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Centralized pain may warn of poor opioid response

Tuesday 14 January 2014


From medwireNews:



Centralized pain may warn of poor opioid response

By Lucy Piper, Senior medwireNews Reporter
06 January 2014

Reg Anesth Pain Med 2014; Advance online publication

medwireNews: Patients with centralized pain syndromes, such as fibromyalgia, may have a poor response to opioids, research suggests.

The findings showed that patients with persistently high pain despite opioid therapy were more likely to show characteristics consistent with having centralized pain, regardless of their primary pain disorder, than patients with lower pain levels.

However, researcher Ronald Wasserman (University of Michigan, Ann Arbor, USA) and co-workers note that their study was unable to determine whether these characteristics were present before or after the initiation of opioids, and therefore whether they represented an opioid-resistant fibromyalgia-type illness or opioid-induced hyperalgesia.

Given that these distinct conditions merit very different treatment options, the team acknowledges the need for quantitative sensory testing to “aid in the diagnosis of the pain mechanism and, ultimately, the best treatment strategies, for these patients.”

The team used the Brief Pain Inventory (BPI) to assess pain severity in 582 patients taking opioids. Almost half (49%) of these patients continued to experience severe pain – score of at least 7 – despite their medication

Independent predictors for higher pain scores in a multivariate linear regression model were higher scores on the American College of Rheumatology (ACR) fibromyalgia survey, more neuropathic pain symptoms, and higher depressive symptoms.

“These are features that have been classically demonstrated in patients with altered central pain processing,” the researchers note in Regional Anesthesia and Pain Medicine.

Indeed, when the patients were grouped according to pain severity scores, 50.3% of the 185 patients with the greatest pain (BPI>7.5) and 46.1% of the 178 patients with moderate pain (BPI>6 and ≤7.5) met survey criteria for fibromyalgia, compared with 27.8% of the 203 patients with the least pain (BPI≤6).

Only 18 (3.2%) of the 566 patients with primary diagnostic code data available had been diagnosed as having fibromyalgia by their treating physician, but ACR survey criteria for fibromyalgia were met by 40.8% of all new patients taking opioids.

“The characteristics (phenotype) of the high pain opioid group in this study suggest the need for an alternative treatment approach, as opioids are less likely to be helpful in a centralized pain population,” say Wasserman et al.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2014

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The above originally appeared here.


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