September 26, 2019

In a newly published Michigan study, nearly 1 in 3 adults with systemic lupus erythematosus used prescription opioids to treat pain despite lack of evidence that opioids effectively reduce pain from lupus and rheumatic diseases.

As people with lupus know only too well, symptoms of the disease commonly include pain in the joints and muscles as well as fibromyalgia characterized by dysregulation of pain processing in the central nervous system.

This study compared the use of opioids among 462 patients with SLE from the population-based Michigan Lupus Epidemiology and Surveillance (MILES) cohort versus 192 people without SLE.  Data showed that nearly one third (31%) of SLE patients were using prescription opioids during the study period (2014–2015), compared with 8% of persons without lupus. Among those people with lupus who were using opioids, about 70% were using them for over one year, and 22% were taking two or more opioid medications at the same time.

Study investigators pointed out that opioids are not necessarily effective for the pain experienced by people with lupus and fibromyalgia. “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.

Their paper expressed concern for long-term effects of opioid use by people with lupus: “In SLE, the combined contributions of underlying disease and adverse effects of immunosuppressive and glucocorticoid therapies already put patients at higher risk for some known adverse effects attributed to long-term opioid use. Addressing the widespread and long-term use of opioid therapy in SLE will require strategies aimed at preventing opioid initiation, tapering and discontinuation of opioids among patients who are not achieving treatment goals of reduced pain and increased function, and consideration of nonopioid pain management strategies.”

The conclusion advised that “given the risks for opioid therapy and the lack of pain efficacy data in SLE, it is important that clinicians managing SLE, including providers in EDs, be aware of the potential adverse effects of opioid therapy in these patients, consider nonopioid pain management strategies, and be familiar with guidance for opioid tapering or discontinuation when patients are not achieving treatment goals of reduced pain and increased function or when otherwise indicated.