A leading U.S. medical organization is urging its members not prescribe opioid painkillers to patients suffering from fibromyalgia, low back pain or headaches, because the risk of serious side effects outweighs the benefits of pain relief.
“Whereas there is evidence for significant short-term pain relief, there is no substantial evidence for maintenance of pain relief or improved function over long periods of time without incurring serious risk of overdose, dependence, or addiction,” wrote Gary M. Franklin, MD, in a position paper published in Neurology, the official medical journal of the American Academy of Neurology (AAN).
The Academy represents 28,000 neurologists and other healthcare providers who treat a wide variety of neurological disorders, including neuropathy, migraine, multiple sclerosis, epilepsy, and Alzheimer’s disease.
“It seems likely that, in the long run, the use of opioids chronically for most routine conditions, such as chronic low back pain, chronic headaches, or fibromyalgia, will not prove to be worth the risk,” said Franklin, a research professor in the Department of Environmental & Occupational Health Sciences at the University of Washington’s School of Public Health.
“Even for more severe conditions, such as destructive rheumatoid arthritis, sickle-cell disease, severe collagen disease, or severe neuropathic pain, prescribers need specific guidance on dosing, publicly available brief tools to effectively screen patients for risk, and guidance on how to monitor patients for early signs of severe adverse events, misuse, or opioid use disorder.”
Over 100,000 people have died from prescription opioid use since the late 1990s, according to Franklin, when policies were liberalized to promote the use of opioids for non-cancer pain. Studies have shown that about half of patients taking opioids for at least three months are still on opioids five years later.
“For some time the opioid data have failed to show significant benefit for headache, migraine, low back pain, irritable bowel disorder, and fibromyalgia; the AAN position paper is underscoring that opioids should be avoided in these conditions,” said Beth Darnall, PhD, a pain psychologist and author of Less Pain, Fewer Pills.
“We should be steering patients in the direction of non-pharmacologic treatments: pain psychology (where they may learn information, skills, and techniques to dampen pain processing), physical therapy, and acupuncture. These are just a few options. We know that chronic pain is best treated using a multidisciplinary approach.”
While opioid pain medications are generally not prescribed for fibromyalgia, nearly 60% of women with the disorder are currently taking opioids, according to a recent survey of over 2,400 women by National Pain Report.
“If chronic pain interferes with a person’s ability to function and participate in other treatment modalities, they should be treated with medication and other integrative therapies,” said Celeste Cooper, RN, a patient advocate and fibromyalgia sufferer who argues against a “one size fits all” approach to pain management.
“Some patients respond differently to certain medications, even within the same diagnosis population. In order words, we need a consistent plan for assessment, but individualized care plans. Success should not only be measured by a reduction of pain on the one to ten scale, it should also be measured by function. How is the patient able to socialize, maintain relationships, and contribute?”
The AAN is recommending that doctors consult with a pain management specialist if their patient’s dosage exceeds 80 to 120 (morphine-equivalent dose) milligrams per day. The Academy also recommends that its members take further steps to ensure that opioids are prescribed safely:
- Have an opioid treatment agreement with patients
- Screen patients for drug abuse and depression
- Give patients random urine drug screens
- Do not prescribe drugs such as sedative-hypnotics or benzodiazepines with opioids
- Utilize prescription drug monitoring programs (PDMPs) to see what medications patients are taking
“More research and information regarding opioid effectiveness and management is needed, along with changes in state and federal laws and policy to ensure that patients are safer when prescribed these drugs,” said Franklin.