Characteristics and healthcare costs of patients with fibromyalgia syndrome

Article (PDF Available)inInternational Journal of Clinical Practice 61(9):1498-508 · September 2007with28 Reads
DOI: 10.1111/j.1742-1241.2007.01480.x · Source: PubMed
Abstract
To examine the characteristics and healthcare costs of fibromyalgia syndrome (FMS) patients in clinical practice. Using a US health-insurance database, we identified all patients, aged > or = 18 years, with any healthcare encounters for FMS (ICD-9-CM diagnosis code 729.1) in each year of the 3-year period, 1 July 2002 to 30 June 2005. A comparison group was then constituted, consisting of randomly selected patients without any healthcare encounters for FMS during this 3-year period. Comparison group patients were matched to FMS patients based on age and sex. Characteristics and healthcare costs of FMS patients and comparison group patients were then examined over the 1-year period, 1 July 2004 to 30 June 2005 (the most recent year for which data were available at the time of the study). The study sample consisted of 33,176 FMS patients and an identical number in the comparison group. Mean age was 46 years, and 75% were women. FMS patients were more likely to have various comorbidities, including painful neuropathies (23% vs. 3% for comparison group), anxiety (5% vs. 1%), and depression (12% vs. 3%) (all p < 0.001); they also were more likely to have used pain-related pharmacotherapy (65% vs. 34% for comparison group; p < 0.001). Mean (SD) total healthcare costs over 12 months were about three times higher among FMS patients [$9573 ($20,135) vs. $3291 ($13,643); p < 0.001]; median costs were fivefold higher ($4247 vs. $822; p < 0.001). Patients with FMS have comparatively high levels of comorbidities and high levels of healthcare utilization and cost.

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Available from: Ariel Berger
Characteristics and healthcare costs of patients with
fibromyalgia syndrome
A. Berger,
1
E. Dukes,
2
S. Martin,
2
J. Edelsberg,
1
G. Oster
1
Introduction
Fibromyalgia syndrome (FMS) is a widespread disor-
der of unknown aetiology that affects an estimated
2–4% of the general population (1), and over 5% of
patients in general medical practice (2). Women are
about nine times more likely to develop FMS than
men (1). Symptoms typically appear between the
ages of 20 and 55 years. The predominant symptom
of FMS is widespread musculoskeletal pain. A large
number of additional symptoms are also often pre-
sent, including sleep disturbance, fatigue, morning
stiffness, paresthesias, headaches and exercise intoler-
ance. The symptoms of FMS can be prolonged and
debilitating.
Fibromyalgia syndrome is characterized by wide-
spread pain, tenderness and fatigue, and is typically
difficult to diagnose. While various tests may be
ordered to rule out other possible causes of patients’
symptoms, such as rheumatoid arthritis and lupus,
none is sufficiently sensitive or specific to establish a
diagnosis of FMS. In 1990, the American College of
Rheumatology (ACR) published diagnostic criteria
for FMS namely, widespread pain (both sides of
the body, above and below the waist, and in the cer-
vical spine, anterior chest, thoracic spine or low
back), and pain on digital palpation in at least 11 of
18 specified tender point sites (3). If a patient has
typical symptoms of FMS but does not meet the
ACR criteria, a diagnosis of ‘possible FMS’ is often
assigned, and a therapeutic trial of standard treat-
ment may be prescribed.
Treatment of FMS is typically geared towards
reducing pain and improving quality of sleep. [It has
been suggested that FMS may be due to non-restor-
ative sleep; about three-quarters of FMS patients
report non-restorative sleep (3), which often is fol-
lowed by an increase, or ‘flare-up’, of symptoms.]
Early controlled clinical studies demonstrated that
amitriptyline, cyclobenzaprine, fluoxetine and
OnlineOpen: This article is available free online at www.blackwell-synergy.com
SUMMARY
Purpose: To examine the characteristics and healthcare costs of fibromyalgia syn-
drome (FMS) patients in clinical practice. Materials and methods: Using a US
health-insurance database, we identified all patients, aged 18 years, with any
healthcare encounters for FMS (ICD-9-CM diagnosis code 729.1) in each year of
the 3-year period, 1 July 2002 to 30 June 2005. A comparison group was then
constituted, consisting of randomly selected patients without any healthcare
encounters for FMS during this 3-year period. Comparison group patients were
matched to FMS patients based on age and sex. Characteristics and healthcare
costs of FMS patients and comparison group patients were then examined over
the 1-year period, 1 July 2004 to 30 June 2005 (the most recent year for which
data were available at the time of the study). Results: The study sample consisted
of 33,176 FMS patients and an identical number in the comparison group. Mean
age was 46 years, and 75% were women. FMS patients were more likely to have
various comorbidities, including painful neuropathies (23% vs. 3% for comparison
group), anxiety (5% vs. 1%), and depression (12% vs. 3%) (all p < 0.001); they
also were more likely to have used pain-related pharmacotherapy (65% vs. 34%
for comparison group; p < 0.001). Mean (SD) total healthcare costs over
12 months were about three times higher among FMS patients [$9573 ($20,135)
vs. $3291 ($13,643); p < 0.001]; median costs were fivefold higher ($4247 vs.
