As pain is the cardinal symptom of fibromyalgia (FM), strategies directed towards pain relief are an integral component of treatment. Opioid medications comprise a category of pharmacologic treatments which have impact on pain in various conditions with best evidence for acute pain relief. Although opioid therapy other than tramadol has never been formally tested for treatment of pain in FM, these agents are commonly used by patients. We have examined the effect of opioid treatments in patients diagnosed with FM and followed longitudinally in a multidisciplinary pain center over a period of 2 years. In this first study reporting on health related measures and opioid use in FM, opioid users had poorer symptoms and functional and occupational status compared to nonusers. Although opioid users may originally have had more severe symptoms at the onset of disease, we have no evidence that these agents improved status beyond standard care and may even have contributed to a less favourable outcome. Only a formal study of opioid use in FM will clarify this issue, but until then physicians must be vigilant regarding the multiple adverse consequences of opioid therapy. 1. Introduction Chronic widespread pain is the pivotal symptom of fibromyalgia (FM). In the composite score that has been proposed for the new 2010 diagnostic criteria for FM, pain has been weighted to signify two thirds of the symptom component, with other symptoms including fatigue, sleep disturbance, cognitive changes, and somatic symptoms combined to represent the remaining one third of the symptom complex [1]. It is therefore logical that treatments directed towards pain relief will be an integral part of FM care. Traditional pharmacological treatments for managing pain are centered on simple analgesics, nonsteroidal anti-inflammatory drugs, and the opioid group of medications. Other than tramadol, opioids have never been formally studied as a therapeutic modality in FM and reports of efficacy are based solely on anecdotal and patient report [2]. Opioids are therefore not recommended by any current guidelines for the treatment of FM symptoms. Even in the absence of evidence for effect in FM, about 30% of Canadian and American FM patients reportedly using opioids [3, 4]. Opioids are also perceived by patients to offer the best symptom relief according to an internet survey of persons with self-reported FM [2]. There is however increasing concern regarding the negative effects associated with chronic opioid use, including an increased death rate especially in association with other agents such
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