VA HSRD Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, and the University of Arkansas for Medical Sciences, Division of Pharmaceutical Evaluation and Policy, Little Rock, AR, USA.
J Clin Rheumatol. 2013 Mar;19(2):72-7. doi: 10.1097/RHU.0b013e3182863447.
Chronic opioid therapy in the treatment of chronic nonmalignant pain has increased drastically over the past decade. This is a worrisome trend in general, but specifically, given pathophysiologic characteristics seen in fibromyalgia (FM) syndrome patients, the use of this class of medication deserves special scrutiny. We first describe the current understanding of the etiology and pathophysiology of FM, including the role of genetic and environmental factors in the development of this syndrome. We then discuss the biologic effects of opioid use. Next, we review the pharmaceutical treatment options for FM, including 3 Food and Drug Administration-approved medications, and the evolution of treatment guidelines since 2004. We then highlight the various consequences associated with the mechanism of action of opioids and the specific concerns for FM patients.Finally, summarizing the existing literature, we make the case that chronic opioid use is inappropriate in the treatment of FM because of the interaction of unique pathophysiologic characteristics of the patients and effects associated with chronic opioid use.
在过去十年中，慢性阿片类药物治疗慢性非恶性疼痛的疗法有了大幅增加。这是一个普遍令人担忧的趋势，但具体而言，鉴于纤维肌痛（FM）综合征患者的病理生理特征，此类药物的使用值得特别审查。我们首先描述了对 FM 的病因和病理生理学的当前理解，包括遗传和环境因素在该综合征发展中的作用。然后，我们讨论了阿片类药物使用的生物学效应。接下来，我们回顾了 FM 的药物治疗选择，包括 3 种获得美国食品和药物管理局批准的药物，以及自 2004 年以来治疗指南的演变。然后，我们重点介绍了与阿片类药物作用机制相关的各种后果以及 FM 患者的具体关注点。最后，总结现有文献，我们认为慢性阿片类药物的使用不适合 FM 的治疗，因为患者的独特病理生理特征以及与慢性阿片类药物使用相关的影响。
