Pfizer and Optum researchers compared pain treatments in newly diagnosed fibromyalgia (FM) patients, suggesting new clinical practices to improve disease management. The study entitled “Evaluating Guideline-recommended Pain Medication Use Among Patients with Newly Diagnosed Fibromyalgia” was published in the journal Pain Practice.
FM, a chronic pain condition, affects approximately 2%-6% of the population in the United States. The disease is diagnosed between the ages of 20 and 50 years, and impacts on the working population, reducing productivity and carrying great health care costs. Various treatment guidelines recommend slightly different pain medications. The Canadian and American guidelines suggest the use of antidepressants, including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and anti-convulsants/anti-epileptic drugs (AEDs). Opioids, special weak opioids, are only recommend for patients with moderate to severe pain who are unresponsive to all other treatments. European guidelines are against the use of corticosteroids and strong opioids.
In this study, the authors examined adult commercial health plan members newly diagnosed with FM between January 2008 and February 2012. They defined patient cohorts based on the medication taken after diagnosis: AED, SNRI, SSRI, TCA (guideline-recommended medications) and short-acting and long-acting opioid (SAO, LAO). Mean age among the 96,175 final patient sample was of 47.3 years, and 72.5% were females, with patients distributed into SAO (57%), SSRI (22%), AED (10%), SNRI (6%), TCA (3%), and LAO (2%) cohorts. Treatment discontinuation was more frequent in the SAO cohort (49% vs 6% to 22%) and these patients had less worsening of symptoms due to ongoing treatment known as augmentation (29% vs. 35% to 50%). Analysis of the cohorts also indicated that patients who had taken guideline-recommended medications before diagnosis were 2 to 4 times more likely to receive these medications after being diagnosed with FM. However, patients in the opioid cohorts were about half as likely to receive subsequent guideline-recommended treatments.
This study showed considerable variation in the pharmacotherapeutic treatment of FM and revealed that patients prescribed with opioids after FM diagnosis are less likely to receive guideline-recommend medication, indicating that FM treatment may be improved by introducing these medications into clinical practice.