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Opioids in Fibromyalgia — SCE Rheumatology MCQ

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EasySoft Tissue RheumatologyOpioids in FibromyalgiaSCE Rheumatology

A 50-year-old woman with fibromyalgia has persistent widespread pain despite education, exercise therapy, cognitive behavioural therapy and trials of antidepressant treatment. She asks whether an opioid should now be started. Which statement best reflects current UK guidance?

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Correct answer: C — Do not initiate an opioid for fibromyalgia because effectiveness is unproven and the potential harms are significant

Fibromyalgia is included by NICE within chronic primary pain. NICE NG193 recommends that opioids should not be initiated for chronic primary pain because effectiveness has not been demonstrated and opioid exposure carries important risks, including dependence and other long-term harms. Therefore, no strong or weak opioid should routinely be started specifically for fibromyalgia. The 2017 EULAR recommendations strongly opposed strong opioids but gave tramadol a weak recommendation for severe pain; that historical qualification does not override the later UK-specific NICE recommendation. Morphine, fentanyl and codeine have no established disease-modifying role, and transdermal administration does not remove dependence or other opioid-related risks. Management should remain individualised and predominantly non-pharmacological, with appropriate review of diagnosis, function, sleep and psychological factors.

Reference: National Institute for Health and Care Excellence. Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. NICE guideline NG193, recommendation 1.2.10 and Terms used in this guideline. 2021. https://www.nice.org.uk/guidance/ng193/chapter/recommendations