Lyrica a Better Choice Than Opioids for Harnessing Fibromyalgia Pain and its Consequences

Lyrica (pregabalin), when used on its own for fibromyalgia, is superior to opioids in reducing pain and improving pain interference in daily life, finds a study sponsored by Pfizer.

The analysis, which included 1,421 fibromyalgia patients, showed that those using Lyrica doses recommended for fibromyalgia treatment had the best outcomes, suggesting that many patients should increase their doses to reach recommended levels.

Pfizer and ProCare Systems conducted the study, “Interpreting the Effectiveness of Opioids and Pregabalin for Pain Severity, Pain Interference, and Fatigue in Fibromyalgia Patients,” which took aim at the notion that — despite little evidence of their effectivity — opioids are the most commonly prescribed drugs for fibromyalgia. To examine how different treatments affect pain and related outcomes in fibromyalgia patients, the research team turned to information from the ProCare Systems network of chronic pain clinics in Michigan.

All patients received Lyrica or opioids alone or in combination, and had been through several pain health assessments, including pain characteristics, physical function and psychosocial function.

The team divided the patients into different groups based on their average morphine equivalent dose or average Lyrica dose. Patients were followed between 56 and 365 days. Nearly 78 percent of them were women — typical of fibromyalgia in the real world.

Findings, published in the journal Pain Practice, showed that only 3.4 percent of patients took the recommended Lyrica dose of 300-450 mg. Most patients took less than 150 mg of Lyrica, either alone or combined with high-dose opioids.

The team assessed the number of patients in the different medication groups and noted that more of those who took Lyrica without opioids achieved at least 30 percent improvement across all pain measurements.

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Lyrica treatment was also superior to opioids or opioid-Lyrica combinations in improving pain-related aspects, such as “ability to enjoy life, activity in general, mood and sleep.” The only pain-related aspect that was better in the group combining Lyrica and moderate doses of opioids was “relationships with others.”

When increasing the threshold to an at least 50 percent improvement in pain and pain-related aspects of daily living, Lyrica was again superior to opioids or combinations.

While Lyrica did score low on how well it affected fatigue, it did better when combined with moderate opioid doses.

“Pregabalin without opioids provided the most favorable outcomes overall based on ≥30% and ≥50% improvement thresholds … with support for moderate … opioids+pregabalin in patients suffering from fatigue” researchers wrote.

Researchers also noted that patients taking higher Lyrica doses, reaching the recommended dose range, had better outcomes than those taking low doses.

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