Prescription opioid use in patients with and without systemic lupus erythematosus — Michigan Lupus Epidemiology and Surveillance program, 2014–2015

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@article{3e98785dd9684794a000a9e6f5d55c1a,
title = "Prescription opioid use in patients with and without systemic lupus erythematosus — Michigan Lupus Epidemiology and Surveillance program, 2014–2015",
abstract = "Rheumatic diseases are a leading cause of chronic, noncancer pain. Systemic lupus erythematosus (SLE) is a chronic autoimmune rheumatic disease characterized by periodic flares that can result in irreversible target organ damage, including end-stage renal disease. Both intermittent and chronic musculoskeletal pain, as well as fibromyalgia (considered a centralized pain disorder due to dysregulation of pain processing in the central nervous system), are common in SLE. Opioids are generally not indicated for long-term management of musculoskeletal pain or centralized pain (fibromyalgia) because of lack of efficacy, safety issues ranging from adverse medical effects to overdose, and risk for addiction (1,2). In this study of 462 patients with SLE from the population-based Michigan Lupus Epidemiology and Surveillance (MILES) Cohort and 192 frequency-matched persons without SLE, nearly one third (31{\%}) of SLE patients were using prescription opioids during the study period (2014-2015), compared with 8{\%} of persons without SLE (p<0.001). Among the SLE patients using opioids, 97 (68{\%}) were using them for >1 year, and 31 (22{\%}) were concomitantly on two or more opioid medications. Among SLE patients, those using the emergency department (ED) were approximately twice as likely to use prescription opioids (odds ratio [OR] = 2.1; 95{\%} confidence interval [CI] = 1.3-3.6; p = 0.004). In SLE, the combined contributions of underlying disease and adverse effects of immunosuppressive and glucocorticoid therapies already put patients at higher risk for some known adverse effects attributed to long-term opioid use. Addressing the widespread and long-term use of opioid therapy in SLE will require strategies aimed at preventing opioid initiation, tapering and discontinuation of opioids among patients who are not achieving treatment goals of reduced pain and increased function, and consideration of nonopioid pain management strategies.",
keywords = "Adult, Aged, Analgesics, Opioid/therapeutic use, Cohort Studies, Drug Prescriptions/statistics & numerical data, Emergency Service, Hospital, Female, Humans, Lupus Erythematosus, Systemic/drug therapy, Male, Michigan/epidemiology, Middle Aged, Pain Management/methods, Population Surveillance, Risk",
author = "Somers, {Emily C} and Caroline Gordon",
year = "2019",
month = "9",
day = "27",
doi = "10.15585/mmwr.mm6838a2",
language = "English",
volume = "68",
pages = "819–824",
journal = "Morbidity and Mortality Weekly Report",
issn = "0149-2195",
publisher = "Department of Health and Human Services",
number = "38",

}

RIS

TY - JOUR

T1 - Prescription opioid use in patients with and without systemic lupus erythematosus — Michigan Lupus Epidemiology and Surveillance program, 2014–2015

AU - Somers, Emily C

AU - Gordon, Caroline

PY - 2019/9/27

Y1 - 2019/9/27

N2 - Rheumatic diseases are a leading cause of chronic, noncancer pain. Systemic lupus erythematosus (SLE) is a chronic autoimmune rheumatic disease characterized by periodic flares that can result in irreversible target organ damage, including end-stage renal disease. Both intermittent and chronic musculoskeletal pain, as well as fibromyalgia (considered a centralized pain disorder due to dysregulation of pain processing in the central nervous system), are common in SLE. Opioids are generally not indicated for long-term management of musculoskeletal pain or centralized pain (fibromyalgia) because of lack of efficacy, safety issues ranging from adverse medical effects to overdose, and risk for addiction (1,2). In this study of 462 patients with SLE from the population-based Michigan Lupus Epidemiology and Surveillance (MILES) Cohort and 192 frequency-matched persons without SLE, nearly one third (31%) of SLE patients were using prescription opioids during the study period (2014-2015), compared with 8% of persons without SLE (p<0.001). Among the SLE patients using opioids, 97 (68%) were using them for >1 year, and 31 (22%) were concomitantly on two or more opioid medications. Among SLE patients, those using the emergency department (ED) were approximately twice as likely to use prescription opioids (odds ratio [OR] = 2.1; 95% confidence interval [CI] = 1.3-3.6; p = 0.004). In SLE, the combined contributions of underlying disease and adverse effects of immunosuppressive and glucocorticoid therapies already put patients at higher risk for some known adverse effects attributed to long-term opioid use. Addressing the widespread and long-term use of opioid therapy in SLE will require strategies aimed at preventing opioid initiation, tapering and discontinuation of opioids among patients who are not achieving treatment goals of reduced pain and increased function, and consideration of nonopioid pain management strategies.

AB - Rheumatic diseases are a leading cause of chronic, noncancer pain. Systemic lupus erythematosus (SLE) is a chronic autoimmune rheumatic disease characterized by periodic flares that can result in irreversible target organ damage, including end-stage renal disease. Both intermittent and chronic musculoskeletal pain, as well as fibromyalgia (considered a centralized pain disorder due to dysregulation of pain processing in the central nervous system), are common in SLE. Opioids are generally not indicated for long-term management of musculoskeletal pain or centralized pain (fibromyalgia) because of lack of efficacy, safety issues ranging from adverse medical effects to overdose, and risk for addiction (1,2). In this study of 462 patients with SLE from the population-based Michigan Lupus Epidemiology and Surveillance (MILES) Cohort and 192 frequency-matched persons without SLE, nearly one third (31%) of SLE patients were using prescription opioids during the study period (2014-2015), compared with 8% of persons without SLE (p<0.001). Among the SLE patients using opioids, 97 (68%) were using them for >1 year, and 31 (22%) were concomitantly on two or more opioid medications. Among SLE patients, those using the emergency department (ED) were approximately twice as likely to use prescription opioids (odds ratio [OR] = 2.1; 95% confidence interval [CI] = 1.3-3.6; p = 0.004). In SLE, the combined contributions of underlying disease and adverse effects of immunosuppressive and glucocorticoid therapies already put patients at higher risk for some known adverse effects attributed to long-term opioid use. Addressing the widespread and long-term use of opioid therapy in SLE will require strategies aimed at preventing opioid initiation, tapering and discontinuation of opioids among patients who are not achieving treatment goals of reduced pain and increased function, and consideration of nonopioid pain management strategies.

KW - Adult

KW - Aged

KW - Analgesics, Opioid/therapeutic use

KW - Cohort Studies

KW - Drug Prescriptions/statistics & numerical data

KW - Emergency Service, Hospital

KW - Female

KW - Humans

KW - Lupus Erythematosus, Systemic/drug therapy

KW - Male

KW - Michigan/epidemiology

KW - Middle Aged

KW - Pain Management/methods

KW - Population Surveillance

KW - Risk

UR - http://www.scopus.com/inward/record.url?scp=85072716432&partnerID=8YFLogxK

U2 - 10.15585/mmwr.mm6838a2

DO - 10.15585/mmwr.mm6838a2

M3 - Article

C2 - 31557148

VL - 68

SP - 819

EP - 824

JO - Morbidity and Mortality Weekly Report

JF - Morbidity and Mortality Weekly Report

SN - 0149-2195

IS - 38

ER -