Open Access Open Access  Restricted Access Subscription or Fee Access

Opioid prescription patterns among patients with fibromyalgia

Caio V. M. Sarmento, PT, PhD, Mehrdad Maz, MD, Taylor Pfeifer, DPT, Marco Pessoa, PhD, Wen Liu, PhD


Objectives: To investigate opioid prescribing patterns among patients with fibromyalgia (FM) in terms of age, gender, race, type of opioids, and to examine changes in opioid prescription over the past 8 years compared to the US Food and Drug Administration (FDA)-approved FM medications.

Design: Retrospective review of data using the Healthcare Enterprise Repository for Ontological Narration database. The collected data were analyzed descriptively and a chi-square test for trend was used to analyze a possible linear relationship between the proportions of opioid and non-opioid users along the time.

Participants: Patients with a diagnosis of FM who had received opioid prescriptions from January 1, 2010 to December 31, 2017, and FM patients who had received prescriptions of FDA-approved FM medications in the same period.

Main outcome measure: Trends in opioid and non-opioid prescriptions in patients with FM.

Results: The opioid medications were prescribed more frequently in 2010 (40 percent) and 2011 (42 percent), but the percentages have decreased since 2012 and reached the lowest numbers in 2016 (27 percent). The chi-square test for trend shows that from 2010 to 2017 the prescriptions of opioids had a statistically significant (p < 0.0001) decrease.

Conclusion: This study suggests that the frequency of prescribed opioids in FM patients has decreased since 2012. This decline could be attributed to (1) FDA monitoring programs, (2) national efforts to increase awareness of the addictive and harmful effects of opioids, and (3) the growing research on the efficacy of non-opioid therapies to treat chronic pain conditions including FM.


fibromyalgia, opioid prescription, chronic pain management

Full Text:



Rudd RA, Seth P, David F, et al.: Increases in drug and opioid-involved overdose deaths—United States, 2010-2015. MMWR Morb Mortal Wkly Rep. 2016; 65(50-51): 1445-1452.

Chou R, Fanciullo GJ, Fine PG, et al.: Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009; 10(2): 113-130.

Centers for Disease Control and Prevention (CDC): CDC grand rounds: Prescription drug overdoses—A US epidemic. MMWR Morb Mortal Wkly Rep. 2012; 61(1): 10-13.

Benyamin R, Trescot AM, Datta S, et al.: Opioid complications and side effects. Pain Physician. 2008; 11(2 suppl): S105-S120.

Scholl L, Seth P, Kariisa M, et al.: Drug and opioid-involved overdose deaths—United States, 2013-2017. MMWR Morb Mortal Wkly Rep. 2018; 67(51-52): 1419-1427.

Soelberg CD, Brown RE Jr, Du Vivier D, et al.: The US opioid crisis: Current federal and state legal issues. Anesth Analg. 2017; 125(5): 1675-1681.

Suffoletto B, Lynch M, Pacella CB, et al.: The impact of a statewide mandatory prescription drug monitoring program on opioid prescribing by emergency medicine providers across 15 hospitals in a single health system. J Pain. 2018; 19(4): 430-438.

Lin HC, Wang Z, Boyd C, et al.: Associations between statewide prescription drug monitoring program (PDMP) requirement and physician patterns of prescribing opioid analgesics for patients with non-cancer chronic pain. Addict Behav. 2018; 76: 348-354.

Hwang CS, Turner LW, Kruszewski SP, et al.: Primary care physicians’ knowledge and attitudes regarding prescription opioid abuse and diversion. Clin J Pain. 2016; 32(4): 279-284.

Finnell JT, Twillman RK, Breslan SA, et al.: The role of continuing medical education in increasing enrollment in prescription drug monitoring programs. Clin Ther. 2017; 39(9): 1896-1902.e2.

Jahan F, Nanji K, Qidwai W, et al.: Fibromyalgia syndrome: An overview of pathophysiology, diagnosis and management. Oman Med J. 2012; 27(3): 192-195.

Painter JT, Crofford LJ: Chronic opioid use in fibromyalgia syndrome: A clinical review. J Clin Rheumatol. 2013; 19(2): 72-77.

Peng X, Robinson RL, Mease P, et al.: Long-term evaluation of opioid treatment in fibromyalgia. Clin J Pain. 2015; 31(1): 7-13.

Waitman LR, Warren JJ, Manos EL, et al.: Expressing observations from electronic medical record flowsheets in an i2b2 based clinical data repository to support research and quality improvement. AMIA Annu Symp Proc. 2011; 2011: 1454-1463.

Centers for Disease Control and Prevention: Annual Surveillance Report of Drug-Related Risks and Outcomes—United States, 2017. Surveillance Special Report 1. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services, 2017.

National Institute on Drug Abuse: Overdose Death Rates [Internet]. Bethesda, MD: National Institutes of Health, 2017.

Kim SC, Landon JE, Solomon DH: Clinical characteristics and medication uses among fibromyalgia patients newly prescribed amitriptyline, duloxetine, gabapentin, or pregabalin. Arthritis Care Res (Hoboken). 2013; 65(11): 1813-1819.

Halpern R, Shah SN, Cappelleri JC, et al.: Evaluating guideline-recommended pain medication use among patients with newly diagnosed fibromyalgia. Pain Pract. 2016; 16(8): 1027-1039.