$822; p < 0.001). Conclusions: Patients with FMS have comparatively high levels
of comorbidities and high levels of healthcare utilization and cost.
What’s known
Much is known concerning the epidemiology of
fibromyalgia syndrome (FMS). The efficacy of
various pain-related medications in FMS has also
been studied. Some information regarding
utilization and cost is also available.
What’s new
Our study examines levels of comorbidities and
healthcare utilization and cost among patients with
FMS in actual clinical practice, and seeks to place
these findi ngs in context, using an age- and sex-
matched group of patients without FMS as
comparators. In addition, our findings are based on
data that are relatively current (1 July 2004 to 30
June 2005), as opposed to previous analyses for
which data are at least a decade old.
1
Policy Analysis, Inc. (PAI),
Brookline, MA, USA
2
Pfizer Inc., New York, NY,
USA
Correspondence to:
Gerry Oster, PhD,
Policy Analysis, Inc. (PAI), Four
Davis Court, Brookline, MA
02445, USA
Tel.: + 1 617 232 4400
Fax: + 1 617 232 1155
Email: goster@pai2.com
Disclosures
Mr Berger, Dr Edelsberg and
Dr Oster are employed by
Policy Analysis Inc., an
independent contract research
organization with previous and
ongoing engagements with
Pfizer Inc. as well as other
pharmaceutical manufacturers.
Dr Dukes and Mrs Martin are
employed by Pfizer Inc. All
work performed at Policy
Analysis Inc.
doi: 10.1111/j.1742-1241.2007.01480.x
ORIGINAL PAPER
ª 2007 The Authors
1498 Journal compilation ª 2007 Blackwell Publishing Ltd Int J Clin Pract, September 2007, 61, 9, 1498–1508
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alprazolam are effective in FMS; more recently, trials
of pregabalin and duloxetine have also shown effic-
acy (4–13). Imipramine, steroids and non-steroidal
anti-inflammatory drugs (NSAIDs) have been repor-
ted to be no better than placebo in the treatment of
FMS (13). Non-pharmacological interventions, inclu-
ding cardiovascular fitness training, biofeedback, acu-
puncture and hypnotherapy, have shown limited
efficacy in some patients (14–16).
Information concerning patterns of healthcare util-
ization and costs among FMS patients is somewhat
limited. One study that examined 402 patients with
chronic fatigue, chronic fatigue syndrome (CFS),
FMS, and CFS and FMS reported that levels of
healthcare utilization were generally high and similar
across the four groups of patients (17). In a Cana-
dian study, White et al. compared the healthcare
costs of 100 FMS patients with those of 76 patients
with widespread pain (but not FMS), 135 patients
without widespread pain, and a random sample of
380 ‘controls’ matched on age, sex and geographical
region (18). In this study, FMS patients were found
to use more pain-related medications and outpatient
healthcare services than patients with widespread
pain; their annual healthcare costs also were
CDN$493 higher compared with those of controls.
In their 7-year prospective study of 538 FMS
patients, Wolfe et al. found that FMS patients aver-
aged approximately 10 outpatient visits per year, and
that mean annual healthcare costs were $2274 (in
1996 dollars) (19). In their questionnaire-based study
of 180 women with FMS, Penrod et al. reported that
healthcare costs averaged CDN$2298 over 6 months
(20). Two additional studies were based on electronic
healthcare databases (US and UK respectively) and
were limited to encounters with general practitioners.
In the former study, based on data from a Fortune
100 manufacturer, Robinson et al. reported that
mean annual healthcare costs among FMS patients
(n ¼ 4699) were twice as high as those of a 10%
random sample of the overall insured population
($5945 vs. $2468; p < 0.001) (21). In the latter study,
Hughes et al. reported that, among 2260 patients
newly diagnosed with FMS, there were 25 office visits
and 11 prescriptions, on average, in the year prior to
diagnosis, and that levels of utilization were generally
even higher following diagnosis (22). Another recent
study by Boonen et al. examined costs of Dutch
patients with FMS (n ¼ 69), chronic low back pain
(n ¼ 110) and ankylosing spondylosis (n ¼ 111),
respectively, using cost diaries (23). The authors
reported that FMS patients had the highest annual
healthcare costs (1300 vs. 1104 for chronic low
back pain and 1043 for ankylosing spondylosis);
mean (median) total annual costs (including health-
care, non-medical and production losses during sick
leave) were estimated to be 7814 (5145) for FMS
patients, 8533 (5068) for those with chronic low
back pain and 3205 (1793) for those with ankylos-
ing spondylosis.
