to findings from a retrospective cohort analysis.¹

New data from a team of Spain investigators showed long-term opioid use to treat the painful symptoms of fibromyalgia syndrome could be detrimental to a patient’s psychiatric and sleep-related health. The findings provide evidence to clinical guidelines recommending against the prescription of opioids to treat fibromyalgia in the first place, and emphasize the need for clinicians to gauge and continuously monitor patients’ self-treatment of their fibromyalgia symptoms.

Investigators led by Isabel Hurtado of the Fisabio research institute in Valencia, noted that much prior research has shown that opioids are “routinely prescribed to a considerable proportion of patients with (fibromyalgia), including long-term treatments and strong opioids,” despite an evident history of poor outcomes associated with the pain reliever drug class.

“Most clinical guidelines generally recommend against the use of opioids for (fibromyalgia), but some authors recognize a potential, empirical role in lack of effect of preferred therapeutic approaches, when used as a rescue therapy, for short periods of time and for selected patients,” the team wrote. “Sustained opioid use over time especially is associated to a myriad of potential, serious adverse outcomes and there is evidence that fibromyalgia is a predictor for long-term opioid use in older adults.”

Indeed, experts including Jason Busse, DC, PhD, professor in the Departments of Anesthesia and Health Research Methods, Evidence and Impact at McMaster University, previously told HCPLive that options including opioid and cannabis should not be considered first-line options to treat chronic pain symptoms consistent with conditions like fibromyalgia—and any strategy that includes them in care should be vetted by clinicians.²

“Shared decision-making is going to be critical to ensure that the decision whether or not to look at a trial of these interventions, is consistent with that patient's values and preferences,” Busse said.

Hurtado and colleagues sought to compare the link between long-term opioid use (>90 days) with occurrence of depression, sleep disorders and suicidal ideation events compared with that of short-term opioid use in a cohort of adults with fibromyalgia who received an initial prescription between 2014 – 2018.¹

They conducted their retrospective analysis using multivariable Cox regression modality and propensity scores to interpret the association between each outcome and the duration of opioid treatment for fibromyalgia. Their analysis included 10,334 patients who received either short-term (n =8309 [80.4%]) or long-term (n = 2025 [19.6%]) opioids for their fibromyalgia.

Among the 2 arms, patients using long-term opioids were more likely to be women (89.40% vs 69.59%; P < .001), and were additionally more likely to use tobacco regularly. Investigators additionally observed higher rates of the following outcomes among patients receiving long-term opioids versus short-term opioids, respectively:

• Anxiety (68.9% vs 51.9%; P >.001)
• Depression (45.1% vs 25.9%; P >.001)
• Psychotic disorders (11.3% vs 6.9%; P >.001)
• Sleep disorders (36.4% vs 25.9%; P >.001)
• Dementia (4.2% vs 3.1%; P = .012)

Adjusted analyses showed that long-term opioid use was linked to a 58% increased risk of depression (hazard ratio [HR], 1.58; 95% CI, 1.29 – 1.95) and 30% increased risk of sleep disorders (HR, 1.30; 95% CI, 1.09 – 1.55). However, the risk for suicidal ideation was not considered statistically significant.

“These findings suggest that continued opioid use for 90 days or more may aggravate common comorbidities of (fibromyalgia) when compared with patterns of short-term treatment, and that shorter treatments may be preferable,” investigators wrote.

Hurtado and colleagues concluded their analysis support recommendations against using opioids to treat fibromyalgia, and elucidate in what ways the drugs may actually worsen the condition’s most common comorbidities.

“However, they are routinely employed in clinical practice, and when used for prolonged periods they may lead to worse outcomes,” the team wrote. “Our results are in line with recommendations to avoid long-term opioid therapy in patients with fibromyalgia.”

References

1. ^{Hurtado I, Robles C, Peiró S, et al. Long versus short-term opioid therapy for fibromyalgia syndrome and risk of depression, sleep disorders and suicidal ideation: a population-based, propensity-weighted cohort study. RMD Open. 2024;10(3):e004466. Published 2024 Sep 23. doi:10.1136/rmdopen-2024-004466}
2. ^{Pine L. Jason Busse, DC, PhD: Do Cannabis, Opioids have a Role in Chronic Pain Management? HCPLive. Published May 10, 2024. Accessed October 11, 2024. https://www.hcplive.com/view/jason-busse-dc-phd-do-cannabis-opioids-have-a-role-in-chronic-pain-management-}