Patients with Fibromyalgia Jump to Opioids Early On

Are more patients with newly diagnosed fibromyalgia taking guideline-recommended medications or opioids? The answer may surprise you.

Rachel Halpern, PhD, MPH, from Optum, a health services company, and colleagues evaluated pain management strategies in those with fibromyalgia (diagnosed within six months prior to the study). They noted that the initial diagnosis was the index date, as described in the analysis.

“Patients had six-month pre-index and 12-month postindex periods and received pain medication within six months postindex; cohorts were based on the first postindex medication,” the authors explained in PAIN Practice.

The real-world study included 96,175 patients newly diagnosed with fibromyalgia — 72.5% female and an average age of 47.3. Data collected from January 2008 to February 2012 revealed their medication prescriptions:

• 57% — short-acting opioid (SAO)
• 22% — selective serotonin reuptake inhibitor (SSRI)
• 10% — anti-epileptic drug (AED)
• 6% — serotonin-norepinephrine reuptake inhibitor (SNRI)
• 3% — tricyclic antidepressant (TCA)
• 2% — long-acting opioid (LAO)

All of the listed drugs, besides the opioids (SAO and LAO), are guideline-recommended medications. Yet, as tallied above, SAO was the most common. Notably, the SAO group had the most discontinuation and least augmentation. The authors measured the likelihood of patients taking opioids to move to guidelines-recommended therapy using the cox proportional hazards regression.

“Regression analyses indicated that patients with (versus without) pre-index guideline-recommended medications were two to four times more likely to receive them postindex,” the authors observed. Those in the opioid groups were about half as likely to receive guideline-recommended medication following the opioids.

Not only did the findings reveal that opioids are common among those with fibromyalgia, but there’s the added difficult of switching them over to guideline-recommended medication once they already started opioids. This supports the need for state implemented opioid restrictions.

“These real-world results indicate an opportunity may exist for improved [fibromyalgia] management using recommended therapies in clinical practice,” the team pointed out.