Central sensitization in opioid use disorder: a novel application of the American College of Rheumatology Fibromyalgia Survey Criteria

Abstract

Introduction: Central sensitization (CS) involves dysfunctional central nervous system pain modulation resulting in heightened pain perception. Central sensitization is not commonly assessed among patients with opioid use disorder (OUD), despite the fact that pain has been implicated in the development, maintenance, and relapse of OUD and chronic opioid use may produce opioid-induced hyperalgesia. Central sensitization is a plausibly important mechanism underlying the complex relationship between OUD and chronic pain. However, this premise is largely untested.

Methods: Participants with OUD (n = 141) were recruited from an academic addiction treatment center in Columbus, Ohio. An established surrogate measure of CS, the American College of Rheumatology 2011 Fibromyalgia Survey Criteria, was administered using electronic survey. Participants also responded to questions about pain interference (Brief Pain Inventory), quality of life (RAND-36), and items regarding pain beliefs and expectations of pain and addiction treatment. Descriptive analyses, Spearman rho correlations, and Mann-Whitney U tests were performed.

Results: Hypothesized relationships were confirmed between degree of CS, pain interference, and health-related quality of life. Degree of CS was also positively correlated with greater endorsement of pain as a reason for the onset, maintenance, and escalation of OUD; treatment delay; and OUD relapse. Participants with the American College of Rheumatology 2011 Fibromyalgia Survey Criteria ≥13 had significantly greater endorsement of pain as a reason for delaying OUD treatment, continuing and increasing opioid use, and precipitating OUD relapse.

Conclusions: This study provides early evidence CS may underlie previously observed connections between clinically salient features of chronic pain and OUD, potentially informing future mechanistic research and precision treatment.

Keywords: Central nervous system sensitization; Chronic pain; Fibromyalgia; Opioid-related disorders.

Figure 1.

Frequency of self-reported pain by body region. Anatomic illustration from the ACR-FMS/Michigan body map. ACR-FMS, American College of Rheumatology 2011 Fibromyalgia Survey Criteria.

Figure 2.

Relationships between total ACR-FMS score and endorsement of A. pain as a major reason for continuing opioid use, B. needing more and more opioids to control pain, C. delaying OUD treatment for fear that pain will be worse when stopping opioids, and D. worry about pain-precipitated OUD relapse. Responses (Y axis) to original questions were on a 5-point Likert scale and scaled as strongly disagree (1), disagree (2), neutral (3), agree (4), or strongly agree (5). ACR-FMS, American College of Rheumatology 2011 Fibromyalgia Survey Criteria; OUD, opioid use disorder.

Figure 3.

Group differences (mean with 95% confidence interval) in endorsement of A. pain as a major reason for continuing opioid use, B. needing more and more opioids to control pain, C. delaying OUD treatment for fear that pain will be worse when stopping opioids, and D. worry about pain-precipitated OUD relapse by ACR-FMS cut point ≥13 (consistent with fibromyalgia). Responses (Y axis) to original questions were on a 5-point Likert scale and scaled as strongly disagree (1), disagree (2), neutral (3), agree (4), or strongly agree (5). ACR-FMS, American College of Rheumatology 2011 Fibromyalgia Survey Criteria; OUD, opioid use disorder.