Understanding Opioids in Fibromyalgia

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Fibromyalgia is common, affecting around 2% of people in the general population.1,2 The 2017 EULAR recommendations state that tramadol – a weak opioid – may be considered for pain management in fibromyalgia, but advise against use of strong opioids due to lack of evidence of efficacy, and the high risk of side effects and addiction.3 However, with limited therapeutic options available to tackle this condition, opioids are frequently used in clinical practice.

The impact of the opioid epidemic in North America has caused concern around the world. Long-term opioid use is associated with potential harm and adverse outcomes. In their abstract presented at the 2023 annual congress, in a session on Pain in RMDs, Ramirez Medina and colleagues argue that understanding the factors associated with long-term opioid use in such patients is the first step in helping to develop targeted interventions for de-prescribing.

The team conducted a retrospective cohort study using data from the Clinical Practice Research Datalink (CPRD) – a UK database of electronic health records from primary care. Overall, 28,554 fibromyalgia patients without prior cancer who were new opioid users between 2006 and 2021 were included. Long-term opioid use was defined as having at least three opioid prescriptions within a 90-day period, or at least one prescription lasting 90 days or more in the first year of follow-up.

Findings show that 26% of new opioid users became long-term users in the first year. Several factors were associated with higher risk of long-term opioid use. These included mean daily morphine milligram equivalents (MME) at initiation, history of suicide and self-harm, substance use disorder, deprivation, and obesity. Modelling showed that, of these, the three most important variables were mean MME/day at initiation, history of suicide and self-harm, and deprivation.

This information supports the EULAR position on strong opioid use, and may help clinicians when making prescribing decisions for patients with fibromyalgia.


Ramirez Medina C, et al. Factors associated with long-term opioid use in fibromyalgia patients newly started on an opioid: results using UK primary care electronic patient records. Presented at EULAR 2023; Abstract OP0197.


1. Queiroz LP. Worldwide epidemiology of fibromyalgia. Curr Pain Headache Rep 2013;17:356.

2. Wolfe F, et al. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum 1995;38:19–28.

3. Macfarlane GJ, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis 2017;76:318–28.


EULAR is the European umbrella organisation representing scientific societies, health professional associations and organisations for people with rheumatic and musculoskeletal diseases (RMDs). EULAR aims to reduce the impact of RMDs on individuals and society, as well as improve RMD treatments, prevention, and rehabilitation. To this end, EULAR fosters excellence in rheumatology education and research, promotes the translation of research advances into daily care, and advocates for the recognition of the needs of those living with RMDs by EU institutions.

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