Fibromyalgia-related pain may exacerbate opioid addiction

Key takeaways:

• Among people with opioid use disorder and chronic pain, those with fibromyalgia had a greater risk of addiction exacerbation.
• This is the first study to establish that fibromyalgia may worsen opioid addiction.

People with opioid use disorder who also had fibromyalgia were more likely to have pain-related exacerbation of their addiction compared with people who had chronic pain without fibromyalgia, findings published in Pain showed.

“Many of the brain pathways and chemicals believed to be involved in fibromyalgia are also involved in opioid addiction,” O. Trent Hall, DO, a clinical assistant professor of psychiatry and behavioral health at The Ohio State University Wexner Medical Center in Columbus, said in a press release. “This overlap made us suspect fibromyalgia might worsen OUD. It’s sort of a double hit hypothesis.”

Hall and colleagues recruited 125 patients with pain and OUD at Wexner Medical Center’s Talbot Hall, an addiction treatment facility that provides hospitalization, intensive outpatient, counseling and other services. Participants responded to surveys that collected data on OUD criteria and demographics.

They also completed the American College of Rheumatology Fibromyalgia Survey (ACR-FMS) to assess bodily pain and related symptoms, the 36-item Research and Development Corporation Health Survey to assess health-related quality of life and a four-item pain-related OUD exacerbation scale (PrOUD ES). This scale identified pain-related reasons for OUD maintenance and escalation, as well as treatment delays and fear of relapse.

Most (96.8%) participants met criteria for severe OUD, and participants most commonly reported low back pain (79.2%), neck pain (36%) and upper back pain (34.4%). Scores on the ACR-FMS indicated that 39 (31.2%) participants met criteria for fibromyalgia.

Participants with fibromyalgia were more likely to recognize pain-related exacerbations of OUD on the PrOUD ES compared with other participants. Specifically, fibromyalgia increased the odds of pain-related OUD maintenance (OR = 2.31; 95% CI, 1.08-4.92), escalation (OR = 4.43; 95% CI, 1.98-9.92), OUD treatment delay (OR = 5.7; 95% CI, 1.26-25.9) and fear of relapse (OR = 2.51; 95% CI, 1.17-5.4).

“There are ways we can help people living with fibromyalgia,” Daniel J. Clauw, MD, senior author of the study and director of the Chronic Pain and Fatigue Research Center at the University of Michigan, said in the release. “It’s possible that combining lessons learned from years of studying fibromyalgia might one day inform new treatments for chronic pain and OUD. More research is needed. This is just the beginning.”

References:

• Fibromyalgia may worsen opioid addiction, study finds. https://www.eurekalert.org/news-releases/984248. Published March 28, 2023. Accessed April 4, 2023.
• Hall OT, et al. Pain. 2023;doi:10.1097/j.pain.0000000000002878.