Fibromyalgia May Predict Pain-Related Opioid Use Disorder Exacerbation

Fibromyalgia may be a risk factor for pain-related exacerbation of opioid use disorder (OUD), according to study results published in Pain.

Researchers identified 125 adults with OUD who were included in a study conducted at the Ohio State University Wexner Medical Center Talbot Hall from July 7, 2021, to December 10, 2021. OUD was defined in this cohort as the presence of at least 2 out of 11 OUD criteria during the past 12 months, as outlined in the DSM-5. All participants also reported pain in at least 1 region of the body; most frequently low back pain (n=99; 79.2%).

Participants self-reported data using tablet computers to privately access the 2011 American College of Rheumatology Fibromyalgia Survey (ACR-FMS), which measured bodily pain and related symptoms, as well as the Pain-related OUD Exacerbation Scale (PrOUD ES).

The PrOUD ES scale was found to have a single-factor solution, strong internal consistency, and construct validity as 84% of participants agreed or strongly agreed with at least 1 PrOUD ES item. In total, 121 participants met criteria for severe OUD, 3 participants had moderate OUD and 1 had mild OUD. Moreover, participants (n=39; 31.2%) with ACR-FMS scores of 13 or higher met survey criteria for fibromyalgia; the mean total ACRFMS score was 10.57±4.622.

While all participants experienced pain, individuals with fibromyalgia demonstrated greater odds of acknowledging pain-related OUD exacerbations. In addition, most study participants reported seeking treatment for addiction to illicitly manufactured fentanyl (n=96; 76.8%), followed by heroin (n=43; 34.4%) and prescription opioids (n=27; 21.6%).

Limitations of the study included a lack of generalizability, as well as the cross-sectional design of the study, which prevented researchers from testing the relationship between fibromyalgia and observed OUD exacerbation. Moreover, the chronic nature of fibromyalgia pain is not completely characterized by ACR-FMS.

“We have demonstrated a promising new scale for measuring pain-related OUD exacerbations (PrOUD ES), as well as a novel methodology for studying fibromyalgia in OUD treatment settings where practitioners may lack specialized knowledge of musculoskeletal pain conditions,” the study authors concluded. “American College of Rheumatology Fibromyalgia Survey and PrOUD ES may be considered for use as patient reported outcome measures in OUD research. Additional studies are needed to further assess the psychometric properties of PrOUD ES and its relationship to pain catastrophizing,”

Disclosure: This research was supported by the Care Innovation and Community Improvement Plan (CICIP), a program of the Ohio Department of Medicaid. Please see the original reference for a full list of disclosures.