Despite treatment recommendations against the use of opioids for managing fibromyalgia (FM) pain, an estimated 30 percent of patients are treated with opioids. However, opioid-tapering recommendations are not developed for this patient group, according to a recent study.
For patients other than those facing addiction there is a lack of information about how to best taper opioid use, and clinicians lack guidance on how to take patients through a safe and tolerable withdrawal of opioid drugs.
While the use of methadone or partial agonists is often employed when addiction is present, FM patients often seek other pain management options and often do not want to substitute one opioid for another.
To better understand the specific needs of fibromyalgia patients at pain management clinics, the team behind a new study aimed to describe procedures and withdrawal characteristics of this specific patient group.
The work, “Opioid Tapering in Fibromyalgia Patients: Experience from an Interdisciplinary Pain Rehabilitation Program,” by Julie L. Cunningham and colleagues from the Mayo Clinic, was published in the journal Pain Medicine.
The study describes 55 fibromyalgia patients who tapered off opioids at the Mayo Clinic Pain Rehabilitation Center. In general, higher opioid doses required longer tapering times and had higher peak withdrawal symptoms.
The peak of withdrawal symptoms happened at varying times in patients that had been using opioids for different periods of time. In patients using opioids for fewer than two years, the peak appeared when the drug was reduced to 90 percent of the initial dose, while long-term users peaked at a 75 percent of dose reduction.
Researchers also explored how well the patients improved on a number of clinical measures: pain perception, pain catastrophizing, pain interference with life, symptoms of depression, health perception, and perceived life control.
Comparing the fibromyalgia patients on opioids to fibromyalgia patients enrolled in the program but not taking opioids, opioid users reported more pain, depression and pain interference with life at the start of the program. There were no differences in levels of pain catastrophizing, health perception, or perceived life control between the groups.
At the end of the program, the only different factor between the groups was the depression that remained more frequent in the opioid group.
The results suggest that tapering opioids without the addition of replacement opioid drugs, particularly if used in combination with cognitive behavioral methods, is an effective model for opioid discontinuation in fibromyalgia patients.