Background/Purpose: Lyme disease is a tick-borne illness with three clinical phases: early localized, early disseminated, and late phase. Other nonspecific symptoms, such as fatigue, body aches, cognitive difficulty, and headaches, have been described and can last for months or years after the treatment of Lyme disease. While some studies suggest Lyme disease as a possible trigger for fibromyalgia, the association between these two conditions is not well understood.

Methods: In this observational, retrospective cohort study, we explore various outcomes in patients with Lyme disease compared to those without Lyme disease. We utilized the TrinetX database, which includes electronic health records from over 80 different global healthcare organizations.

We created two groups: the first cohort included patients with Lyme disease (284,817 patients), and the second cohort included patients without Lyme disease (105,921,542 patients). The outcomes investigated were fibromyalgia, chronic opiate use, depression, and opiate overdose/toxicity (occurring within 5 years after Lyme disease “index event”), using International Classification of Diseases, Tenth Revision (ICD-10) codes. We excluded patients who had chronic pain syndrome, fibromyalgia, opioid use, and depression before the diagnosis of Lyme disease.

Results: For fibromyalgia, there is an increased risk in the first cohort with Lyme disease (2.16% versus 0.567%), with a risk ratio (RR) of 3.806, P value < 0.0001, 95% CI (3.76–3.97). For chronic opiate use, the first cohort had an increased risk (0.42% versus 0.2%) with an RR of 2.05, P value < 0.0001, 95% CI (1.94–2.18). For depression, the first cohort also had an increased risk (5.75% versus 3.3%) with an RR of 1.74, P value < 0.0001, 95% CI (1.75–1.82). For opiate overdose, there was an increased risk for the first cohort (0.2% versus 0.11%) with an RR of 1.84, P value < 0.0001, 95% CI (1.69–2).

Conclusion: Lyme disease not only has immediate clinical impacts but can also result in long-term complications such as fibromyalgia and chronic pain syndrome. These complications can drive increased opioid use and the associated risks of dependency and overdose. Psychiatric disorders such as depression are often associated with fibromyalgia, further complicating the clinical picture. Despite the lack of evidence supporting the effectiveness of opioids for treating fibromyalgia and chronic pain syndrome, they are still frequently prescribed, potentially leading to harmful outcomes. Addressing the underlying causes of chronic pain and exploring alternative pain management strategies are crucial to improving outcomes for patients with a history of Lyme disease.

Limitations: The reliance on electronic health records may result in incomplete or inaccurate data capture. Additionally, the large size of the second cohort prevented propensity score matching, potentially introducing selection bias.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/exploring-long-term-complications-of-lyme-disease-insights-from-a-retrospective-cohort-study/