Prolonged Opioid Use in Patients with Fibromyalgia Linked to Depression and Sleep Disorders

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A retrospective cohort study of over 10,000 patients with fibromyalgia shed light on the impact of long-term (more than 90 days) opioid use, with results revealing increased risks of depression and sleep disorders compared with short-term use (less than 29 days). Additionally, while the risk of suicidal ideation was not initially significant, it became notable after 90 days of opioid use, highlighting the potential dangers of prolonged opioid treatment in fibromyalgia management.

Although opioids are not generally recommended to manage the symptoms of fibromyalgia, they are often prescribed to a significant percentage of patients as they may be beneficial short-term option when other strategies fail to provide pain relief.

“Sustained opioid use over time especially is associated to a myriad of potential, serious adverse outcomes and there is evidence that fibromyalgia is a predictor for long-term opioid use in older adults,” wrote a team of investigators including Aníbal García-Sempere, PhD, PharmD, real world evidence manager at the Foundation for the Promotion of Health and Biomedical Research of the Valencian Community (FISABIO) in Valencia, Spain. “However, little is known about the effect of long-term use of opioids on relevant fibromyalgia comorbidities in patients with fibromyalgia.”

Patients with fibromyalgia often report symptoms of depression and poor sleep quality, which could in turn increase the risk of suicidal ideation. To evaluate the association of long-term opioid prescription with these outcomes compared with short-term use among patients with fibromyalgia, investigators collected data from the Valencia Health System Integrated Database (VID), which covers a population of approximately five million individuals, to identify the records of all adults with fibromyalgia who received an initial prescription to opioids between January 2014 and September 2018.

A total of 10,334 patients received either short-term (80.40%) or long-term (19.60%) prescription opioids for their fibromyalgia within the four-year period. Compared with the short-term group, patients in the long-term group were more likely to be women (89.4% vs 69.59%, respectively), had more anxiety (68.9% vs 51.9%, respectively) and depression (45.1% vs 25.9%, respectively), and were more likely to be diagnosed with a sleep disorder (36.4% vs 25.9%, respectively).

Patients who initiated long-term use had an increased risk of depression and sleep disorders compared with short-term users, but suicidal ideation did not increase with the first 90 days. However, an increase in suicidal thoughts was observed after the initial 90-day period.

Although the study was the first to assess the impact of long-term opioid use compared with short-term use on these outcomes in this patient population, investigators noted some important limitations. First, databases like the VID are susceptible to misclassification bias, differential recording or missing data. Additionally, investigators excluded certain patients, including those who initiated opioid treatments lasting more than 30 days but less than 90 days, or those not treated with opioids. With this specific eligibility criteria, the results indicated short-term opioid treatment was safer than long-term treatment, although findings should be interpreted with caution.

“Opioids are not recommended to treat pain in patients with fibromyalgia and may worsen common fibromyalgia comorbidities, such as sleep and depression disorders,” investigators wrote. “However, they are routinely employed in clinical practice, and when used for prolonged periods they may lead to worse outcomes. Our results are in line with recommendations to avoid long-term opioid therapy in patients with fibromyalgia.”