Chronic Opioid Use in Fibromyalgia Syndrome. A "worrisome trend"

http://www.ncbi.nlm.nih.gov/pubmed/23364665

J Clin Rheumatol. 2013 Jan 29. [Epub ahead of print]

Chronic Opioid Use in Fibromyalgia Syndrome: A Clinical Review.

Painter JT, Crofford LJ.

Source

From the *Division of Pharmaceutical Evaluation & Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR; and †Division of Rheumatology & Women's Health College of Medicine, Department of Internal Medicine, University of Kentucky, Lexington, KY.

Abstract

ABSTRACT: Chronic opioid therapy in the treatment of chronic nonmalignant pain has increased drastically over the past decade. This is a worrisome trend in general, but specifically, given pathophysiologic characteristics seen in fibromyalgia (FM) syndrome patients, the use of this class of medication deserves special scrutiny. We first describe the current understanding of the etiology and pathophysiology of FM, including the role of genetic and environmental factors in the development of this syndrome. We then discuss the biologic effects of opioid use. Next, we review the pharmaceutical treatment options for FM, including 3 Food and Drug Administration-approved medications, and the evolution of treatment guidelines since 2004. We then highlight the various consequences associated with the mechanism of action of opioids and the specific concerns for FM patients. Finally, summarizing the existing literature, we make the case that chronic opioid use is inappropriate in the treatment of FM because of the interaction of unique pathophysiologic characteristics of the patients and effects associated with chronic opioid use.