title: Opioid Use in Fibromyalgia: A Cautionary Tale.
abstract: Multiple pharmacotherapies are available for the treatment of fibromyalgia (FM), including opioid analgesics. We postulate that the mechanism of action of traditional opioids predicts their lack of efficacy in FM. Literature searches of the MEDLINE and Cochrane Library databases were conducted using the search term opioid AND fibromyalgia to identify relevant articles, with no date limitations set. Citation lists in returned articles and personal archives of references were also examined for additional relevant items, and articles were selected based on the expert opinions of the authors. We found no evidence from clinical trials that opioids are effective for the treatment of FM. Observational studies have found that patients with FM receiving opioids have poorer outcomes than patients receiving nonopioids, and FM guidelines recommend against the use of opioid analgesics. Despite this, and despite the availability of alternative Food and Drug Administration-approved pharmacotherapies and the efficacy of nonpharmacologic therapies, opioids are commonly used in the treatment of FM. Factors associated with opioid use include female sex; geographic variation; psychological factors; a history of opioid use, misuse, or abuse; and patient or physician preference. The long-term use of opioid analgesics is of particular concern in the United States given the ongoing public health emergency relating to excess prescription opioid consumption. The continued use of opioids to treat FM despite a proven lack of efficacy, lack of support from treatment guidelines, and the availability of approved pharmacotherapy options provides a cautionary tale for their use in other chronic pain conditions.
authors.affiliation: Department of Medicine, Tufts University School of Medicine, Boston, MA. Electronic address: dongoldenberg44@gmail.com.
authors.forename: Don L
authors.initials: DL
authors.lastname: Goldenberg
authors.affiliation: Department of Anesthesiology, University of Michigan, Ann Arbor.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Clauw
authors.affiliation: Pfizer Inc, New York, NY.
authors.forename: Roy E
authors.initials: RE
authors.lastname: Palmer
authors.affiliation: Pfizer Inc, New York, NY.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Clair
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000592:standards / Q000627:therapeutic use; D059350:Chronic Pain / Q000188:drug therapy* / Q000209:etiology; D055317:Evidence-Based Practice / Q000379:methods / Q000592:standards*; D005260:Female; D005356:Fibromyalgia / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000209:etiology; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D059408:Pain Management / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D017410:Practice Guidelines as Topic; D000067490:Prescription Drug Overuse / Q000009:adverse effects* / Q000706:statistics & numerical data; D015995:Prevalence; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid