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Clinical Journal of Pain:
doi: 10.1097/AJP.0000000000000079
Original Article: PDF Only

Long-Term Evaluation of Opioid Treatment in Fibromyalgia.

Peng, Xiaomei MD, PhD; Robinson, Rebecca L. MS; Mease, Philip MD; Kroenke, Kurt MD; Williams, David A. PhD; Chen, Yi MS; Faries, Douglas PhD; Wohlreich, Madelaine MD; McCarberg, Bill MD; Hann, Danette PhD

Published Ahead-of-Print
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Objectives: In a 12-month observational study, we evaluated the effect of opioid use on outcomes in 1700 adult patients with fibromyalgia (FM).

Methods: Data were evaluated using propensity-score-matching after patients were divided into cohorts based on their baseline medication use:(1) taking an opioid (concurrent use of tramadol was permitted); (2) taking tramadol (but no opioids); and (3) not taking opioids or tramadol. Changes in outcomes were assessed using the Brief Pain Inventory for severity and pain-related interference (BPI-S, BPI-I), Fibromyalgia Impact Questionnaire (FIQ), Patient Health Questionnaire for depression (PHQ-8), Insomnia Severity Index (ISI), Sheehan Disability Scale (SDS), 7-item Generalized Anxiety Disorder scale (GAD-7) and economic factors. Time to opioid or tramadol discontinuation was analyzed using Kaplan-Meier survival analyses.

Results: Compared with the opioid cohort, the non-opioid cohort demonstrated significantly greater reductions (P<0.05) in BPI-I, FIQ, PHQ-8, SDS and ISI; the tramadol cohort compared with the opioid group showed greater reductions on FIQ and ISI. Reductions in BPI-S and GAD-7 did not differ significantly among cohorts. Compared with the opioid cohort, patients in the tramadol cohort had fewer outpatient visits to healthcare providers. Few significant differences were found between the tramadol and non-opioid cohorts across outcomes.

Discussion: While pain severity was reduced over time in all cohorts, opioid users showed less improvement in pain-related interference with daily living, functioning, depression, and insomnia. Overall, the findings show little support for the long-term use of opioid medications in patients with FM given the poorer outcomes across multiple assessment domains associated with this cohort.

(C) 2014 by Lippincott Williams & Wilkins

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