Improved Physician Education Needed to Curb Opioid Use for Juvenile Fibromyalgia

Female gender, older age, and Caucasian race were the most likely predictors of opioid use in patients with juvenile fibromyalgia syndrome (JFMS), according to a study presented at the 2017 American College of Rheumatology/Association of Rheumatology Health Professionals

Annual Meeting.

“These findings suggest that increased physician education in inpatient settings and among anesthesiologists is needed to reduce opioid prescribing for JFMS,” Sabrina Gmuca, MD, an attending physician in the division of rheumatology at Children’s Hospital of Philadelphia, told Specialty Pharmacy Times. “Additionally, increased availability of mental health resources and non-pharmacologic treatment options might represent effective strategies to reduce opioid exposure among children with JFMS.”

Although no evidence supports their use in patients with adult fibromyalgia syndrome, approximately 30% of patients receive an opioid prescription, according to research from Fitzcharles et al.

“The prevalence of and risk factors for opioid prescribing for JFMS, however, have not been established,” Gmuca said.

Using US health care claims data, the researchers performed a retrospective cohort study on 25,321 patients with JFMS. Approximately 20% of the patients in this study received at least 1 prescription for an opioid medication. The most commonly prescribed opioids were codeine (70.4%), tramadol (20.0%), and oxycodone (13.5%).

The biggest factors associated with opioid exposure included female sex, older age, and Caucasian race, according to Gmuca. Opioid exposure risk was associated with at least 1 prior hospitalization (OR, 1.20, 95 % CI, 1.09-1.31) or at least 1 previous encounter with an anesthesiologist (OR, 1.97, 95% CI, 1.83-2.13). In addition, patients living in the western United States had an increased risk of opioid exposure (OR, 1.20; P<).

Children with at least 1 previous encounter for a diagnosis of anxiety (OR, 0.86, 95% CI, 0.78-0.95) or seen by a psychologist (OR, 0.67, 95% CI, 0.45-0.99) had a decreased risk of opioid exposure. Additionally, patients seen by a chiropractor (OR, 0.35) or an emergency medicine physician (OR, 0.83) had a decreased risk of opioid use, according to the study.