Wolfe F, Walitt BT, Katz RS, et al.: Longitudinal patterns of analgesic and central acting drug use and associated effectiveness in fibromyalgia. Eur J Pain. 2013; 17(4): 581-586.

Curtis JR, Xie F, Smith C, et al.: Changing trends in opioid use among patients with rheumatoid arthritis in the United States. Arthritis Rheumatol. 2017; 69(9): 1733-1740.

Wen H, Schackman BR, Aden B, et al.: States with prescription drug monitoring mandates saw a reduction in opioids prescribed to medicaid enrollees. Health Aff (Millwood). 2017; 36(4): 733-741.

Bohnert AS, Valenstein M, Bair MJ, et al.: Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA. 2011; 305(13): 1315-1321.

Campbell G, Nielsen S, Bruno R, et al.: The pain and opioids in treatment study: Characteristics of a cohort using opioids to manage chronic non-cancer pain. Pain. 2015; 156(2): 231-242.

Sjogren P: Epidemiology of chronic pain and critical issues on opioid use. Pain. 2011; 152(6): 1219-1220.

Seal KH, Shi Y, Cohen G, et al.: Association of mental health disorders with prescription opioids and high-risk opioid use in US veterans of Iraq and Afghanistan. JAMA. 2012; 307(9): 940-947.

Hojsted J, Ekholm O, Kurita GP, et al.: Addictive behaviors related to opioid use for chronic pain: A population-based study. Pain. 2013; 154(12): 2677-2683.

Chou R, Turner JA, Devine EB, et al.: The effectiveness and risks of long-term opioid therapy for chronic pain: A systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2015; 162(4): 276-286.

Dowell D, Haegerich TM, Chou R: Contextual Evidence Review for the CDC Guideline for Prescribing Opioids for Chronic Pain—United States. Washington, DC: CDC Stacks, Public Health Publications, 2016. Available at Accessed May 18, 2018.

Goldenberg DL, Clauw DJ, Palmer RE, et al.: Opioid use in fibromyalgia: A cautionary tale. Mayo Clin Proc. 2016; 91(5): 640-648.

Zgierska A, Rabago D, Miller MM: Impact of patient satisfaction ratings on physicians and clinical care. Patient Prefer Adherence. 2014; 8: 437-446.

Biasi G, Manca S, Manganelli S, et al.: Tramadol in the fibromyalgia syndrome: A controlled clinical trial versus placebo. Int J Clin Pharmacol Res. 1998; 18(1): 13-19.

Bennett RM, Kamin M, Karim R, et al.: Tramadol and acetaminophen combination tablets in the treatment of fibromyalgia pain: A double-blind, randomized, placebo-controlled study.

Am J Med. 2003; 114(7): 537-545.

Coleman JJ: Rescheduling hydrocodone combination products: Addressing the abuse of America’s favorite opioid. ASAM Magazine. April 10, 2015.

Chambers J, Gleason RM, Kirsh KL, et al.: An online survey of patients’ experiences since the rescheduling of hydrocodone: The first 100 days. Pain Med. 2016; 17(9): 1686-1693.

Ballantyne JC: Opioids for the treatment of chronic pain: Mistakes made, lessons learned, and future directions. Anesth Analg. 2017; 125(5): 1769-1778.

Porreca F, Navratilova E: Reward, motivation, and emotion of pain and its relief. Pain. 2017; 158(suppl 1): S43-S49.

Kucyi A, Davis KD: The dynamic pain connectome. Trends Neurosci. 2015; 38(2): 86-95.

Bershad AK, Miller MA, Norman GJ, et al.: Effects of opioid-and non-opioid analgesics on responses to psychosocial stress in humans. Horm Behav. 2018; 102: 41-47.

Meghani SH, Byun E, Gallagher RM: Time to take stock: A meta-analysis and systematic review of analgesic treatment disparities for pain in the United States. Pain Med. 2012; 13(2): 150-174.

Burgess DJ, Nelson DB, Gravely AA, et al.: Racial differences in prescription of opioid analgesics for chronic noncancer pain in a national sample of veterans. J Pain. 2014; 15(4): 447-455.

Dunn KM, Saunders KW, Rutter CM, et al.: Opioid prescriptions for chronic pain and overdose: A cohort study. Ann Intern Med. 2010; 152(2): 85-92.

Rivat C, Ballantyne J: The dark side of opioids in pain management: Basic science explains clinical observation. Pain Rep. 2016; 1(2): e570.

Lunn MP, Hughes RA, Wiffen PJ: Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database Syst Rev. 2014; 2014 (1): CD007115.

Cording M, Derry S, Phillips T, et al.: Milnacipran for pain in fibromyalgia in adults. Cochrane Database Syst Rev. 2015; 2015 (10): CD008244.

Tzellos TG, Toulis KA, Goulis DG, et al.: Gabapentin and pregabalin in the treatment of fibromyalgia: A systematic review and a meta-analysis. J Clin Pharm Ther. 2010; 35(6): 639-656.

Kosten TR, George TP: The neurobiology of opioid dependence: Implications for treatment. Sci Pract Perspect. 2002; 1(1): 13-20.



  • There are currently no refbacks.