Session Type: Abstract Submissions (ACR)
Background/Purpose: Fibromyalgia (FM) is a chronic disease of unknown etiology characterized by diffuse pain leading to fatigue, unrefreshing sleep and mood disturbances. The Fibromyalgia Activity Study with Tens (FAST) is a randomized controlled multicenter trial designed to evaluate the efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) for FM. We have found that at baseline, approximately 40% of patients enrolled in FAST have been prescribed chronic opioids. Data supporting opioid efficacy for FM is lacking and they are not recommended by professional societies. The purpose of this study is to compare the baseline characteristics of FAST participants who are taking opioids to those who are not.
Methods: Patients screened for FAST (n = 44) wore ActiGraph wGT3X-BT accelerometers for 7 days prior to each visit and were evaluated by pre-randomization baseline data. These included the Demographic Health History questionnaire, the Fibromyalgia Impact Questionnaire-Revised (FIQR), the Short-form-36 Health Survey (SF-36), the Brief Pain Inventory (BPI), the Pain Self-Efficacy Questionnaire (PSEQ), the Pain Catastrophizing Scale (PCS), and others. These results were compared between patients separated into a non-opioid vs. opioid classifications (n = 25 vs. n = 19). These data were analyzed using two-sample Wilcoxon rank-sum (Mann-Whitney) test and Fisher’s exact test with significance set at P ≤ 0.05.
Results: There were no significant differences between the two groups in terms of age, sex, race, education, income level, marital status, years diagnosed with FM, smoking history, and activity level as measured by actigraphy. FIQR scores, the main disease activity measure for FAST, between non-opioid and opioid users (median: 55.6; IQR: 49.5-63.6 vs. 53.1; 47.9-75.6; P = 0.17), and the SF-36, a quality of life measure, did not differ across domains except for General Health, which was lower in opioid patients (median: 38.9; IQR: 34.2-43.7 vs. 33.2; 26.1-38.9; P = 0.05). Patients in the opioid group had significantly lower ratings on the PSEQ (median: 25.5; IQR: 14.0-34.0 vs. 37.0; 25.5-49.5), which assesses patients’ confidence to accomplish specific tasks despite concurrent pain (P = 0.01). In addition, PCS total scores, which measure negative thoughts experienced during pain, were significantly higher in the opioid group (median: 22.0; IQR: 13.0-35.0 vs. 10.5; 6.0-23.0; P= 0.02), although pain severity was not significantly different based on BPI.
Conclusion: These data suggest an association between opioid use, pain catastrophizing and low levels of pain self-efficacy. The reasons for these associations are not clear, but it is possible that patients with these characteristics are more likely to be prescribed opioids. There is no evidence that patients on opioids have improved disease activity or better health outcomes than those not on opioids.
C. P. Chung,
L. Alemo Munters,
L. J. Crofford,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/fibromyalgia-patients-taking-opioids-have-low-self-efficacy-and-high-pain-catastrophizing-but-no-reduction-in-pain-or-improvement-in-activity/