By Adrienne Dellwo, About.com Guide October 5, 2011
A study published in the American Journal of Medicine discourages
long-term use of opioids for treating fibromyalgia pain.
In a review of charts at a multidisciplinary fibromyalgia clinic,
researchers found that 32% of patients were taking opioids (i.e.,
Vicodin, Percocet, OxyContin,) with more than 2/3 of them on strong
ones.
Researchers identified several characteristics that made people more
likely to be on long-term opioids: lower education, unemployment,
being on disability, current unstable psychiatric disorder, history of
substance abuse and prior suicide attempts. They also say they
"observed negative health and psychosocial status in patients using
opioids."
The paper supports the current medical opinion discouraging opioid use
in fibromyalgia and concludes that prolonged use requires evaluation.
It's common to hear doctors say that these drugs are ineffective in
fibromyalgia, but so far we have very little research to go on. The
patient community is divided, with some saying they don't work and
others saying they're the only drugs that do anything.
The issues of abuse and addiction complicate the matter, especially
with doctors afraid of serious legal consequences for what may be
considered improper prescribing.
As a fibromyalgia patient who's been on Vicodin for 5.5 years, I can
confidently say that these drugs do help me - and what's more, they're
the only ones I've been able to tolerate. I wish I didn't need to take
them, for several reasons, but the reality is that I do. It scares me
that someday I might not be able to get them anymore, and I'd be left
in pain and desperate. (And just for the record, no I am not addicted.
I take, on average, 1-2 pills a week - down from 1-2 per day a few
years ago - and I've never had a dosage increase.) What's more, I'm
concerned about being stereotyped by studies like this even though not
one of the characteristics describes me.
http://www.ncbi.nlm.nih.gov/pubmed/21962316
Am J Med. 2011 Oct;124(10):955-60.
Opioid use, misuse, and abuse in patients labeled as fibromyalgia.
Fitzcharles MA, Ste-Marie PA, Gamsa A, Ware MA, Shir Y.
Division of Rheumatology, McGill University Health Center, Montreal,
Quebec, Canada; Alan Edwards Pain Management Unit, McGill University
Health Center, Montreal, Quebec, Canada.
Abstract
BACKGROUND:
As pain is the cardinal symptom of fibromyalgia, it is logical that
treatments directed toward pain relief will be commonly used.
Analgesic drug therapy remains the traditional treatment intervention
for most chronic pain conditions, with a progressive increased use of
opioids in the past 20 years. Concerns about efficacy, risk-benefit
ratio, and possible long-term effects of chronic opioid therapy have
been raised. There is limited information about opioid treatment in
fibromyalgia, with all current guidelines discouraging opioid use.
METHODS:
A chart review of all patients referred to a tertiary care pain center
clinic with a referring diagnosis of fibromyalgia was conducted to
evaluate use of opioid medications.
RESULTS:
We have recorded opioid use by 32% of 457 patients referred to a
multidisciplinary fibromyalgia clinic, with over two thirds using
strong opioids. Opioid use was more commonly associated with lower
education, unemployment, disability payments, current unstable
psychiatric disorder, a history of substance abuse, and previous
suicide attempts.
CONCLUSION:
We have observed negative health and psychosocial status in patients
using opioids and labeled as fibromyalgia. Prolonged use of opioids in
fibromyalgia requires evaluation.
Copyright =A9 2011 Elsevier Inc. All rights reserved.
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