Abstract
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.
Highlights
Chronic widespread pain is the pivotal symptom of fibromyalgia (FM)
These results suggest that function, pain, and psychological variables improved during care in a multidisciplinary pain clinic, these measures were independent of opioid use
Wisdom suggests that opioid treatments may be less favourable for patients with FM, patient choices regarding treatments were respected and may have led to continued opioid treatments for some patients which may have been contrary to the recommendation of the multidisciplinary treating team. In this first study reporting on health related measures and opioid use in FM patients, followed longitudinally over a two year period, opioid treated patients were more symptomatic and were more likely to be unemployed and to be receiving disability benefits
Summary
Chronic widespread pain is the pivotal symptom of fibromyalgia (FM). In the composite score that has been proposed for the new 2010 diagnostic criteria for FM, pain has been weighted to signify two thirds of the symptom component, with other symptoms including fatigue, sleep disturbance, cognitive changes, and somatic symptoms combined to represent the remaining one third of the symptom complex [1]. It is logical that treatments directed towards pain relief will be an integral part of FM care. Traditional pharmacological treatments for managing pain are centered on simple analgesics, nonsteroidal anti-inflammatory drugs, and the opioid group of medications. Opioids are not recommended by any current guidelines for the treatment of FM symptoms
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