Clinical research study
Opioid Use, Misuse, and Abuse in Patients Labeled as Fibromyalgia

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Abstract

Background

As pain is the cardinal symptom of fibromyalgia, it is logical that treatments directed toward pain relief will be commonly used. Analgesic drug therapy remains the traditional treatment intervention for most chronic pain conditions, with a progressive increased use of opioids in the past 20 years. Concerns about efficacy, risk-benefit ratio, and possible long-term effects of chronic opioid therapy have been raised. There is limited information about opioid treatment in fibromyalgia, with all current guidelines discouraging opioid use.

Methods

A chart review of all patients referred to a tertiary care pain center clinic with a referring diagnosis of fibromyalgia was conducted to evaluate use of opioid medications.

Results

We have recorded opioid use by 32% of 457 patients referred to a multidisciplinary fibromyalgia clinic, with over two thirds using strong opioids. Opioid use was more commonly associated with lower education, unemployment, disability payments, current unstable psychiatric disorder, a history of substance abuse, and previous suicide attempts.

Conclusion

We have observed negative health and psychosocial status in patients using opioids and labeled as fibromyalgia. Prolonged use of opioids in fibromyalgia requires evaluation.

Section snippets

Methods

From January 2005 to December 2010, all patients referred to the Alan Edwards Pain Management Unit with a referring diagnosis of fibromyalgia were evaluated in a designated fibromyalgia clinic. Patients were referred mostly by primary care physicians, with a few being referred by other specialists; the ongoing clinical care of almost all patients was the responsibility of their primary care physician. Patients were assessed individually by members of a multidisciplinary team that included a

Results

There were 457 patients referred to the fibromyalgia clinic during the study period. All had a referring diagnosis of fibromyalgia. After formal evaluation, 302 (66%) retained a diagnosis of fibromyalgia, whereas 155 (34%) were assigned some other primary diagnosis by the first author, a rheumatologist. Of the 302 fibromyalgia patients, 251 were eligible for entry into a prospective longitudinal cohort study, which is currently in progress. Fibromyalgia patients had a mean pain VAS of 6.4 and a

Discussion

Opioid use for the management of pain in fibromyalgia is strongly discouraged and is not recommended by any current guideline.8, 9, 10 The major finding of this study is that one third of those labeled as fibromyalgia patients and referred to a multidisciplinary pain center were currently using daily opioids, although duration of use is not known. Moreover, those on opioids had indications of poorer health status, with more patients being unemployed, receiving disability benefits, and presented

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    Funding: Funding for PAS-M was received from the Louise and Alan Edwards Foundation. MAW is supported by the “Fonds de la Recherche en Santé du Québec” and the Louise and Alan Edwards Foundation.

    Conflict of Interest: Dr Fitzcharles has received consulting fees, speaking fees or honoraria from Biovail, Janssen, Pfizer, Purdue, and Valeant (less than $10,000). Dr Ware has received consulting fees, speaking fees or honoraria from Janssen, Purdue, and Valeant (less than $10,000). Peter Ste-Marie, Dr Gamsa and Dr Shir declare no conflict of interests.

    Authorship: All authors had access to all data and participated in the data compilation, analysis, and writing of the manuscript.

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