Emily C. Somers
During 2014 to 2015, nearly one-third of patients with systemic lupus erythematosus in a Michigan-based cohort used prescription opioids, with about two-thirds of those users doing so for more than 1 year, according to data published in Morbidity and Mortality Weekly Report.
“Both intermittent and chronic musculoskeletal pain, as well as fibromyalgia (considered a centralized pain disorder due to dysregulation of pain processing in the central nervous system), are common in SLE,” Emily C. Somers, PhD, of the University of Michigan, Ann Arbor, and colleagues wrote. “Opioids are generally not indicated for long-term management of musculoskeletal pain or centralized pain (fibromyalgia) because of lack of efficacy, safety issues ranging from adverse medical effects to overdose, and risk for addiction.”
In an interview with Healio Rheumatology, Somers added, “This study finds a very high level of long-term prescription opioid use in systemic lupus erythematosus that was previously unrecognized.”
To analyze prescription opioid use among patients with SLE, Somers and colleagues studied data from the Michigan Lupus Epidemiology and Surveillance (MILES) Cohort. According to the researchers, the MILES cohort includes patients with SLE from the precursor MILES Surveillance Registry, which contained data on patients with SLE during 2002 to 2005 in Wayne and Washtenaw counties — which includes Detroit and Ann Arbor — in Southeastern Michigan. All patients in the MILES Registry who still lived in or near this region during the 2014 to 2015 recruitment period were eligible for inclusion.
During 2014 to 2015, nearly one-third of patients with SLE in a Michigan-based cohort used prescription opioids, according to data.
Somers and colleagues included 462 patients with SLE from the MILES cohort, as well as 192 nonpatients recruited from a random sample of households in the region, in their study. Nonpatients were frequency-matched to those with SLE based on age, sex, race and county of residence. The researchers collected data through structured interviews during February 2014 to September 2015. Participants self-reported all prescription medications they were taking at that time, and the duration of use. Patient-reported outcome measures included fibromyalgia, pain and physical function and depression and anxiety.
The researchers used Chi-squared tests or independent two-sample t-tests to compare between groups. In addition, they used two multivariable logistic regression models to analyze factors associated with opioid use in both the total study population and among patients with SLE specifically.
According to the researchers, 31% of patients with SLE patients used prescription opioids during the study period, compared with 8% of those without SLE (P < .001). Among patients with SLE who used opioids, 68% had been taking them for more than 1 year, and 22% were on two or more opioid drugs at the same time. Patients with SLE who visited the ED were approximately twice as likely to use prescription opioids, compared with patients with SLE who had not gone to the ED (OR = 2.1; 95% CI, 1.3-3.6).
“Nearly one in three adults with lupus use prescription opioids for pain, often for longer than a year, despite lack of evidence that opioids effectively reduce pain from lupus and other rheumatic diseases,” Somers told Healio Rheumatology. “Health professionals need to consider safer and more effective nonopioid pain management strategies in these patients.”
“There is a need for improved dialogue related to pain management between patients with lupus and their health care team,” she added. “Safer and more effective strategies, including nondrug options such as physical activity and chronic disease self-management education, are important considerations as part of a comprehensive approach to pain management.” – by Jason Laday
Disclosure: Somers reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.