Addiction to opioids may be exacerbated by fibromyalgia-related pain

Both fibromyalgia and opioid use disorder (OUD) are severe chronic disorders with many common behavioral, molecular, and clinical characteristics. Certain previous studies have investigated the association between fibromyalgia and OUD interaction, but the requirement for a clinical evaluation to identify fibromyalgia has restricted such studies. According to research published in the journal Pain, patients with OUD who also have fibromyalgia are more likely to experience a worsening of their addiction due to the disease-associated pain.

Trent Hall and co-researchers conducted the observational study using the 2011 American College of Rheumatology Fibromyalgia Survey (ACR-FMS) to assess whether fibromyalgia impacts a sample of participants with pain and OUD’s propensity to report pain-related OUD exacerbations. Both the Pain-related OUD Exacerbation Scale and the ACR-FMS were administered through an online survey to 125 participants. Experts reported pain levels in some patients, but those with fibromyalgia had a considerably higher propensity to report pain-related OUD exacerbations. Strong internal consistency, construct validity, and a single-factor solution were discovered for the Pain-related OUD Exacerbation Scale. This work develops a novel scale with promising psychometric features to quantify pain-related OUD aggravation and offers the first evidence of fibromyalgia as a risk factor for this condition.

In 2022, Hall et al. provided preliminary evidence that central sensitization (CS) might explain previously noted relationships between clinically important characteristics of chronic pain and OUD. The degree of CS, pain interference, and health-related quality of life showed predicted associations. Moreover, a positive correlation was found between the degree of CS and a stronger acceptance of pain as a contributing factor in OUD development, maintenance, escalation, treatment resistance, and relapse. Individuals who met the criteria for fibromyalgia in the 2011 ACR-FMS (criterion 13) were found to endorse pain more frequently as a factor in delaying OUD treatment, continuing and increasing opioid usage, and triggering OUD relapse.

The present study is the first to demonstrate an association between fibromyalgia and the exacerbation of opioid addiction. These findings might have implications for future mechanistic research and precision medicine. The results also underscore the importance of addressing fibromyalgia in treating opioid addiction to improve patient outcomes and quality of life.”

References 

  1. Hall OT, Teater J, Entrup P, Deaner M, Bryan C, Harte SE, Kaplan CM, Phan KL, Clauw DJ. Fibromyalgia predicts increased odds of pain-related addiction exacerbation among individuals with pain and opioid use disorder. Pain. 2022 May 13:10-97.
  2. Hall OT, Teater J, Rood KM, Phan KL, Clauw DJ. Central sensitization in opioid use disorder: a novel application of the American College of Rheumatology Fibromyalgia Survey Criteria. Pain Reports. 2022 Jul;7(4). 
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