From the Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL.
Department of Global Health, Baylor College of Medicine, Houston, TX.
J Clin Rheumatol. 2021 Aug 1;27(5):187-193. doi: 10.1097/RHU.0000000000001273.
BACKGROUND/OBJECTIVE: The aim of this cross-sectional study is to determine the prevalence of opioid use in a large sample of fibromyalgia (FM) patients and examine the factors associated with opioid prescription/use despite multiple clinical guidelines that do not recommend opioid use in this population.
Data were collected from a convenience sample of 698 patients admitted from August 2017 to May 2019 into an intensive 2-day Fibromyalgia Treatment Program at a tertiary medical center in the United States after FM diagnosis. Patients were administered the Fibromyalgia Impact Questionnaire-Revised, the Center for Epidemiologic Study of Depression Scale, and the Pain Catastrophizing Scale upon admission to the program. Demographic information and opioid use were self-reported. Logistic regression analysis was utilized to determine associations between patient-related variables and opioid use in this prospective study.
Of 698 patients, 27.1% (n = 189) were taking opioids at intake. Extended duration of symptoms (>3 years), increased age, higher degree of functional impairment, and increased pain catastrophizing were significantly associated with opioid use.
Opioids are not recommended for the treatment of FM under current guidelines. Greater burden of illness appeared to be associated with the prescription and use of opioids in this population. These findings suggest that some providers may not be aware of current recommendations that have been found to be effective in the management of FM that are contained in guidelines. Alternative approaches to the management of FM that do not involve opioids are reviewed in an effort to improve care.
背景/目的：本横断面研究旨在确定大量纤维肌痛 (FM) 患者中阿片类药物使用的流行率，并研究与阿片类药物处方/使用相关的因素，尽管有多项临床指南不建议在该人群中使用阿片类药物。
数据来自美国一家三级医疗中心的一个强化 2 天纤维肌痛治疗计划的便利样本，该计划于 2017 年 8 月至 2019 年 5 月期间纳入了 698 名经诊断为 FM 的患者。患者在入院时接受了纤维肌痛影响问卷修订版、流行病学研究中心抑郁量表和疼痛灾难化量表的评估。人口统计学信息和阿片类药物使用情况为自我报告。逻辑回归分析用于确定前瞻性研究中患者相关变量与阿片类药物使用之间的关联。
在 698 名患者中，27.1%（n=189）在入组时正在服用阿片类药物。症状持续时间延长（>3 年）、年龄较大、功能障碍程度较高以及疼痛灾难化程度较高与阿片类药物使用显著相关。
根据当前指南，不建议将阿片类药物用于 FM 的治疗。在该人群中，疾病负担的增加似乎与阿片类药物的处方和使用相关。这些发现表明，一些提供者可能不知道包含在指南中的、已被发现对 FM 管理有效的当前建议。为了改善护理，我们回顾了不涉及阿片类药物的 FM 管理的替代方法。
