Division of Rheumatology, McGill University Health Center, Montreal, Quebec, Canada.
Am J Med. 2011 Oct;124(10):955-60. doi: 10.1016/j.amjmed.2011.05.031.
As pain is the cardinal symptom of fibromyalgia, it is logical that treatments directed toward pain relief will be commonly used. Analgesic drug therapy remains the traditional treatment intervention for most chronic pain conditions, with a progressive increased use of opioids in the past 20 years. Concerns about efficacy, risk-benefit ratio, and possible long-term effects of chronic opioid therapy have been raised. There is limited information about opioid treatment in fibromyalgia, with all current guidelines discouraging opioid use.
A chart review of all patients referred to a tertiary care pain center clinic with a referring diagnosis of fibromyalgia was conducted to evaluate use of opioid medications.
We have recorded opioid use by 32% of 457 patients referred to a multidisciplinary fibromyalgia clinic, with over two thirds using strong opioids. Opioid use was more commonly associated with lower education, unemployment, disability payments, current unstable psychiatric disorder, a history of substance abuse, and previous suicide attempts.
We have observed negative health and psychosocial status in patients using opioids and labeled as fibromyalgia. Prolonged use of opioids in fibromyalgia requires evaluation.
疼痛是纤维肌痛的主要症状，因此针对缓解疼痛的治疗方法将被广泛应用是合乎逻辑的。在过去的 20 年中，镇痛药物治疗仍然是大多数慢性疼痛疾病的传统治疗干预措施，阿片类药物的使用逐渐增加。人们对其疗效、风险-效益比以及长期使用的可能影响表示担忧。关于纤维肌痛中阿片类药物治疗的信息有限，所有现行指南都不鼓励使用阿片类药物。
对转诊至三级护理疼痛中心门诊、以纤维肌痛为转诊诊断的所有患者进行图表回顾，以评估阿片类药物的使用情况。
我们记录了在转诊至多学科纤维肌痛诊所的 457 名患者中，有 32%的患者使用了阿片类药物，其中超过三分之二的患者使用了强效阿片类药物。阿片类药物的使用与较低的教育程度、失业、残疾津贴、当前不稳定的精神疾病、药物滥用史和以前的自杀企图更相关。
我们观察到使用阿片类药物并被诊断为纤维肌痛的患者存在负面的健康和社会心理状况。纤维肌痛患者长期使用阿片类药物需要进行评估。
