Summary: Pain associated with fibromyalgia may put patients at risk of developing opioid use disorder, a new study reports.
Source: Ohio State University
There is new evidence that fibromyalgia, and the chronic pain associated with it, could worsen opioid use disorder. Researchers at The Ohio State University Wexner Medical Center, College of Medicine and University of Michigan report their findings in Pain.
Scientists have long suspected a connection between opioid use disorder (OUD) and chronic pain. Many people first use opioids to treat pain. Chronic pain has been tied to worsening of OUD and even relapse among those in recovery from opioid addiction.
However, researchers didn’t know whether all pain has the same effect on OUD, or whether certain pain diagnoses might have a much larger impact. Different impacts might lead to more targeted treatments for people with pain and OUD.
Symptoms of fibromyalgia include widespread body pain, extreme tiredness and difficulty thinking and sleeping. This condition is thought to involve unusually strong pain signals in the brain.
“Many of the brain pathways and chemicals believed to be involved in fibromyalgia are also involved in opioid addiction. This overlap made us suspect fibromyalgia might worsen OUD. It’s sort of a double hit hypothesis,” said Dr. O. Trent Hall, lead author and an addiction medicine physician in Ohio State’s Department of Psychiatry and Behavioral Health.
The research team surveyed 125 people living with pain and OUD, 39 (31%) of whom met criteria for fibromyalgia. Although all participants had pain and OUD, those with fibromyalgia were much more likely to say pain had worsened their addiction.
Specifically, those with fibromyalgia more often agreed that pain caused them to continue and increase their opioid use, and that they put off seeking help out of fear their pain would be unbearable if they stopped using opioids.
“These are serious findings. Worries about pain may cause people with fibromyalgia and OUD to delay getting addiction treatment. In our current overdose crisis, every day a person puts off OUD treatment might be the last day of their life,” said Dr. Julie Teater, study co-author and medical director of addiction medicine at Ohio State Wexner Medical Center.
Researchers also found fibromyalgia was associated with greater odds of fearing that pain might cause relapse in the future.
“There are ways we can help people living with fibromyalgia. 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,” said senior author Dr. Daniel J. Clauw, director of the Chronic Pain and Fatigue Research Center at the University of Michigan.
Craig Bryan and Dr. K. Luan Phan from Ohio State were also involved in this research.
About this addiction and pain research news
Original Research: Open access.
“Fibromyalgia predicts increased odds of pain-related addiction exacerbation among individuals with pain and opioid use disorder” by Orman Trent Hall et al. Pain
Fibromyalgia predicts increased odds of pain-related addiction exacerbation among individuals with pain and opioid use disorder
Fibromyalgia and opioid use disorder (OUD) are highly impactful chronic illnesses with substantially overlapping psychosocial, biological, and clinical features. Little previous research has examined interactions between fibromyalgia and OUD. Limiting such research has been the previous requirement of a clinical examination to diagnose fibromyalgia.
The 2011 American College of Rheumatology Fibromyalgia Survey (ACR-FMS) is a validated self-report instrument with high sensitivity and specificity for fibromyalgia intended to enable fibromyalgia research in settings where a clinical examination is impractical.
The present observational study uses the ACR-FMS to determine whether fibromyalgia affects odds of acknowledging pain-related OUD exacerbations among a sample of participants with pain and OUD.
Participants with pain and OUD (n = 125) were recruited from an academic substance use treatment facility. The ACR-FMS, along with an original scale measuring pain-related OUD exacerbation—the Pain-related OUD Exacerbation Scale—was administered through an electronic survey. The factor structure, internal consistency, and construct validity of Pain-related OUD Exacerbation Scale were tested.
In addition, descriptive analyses, multiple hierarchical linear regression, ordinal logistic regression, and multinomial logistic regression analyses were performed.
Although all participants had pain, those with fibromyalgia demonstrated significantly greater odds of acknowledging pain-related OUD exacerbations. Pain-related OUD Exacerbation Scale was found to have a single-factor solution, strong internal consistency, and construct validity.
This study provides first evidence of fibromyalgia as a risk factor for pain-related exacerbation of OUD and introduces a new scale with promising psychometric properties to measure pain-related OUD exacerbation.