Background/Purpose: Chronic widespread pain is a cardinal symptom in patients with fibromyalgia.  Current pharmacotherapies for fibromyalgia targets central neurochemical abnormalities and pain processing pathways. Analgesics and opioids are currently not standard of care for patients with fibromyalgia. Our objective was to evaluate the frequency of opioid use and clinical characteristics, symptom severity and quality of life (QOL) associated with opioid use in patients seen in a fibromyalgia treatment program (FTP) at a tertiary medical center.

Methods: We studied 971 patients (917 women and 54 men) with fibromyalgia who met the 1990 ACR clinical criteria for fibromyalgia. Comprehensive medication review was conducted when they were seen at the FTP. Opioid users and nonusers were compared with respect to demographic characteristics, numeric rating scale (NRS) for current pain, Fibromyalgia Impact Questionnaire (FIQ) and Short Form–36 Health Survey (SF-36)scores, and tender point count. Univariate logistic regression models were used to model the endpoint of opioid use (Yes vs No). Variables significant at the alpha = 0.05 level were entered into a multivariable logistic regression model.

Results: Mean age of patients was 49 (SD, 12.8) years and mean duration of symptoms was 130 months (SD, 134.8).  Two hundred thirty-six patients (24%) who presented to the FTP used opioids for pain. In a univariate analysis, the opioid users had higher rates of tobacco use (p<0.001), unemployment (p<0.001), tender point (p=0.001) and NRS scores (P<0.0001) and lower alcohol use (p=0.009), when compared to the nonusers. There were no significant differences in age, sex, race, marital status, abuse history, education level or BMI status between the 2 groups. The opiod users also had higher symptom severity as measured by the FIQ total (p<0.001) and all subscales (p≤0.01) and worse QOL as measured by all SF-36 subscales (p≤0.04) and physical and mental components (p<0.001).  Multivariate analysis confirmed that opioid use was independently and significantly associated with increased tobacco use (p=0.003), unemployment (p=0.002), increased symptom severity (p=0.009) and worse SF-36 physical component score (p=0.02). However, no significant associations were found between opioid use and alcohol use, NRS scores, tender points or SF-36 mental component score.

Conclusion: The frequency of opioid use was 24 % in patients with fibromyalgia seen in the FTP at a tertiary medical center. Our results demonstrate that opioid use is associated with adverse social factors and worse symptom severity and physical health in patients with fibromyalgia. To better deal with this problem in clinical practice, factors that predispose to opiod use in patients with fibromyalgia need to be further investigated.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-of-opioid-use-with-symptom-severity-and-quality-of-life-in-patients-with-fibromyalgia/