There are substantial limitations to existing
research, however. Several of the studies were con-
ducted well over a decade ago, and many of the
more recent ones have other shortcomings, inclu-
ding small sample size and/or choice of reference
group. Moreover, many of these studies are based
on questionnaire data, which may not necessarily
reflect actual patterns of utilization because of prob-
lems with patient recall and/or comprehensiveness
of data collection. In this study, we compare the
characteristics and healthcare costs of patients with
FMS with those of an age- and sex-matched com-
parison group, using a large US health-insurance
claims database.
Methods
Data were obtained from the PharMetrics Patient-
Centric Database. The database is composed of facil-
ity, professional service and retail (i.e. outpatient)
pharmacy claims from over 85 US health plans. The
plans provide healthcare coverage to approximately
11 million persons annually throughout the US
(Midwest, 35%; Northeast, 21%; South, 31%; West,
13%). All patient identifiers in the database have
been fully encrypted, and the database is fully com-
pliant with the Health Insurance Portability and
Accountability Act of 1996.
Information available for each facility and profes-
sional service claim includes date and place of ser-
vice, diagnoses (in ICD-9-CM format), procedures
[in ICD-9-CM (selected plans only) and HCPCS for-
mats], provider specialty, and charged and paid
amounts. Data available for each retail pharmacy
claim include the drug dispensed (in NDC format),
the dispensing date, and the quantity dispensed and
number of days of therapy supplied (selected plans
only). All claims include a charged amount; the data-
base also provides paid (i.e. total reimbursed, inclu-
ding patient deductible, copayment, and/or
coinsurance) amounts.
Selected demographic and eligibility information is
also available, including age, gender, geographical
region, coverage type and the dates of insurance cov-
erage. All patient-level data can be arrayed in chro-
nological order to provide a detailed, longitudinal
profile of all medical and pharmacy services used by
each insured person.
Using the PharMetrics Patient-Centric Database,
we identified all patients, aged 18 years, who had
Characteristics and costs of patients with fibromyalgia 1499
ª 2007 The Authors
Journal compilation ª 2007 Blackwell Publishing Ltd Int J Clin Pract, September 2007, 61, 9, 1498–1508
one or more healthcare encounters with a diagnosis
of FMS (ICD-9-CM diagnosis code 729.1) in each
year of the 3-year period, 1 July 2002 to 30 June
2005 (i.e. all patients were required to have encoun-
ters with a diagnosis of FMS in three concurrent
years). As FMS is often difficult to diagnosis cor-
rectly, we used this selection algorithm to maximize
the likelihood that subjects in our study actually had
FMS. Patients enrolled in Medicaid programmes and
those aged 65 years who were enrolled in Medicare
supplemental or capitated plans were also excluded,
as their claims histories may be incomplete.
A comparison group was constituted, consisting of
a cohort of randomly selected patients without any
encounters with a diagnosis of FMS over the 3-year
period, 1 July 2002 to 30 June 2005. The comparison
group was matched to FMS patients on the basis of
age and sex. All other inclusion/exclusion criteria
used to constitute the cohort of FMS patients were
used to constitute the comparison group.
All pharmacy, professional service and facility
claims were then compiled for all study subjects
(FMS and comparator group) between 1 July 2004
and 30 June 2005 (or the patient’s period of continu-
ous eligibility, if less than 365 days).
The prevalence of selected (medically attended)
comorbidities was examined for both FMS patients
and patients in the comparison group (Table 1);
patients were deemed to have any of the conditions
of interest if they had either one or more hospitaliza-
tions or two or more outpatient claims on different
days with a relevant diagnosis code during the year
of interest.
The number of patients receiving 1 prescriptions
for various ‘pain-related’ medications during the year
of interest was examined, including: (i) antiepileptics
(AEDs); (ii) benzodiazepines; (iii) corticosteroids;
(iv) cyclo-oxygenase (COX)-2 inhibitors and other
prescription NSAIDs; (v) muscle relaxants; (vi) seda-
tives/hypnotics; (vii) opioids (both short- and long-
acting agents); (viii) antidepressants [including
tricyclic antidepressants (TCAs), monoamine oxidase
(MAO) inhibitors, and selective serotonin reuptake
inhibitors (SSRIs)]; (ix) antimigraine agents (trip-
tans, all other); and (x) miscellaneous agents [inject-
able analgesics (e.g. bupivacaine), topical analgesics
(e.g. lidocaine), clonidine]. Medications were desig-
nated as being ‘pain-related’ based on their designa-
tion as analgesics or adjuvant medications in the
World Health Organization’s (WHO) ‘analgesic lad-
der’, which was developed initially for the treatment
of cancer pain (24). Published literature has suppor-
ted the use of adjuvant medications for the treatment
of neuropathic pain in patients with and without
cancer (25–36). Patients were considered to have
received combinations of pain-related medications if,
during the year of interest, they received at least one
prescription for 2 classes of pain-related medica-
tions (e.g. antidepressants and opioids). All other
medications were defined to be non-pain-related.
