Study finds patients with fibromyalgia may have heightened risk of death

18th July 2023

Patients with fibromyalgia may have a heightened risk of death as a result of vulnerability to accidents, infections and, especially, suicide, researchers have warned.

The results suggest ‘fibromyalgia should be taken seriously’ with a need for regular monitoring of patients’ physical and mental health to minimise these risks, they concluded.

Published in the journal RMD Open, the systematic review of eight studies covering more than 188,000 patients found a 27% increased risk of death from all causes for patients diagnosed with the condition under more modern criteria from 2010 onwards.

All the adults in the review had other co-existing conditions, the researchers said, and they also reported a 44% increased risk of infections, including pneumonia and septicaemia, and more than three times the risk for suicide. 

For accidents, the risk was 5% higher, but the risk of death from cancer was 12% lower than it was for the general population of the same age.

Whether the heightened risk is due to the fibromyalgia itself or the concomitant conditions is unclear, but it is an important finding that needs to be looked at in further research, the authors concluded.

Fibromyalgia prevalence increasing

It’s not clear what causes fibromyalgia, but its prevalence is increasing and there is growing recognition that the condition often coexists with other health problems, including rheumatic, gut, neurological and mental health disorders.

The higher risk of suicide could potentially be explained by the physical, and especially the psychiatric, comorbidities that are characteristic of fibromyalgia patients, the researchers said.

And increased mortality associated with accidents could stem from fatigue, unrefreshing sleep and the concentration difficulties linked to the condition.

When it comes to infection, increasing evidence supports immune system involvement and inflammation in the development of fibromyalgia, they added.

‘A serious public health problem’

The risks identified in their analysis ‘could represent a serious public health problem, given the high prevalence of the condition’, which clinicians don’t always take seriously, they wrote.

‘Studies have shown that medical staff are reluctant to accept fibromyalgia as a medical condition, and they face emotional and psychological difficulties interacting with these patients and coping with their disorder.

‘Our review provides further proof that fibromyalgia patients should be taken seriously, with particular focus on screening for suicidal ideation, prevention of accidents, and prevention and treatment of infections.’

A 2020 study by UK researchers found an increased risk of self-harm associated with some rheumatic conditions, particularly fibromyalgia where the incidence was found to be highest.

Author of this 2020 study, Carolyn Chew-Graham, a GP and professor of general practice research at Keele University, said: ‘In our research we concluded clinicians need to be aware of the potential for self-harm in patients with rheumatic conditions (particularly fibromyalgia), explore mood and risk with them, and offer appropriate support and management.’

Long-term opioid use risk in one in three patients with rheumatic and MSK conditions

19th May 2023

Patients with rheumatic and musculoskeletal conditions are particularly vulnerable to long-term opioid use, new research has found.

A study of GP research database between 2006 and 2021 found one in three of those with rheumatoid arthritis or fibromyalgia had received long-term prescriptions for the potentially addictive drugs to manage their pain.

Overall, the team analysed more than 840,000 patient records and looked at different patterns of opioid use depending on frequency and number of prescriptions.

There were 1,081,216 new episodes of opioid use among all patients with just under 17% transitioning to ‘standard’ long-term use, defined as three or more prescriptions within a 90-day period, or more than 90 days supply in the first year.

Another 11% were categorised as having ‘stringent’ opioid prescribing with 10 or more prescriptions over more than 90 days, or 120 plus days of supply in the first year.

The research also found that 22% moved onto ‘broad’ opioid prescriptions which was classed as more than three opioid prescriptions at monthly intervals in the first year.

Reporting the findings in the Annals of Rheumatic Diseases, the team said the highest proportion of long-term users were patients with fibromyalgia—27.5%, 21%, and 34% for standard, stringent and broad prescribing categories.

This was followed by those with rheumatoid arthritis (26%, 18.5%, and 32% respectively) and those with axial spondyloarthritis at 24%, 17%, and 30%.

The results also showed an increasing proportion of patients with systemic lupus erythematosus and fibromyalgia who moved from one opioid prescription to long-term prescribing between 2006 and 2019.

But the converse pattern was true in rheumatoid arthritis with a decreasing trend over the time period, although the researchers noted the overall proportion remained high at 24.5% in 2020.

Calls for opioid use optimisation

A 2019 review by Public Health England, found one in four adults were prescribed medications associated with dependence, including opioids, benzodiazepines and antidepressants.

NICE has since issued guidance on safe prescribing and withdrawal management for addictive drugs.

Dr Joyce Huang, study author and research associate in the Division of Musculoskeletal and Dermatological sciences at the University of Manchester, said: ‘Our study does not intend to stigmatise patients who use opioids.

‘We want to highlight the high frequency of long-term opioid use needs to be optimised and prevent people living with [rheumatic and musculoskeletal disorders] from opioid-related harm.’

Study lead Dr Meghna Jani, senior lecturer at the Centre for Epidemiology Versus Arthritis, said the results show that a ‘considerable proportion of patients’ with these conditions starting opioids for the first time, transition to long-term use that is much higher than people who are starting an opioid for non-cancer pain in general which is around one in seven people.

‘Because long-term opioid therapy is associated with poor health outcomes, these findings warrant vigilance when prescribing these drugs.

‘Long term use is particularly pronounced in fibromyalgia patients, who suffer chronic widespread pain for which there are no disease modifying treatment options. This is also more common than we initially thought, in rheumatoid arthritis and axial spondyloarthritis.’

A version of this story was originally published by our sister publication Pulse.