Opioid Usage Increasing in Patients with Fibromyalgia in Recent Years

Javier Rivera, MD, PhD

Credit: Fibromialgia sin miedos

Although clinical guidelines do not recommend opioids for patients with fibromyalgia, data revealed a progressive increase in opioid prescriptions during the last 12 years, according to a study published in BMC Musculoskeletal Disorders.¹ Although opioid usage was linked to concomitant non-opioid drug consumption, it was not linked to the severity of fibromyalgia symptoms.

The well-established risks of opioid use, including overdosing, abuse, suicides, and deaths, are among the most significant adverse events. This is important to patients with fibromyalgia as, globally, the prevalence of opioid treatment in patients with chronic musculoskeletal pain is estimated to be approximately 20%.²

“After an initial peak in US 20 years ago, followed by an increase in other countries such as Australia and Canada, the opioid crisis has caused an alarming increase of deaths requiring a drastic intervention of the Health Authorities in that country,” wrote a team of investigators led by Javier Rivera, MD, PhD, associated with the Rheumatology Department at Hospital General Universitario Gregorio Marañón, in Spain. “Although in Spain and other European countries the increase in opioid prescriptions has not been so alarming, Health Authorities have detected an increase in prescription, which has risen some concerns.”

A retrospective, observational study examined the frequency of opioid use using a large fibromyalgia cohort—the Combined Index of Severity in Fibromyalgia (ICAF)—from a tertiary care center in Spain. Investigators evaluated the severity of symptoms, functional capacity, drug consumption, anxiety and depression, and the individual’s impression of change. Patients who were considered “strong opioid consumers (SOC)” were compared with non-SOC.

At a follow-up appointment at the 3-month mark, participants completed the ICAF questionnaire, the Patient Global Impression of Change (PGIC) questionnaire, and information on drug treatment was collected again. Factors associated with opioid consumption were identified using inferential statistical and logistic regression analysis.

A total of 1087 patients were included in the analysis, of which 9.2% (n = 100) were SOC. Between 2010 and 2022, there was a progressive and significant increase in the frequency of SOC patients over 3 different time periods: 5.8% between December 2010 and October 2014; 9.1% between November 2014 and August 2018; and 12.8% between September 2018 and July 2022.

Demographic variables did not differ significantly between both cohorts. However, clinical variables were more severe in the SOC group, and these patients consumed more non-opioid drugs (P <.0001). Opioid consumption was independently linked to other non-opioid drug use (odds ratio [OR] 1.25, confidence interval [CI]: 1.13 – 1.38), although it was not linked to fibromyalgia severity.

At the follow-up appointment, 62% (n = 43/68) of patients with fibromyalgia stopped using opioids, while 38% (n = 26/69) continued treatment. Patients who withdrew opioids demonstrated better coping strategies when compared with those who did not (P = .044). No statistically differences in severity of symptoms were observed at the initial evaluation, nor did the participant’s impression of change in patients who withdrew opioids and those who continued opioid treatment.

The study was strengthened by the large cohort of patients with fibromyalgia and the long follow-up period with intermittent evaluations. However, investigators note limitations including the retrospective design and conducting the study at a single care center, which may have hindered generalizability. Although there is a possibility of overestimation of the frequency of SOC among patients with fibromyalgia, investigators believe the increases observed throughout the duration of the study likely reflects the real-word tendency of opioid treatment among this patient population.

“Although at present, there is not good scientific evidence about the efficacy of opioid therapy for the treatment of pain in patients with fibromyalgia, all these arguments strongly advise against the use of this treatment in these patients,” investigators concluded. “All the physicians involved in the treatment of fibromyalgia patients should be aware of the severe risks associated with the use of opioids in these patients.”

References

1. ^{Rivera J, Molina-Collada J, Martínez-Barrio J, et al. Opioids and fibromyalgia: frequency of use and factors associated with increased consumption in patients remitted to a tertiary care center. BMC Musculoskelet Disord. 2024;25(1):121. Published 2024 Feb 9. doi:10.1186/s12891-024-07263-x}
2. ^{De Sola H, Dueñas M, Salazar A, Ortega-Jiménez P, Failde I. Prevalence of therapeutic use of Opioids in Chronic Non-cancer Pain patients and Associated factors: a systematic review and Meta-analysis. Front Pharmacol. 2020;11:564412.}