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Daily Dose: Long-term Opioid Use Affects 1 in 5 with Musculoskeletal Pain


Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On May 17, 2023, we reported on findings from a research letter published in the journal Annals of Rheumatic Diseases that examined the proportion of patients with rheumatic and musculoskeletal diseases (RMDs) that transition to long-term opioid use after treatment initiation.

The study

Researchers looked at 6 RMD conditions and used 3 definitions of long-term use from the contemporary literature. The team searched anonymized medical records of adults aged ≥18 years entered into the Clinical Practice Research Datalink, a nationally representative UK-wide primary care research database, for those with a diagnosis of rheumatoid arthritis, psoriatic arthritis (PsA), axial spondyloarthritis (AxSpA), systemic lupus erythematosus (SLE), osteoarthritis, and fibromyalgia and without prior cancer.

Included were patients with a new episode of opioid use, (ie, no opioid prescriptions in the prior 2 years), prescribed up to 6 months before or any time after receiving 1 of the 6 diagnoses between January 1, 2006, and October 31, 2021. Inclusion required at least 1 full year of follow-up data.

The findings

Investigators identified a total of 841 047 patients for inclusion in their analyses. The majority had a diagnosis of osteoarthritis (796 276) followed by fibromyalgia (21 189), rheumatoid arthritis (12 260), PsA (5195), SLE (3081), and AxSpa (3046). The research team reported 1 081 216 new episodes of opioid use among the cohort. Of these, 16.8% of patients transitioned to long-term use using the standard definition, 11.1% using the stringent definition, and 21.9% using the broad definition. More than 97% of the opioid initiation episodes meeting any of the 3 definitions were captured by the broad criteria. Slightly less than half fulfilled all 3, according to the results.

In contrast, the lowest rate of long-term opioid use was observed among the cohort of patients with osteoarthritis, with rates of 16.4%, 10.7% and 21.4% using the standard, stringent, and broad definitions, respectively.

Results of their analysis of trends in opioid use over time found statistically significant increases in the proportion of patients with fibromyalgia who transitioned to long-term opioid, which rose from 21.7% to 33.0% between 2006 and 2019 and reached 28.9% in 2020. The researchers observed a statistically significant decreasing trend among those with rheumatoid arthritis, but the overall proportion in 2020 remained high at 24.4%.

A note from authors

"The findings warrant vigilance in practice of opioid prescribing for RMDs since long-term opioid therapy is associated with poor outcomes (eg, opioid dependence and opioid-related adverse events). Health professionals should be aware of the high proportion of long-term opioid use in patients with RMDs. Introduction of prompt interventions, such as medication reviews or deprescribing, to ensure the appropriateness of long-term opioid therapy, and proactive consideration of nonpharmacological treatments for pain relief would also be of benefit to reduce avoidable harms in this patient population."

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