Patients with systemic lupus erythematosus (SLE) experience pain from multiple factors, and the management of their pain is complex due to limited treatment options, the presence of comorbidities, or
the use of multiple medications for the disease, explains Gabriel Figueroa-Parra, MD.

“Previous studies reported greater use of opioid therapy among patients with SLE but did not report which factors were associated with this higher use,” he says. “Our study team aimed to describe the prevalence of long-term opioid therapy (LTOT) in patients with SLE compared to subjects without SLE and to explore factors associated with its use.”

For a cross-sectional study published in The Journal of Rheumatology, Dr. Figueroa-Parra and colleagues used the Lupus Midwest Network (LUMEN), a population-based registry of a 27-county region in southeast Minnesota and southwest Wisconsin. They matched a cohort of patients with prevalent SLE (by 2019 EULAR/ACR criteria) with comparators without SLE by age, sex, race/ethnicity, and county or residence.

One in 10 Patients With SLE on Long-Term Opioid Therapy

The researchers identified all patients with SLE (N=465) and comparators (N=465) with active use of LTOT (defined as contiguous prescriptions for opioid therapy ≥90 days or ≥10 contiguous prescriptions) on January 1, 2015. “To identify the factors associated with LTOT among patients with SLE, we obtained data on the type of manifestations, organ involvement, and additional conditions known to be associated with the use of opioid therapy, such as mood disorders, osteoarthritis, chronic low back pain (CLBP), cancer, fibromyalgia, avascular necrosis of bone, osteoporosis, and fragility fractures,” Dr. Figueroa-Parra says.

The study team observed that one out of 10 patients with SLE was on LTOT, compared with 1% of comparators without SLE. “Among patients with SLE, having a history of pericarditis, fibromyalgia, fragility fractures, CLBP, or mood disorders was significantly associated with LTOT,” Dr. Figueroa-Parra says. “Our findings suggest that patients with SLE are more likely to receive opioid therapy not only due to SLE manifestations but also because of associated comorbidities.

Compared with patients without fibromyalgia, patients with SLE and fibromyalgia were more than seven times as likely to be on LTOT. Among patients with SLE, mood disorders increased the likelihood of being on LTOT by more than twice. Patients with a history of fragility fractures or who had CLBP were three and four times more likely to be using LTOT, respectively (Figure).

Multidisciplinary Pain Approach Suggested for SLE

Dr. Figueroa-Parra and colleagues acknowledge that they still don’t fully understand the role of opioid therapy in the management of patients with lupus, which patients could benefit from it and under which situations, and at what point opioid use becomes cause for concern. They would like to see future research address the impact of LTOT on lupus-specific outcomes, such as disease activity or damage, or more general outcomes, such as functionality, QOL, and mortality.

Based on the lack of evidence for the effectiveness of opioid therapy in SLE and its comorbid conditions, the study authors suggest a “multidisciplinary pain management approach, including non-opioid and maximizing non-pharmacological therapies to preserve or improve patients’ QOL and function.