Utilization of healthcare services [i.e. outpatient
pharmacy dispenses, doctor office visits, other out-
patient visits, emergency department (ED) visits and
hospitalizations] was examined over the 1-year per-
iod, 1 July 2004 to 30 June 2005, based on paid
medical claims. No attempt was made to attribute
care specifically to the treatment of FMS. Costs
were tallied by category of care, as follows: (i) pain-
related medications; (ii) non-pain-related medica-
tions; (iii) doctor office visits; (iv) ED visits; (v)
hospital outpatient visits; and (vi) inpatient care.
Reimbursed amounts (including patient co-pays)
were used in all analyses of healthcare costs. Where
applicable, measures of counts and costs were annu-
alized for patients not continuously enrolled in the
database over the entire year of interest.
The statistical significance of differences between
FMS patients and the comparison group was calcu-
lated using paired t-tests for normally distributed
continuous measures; otherwise, a Wilcoxon signed-
rank test was used. McNemar’s and Bowker’s tests
were used to determine the statistical significance of
differences in categorical measures, as appropriate.
All analyses were conducted, using PC-SAS
v.9.1
(37).
Results
The study sample consisted of 33,176 FMS patients
and an identical number in the comparison group.
Mean age was 46 years, and 75% were women. FMS
patients were more likely than those in the compar-
ison group to have various comorbidities, including
diseases of the circulatory system [OR (95% CI) ¼
2.1 (2.0–2.1)], diabetes [1.5 (1.4–1.6)], anxiety [4.3
(3.8–4.7)], depression [4.9 (4.5–5.2)], irritable bowel
syndrome [6.2 (4.9–7.9)], gastro-oesophageal reflux
disease [3.8 (3.4–4.2)] and sleep disorders [6.1 (5.4–
6.9)] (all p < 0.001) (Table 2). They also were more
likely to have pain-related comorbidities, including
painful neuropathies [10.3 (9.6–11.0)], back pain
[14.2 (13.3–15.2)], cervical pain [16.3 (14.9–17.9)],
arthritis [6.3 (5.8–6.8)] and migraine headache [6.9
(6.0–8.0)] (all p < 0.001).
Fibromyalgia syndrome patients were nearly four
times as likely as patients in the comparison group
to have received pain-related medications, including
AEDs, benzodiazepines, opioids, antidepressants and
muscle relaxants (Table 3). The most commonly
received medications among FMS patients were
1500 Characteristics and costs of patients with fibromyalgia
ª 2007 The Authors
Journal compilation ª 2007 Blackwell Publishing Ltd Int J Clin Pract, September 2007, 61, 9, 1498–1508
Table 1 Definitions of selected comorbidities*
Comorbidity ICD-9-CM diagnosis codes
Neoplasms 140.X–239.X
Diabetes 250–250.XX
Mental and mood disorders
Anxiety 300.01, 300.3, 309.81, 300.23, 300.21, 300.22, 300.2,
300.20, 300.29, 300.02, 293.84, 309.21, 300.0, 300.00, 300.09,300.1X
Depression 300.4, 309.0, 309.1, 296.5, 296.2, 296.3, 290.21, 292.84, 296.20 - 296.XX, 298.0
Tension headache 307.81
Migraine 346–346.XX
Diseases of the circulatory system 390–459.XX
Diseases of the respiratory system 460–519.X
Diseases of the digestive system
Irritable bowel syndrome 564.1
GERD 530.11, 530.81
Gastritis 535.0–535.5
Other 520.5–537.X, 540–543.X, 550.0–553.X, 555.0–558.X,
560–560.X, 562.00–562.XX, 564–579.X
Diseases of the musculoskeletal system and connective tissue
Back pain 722.92–722.93, 724–724.X
Cervical pain 722.4–722.5, 722.81, 722.91, 723.1, 723.5–723.6
Arthritis 711.00–716.XX
Other body/joint pain 710.0, 717–720.X, 725–729.X
Other 710–710.X, 721–723.X, 730–739.X
Symptoms, signs and ill-defined conditions
Fatigue 780.71, 780.79
Headache 784
Chest pain 786.5–786.5X
Abdominal pain 789.0–789.0X
Anxiety-related symptoms 780.4, 785.0–785.1, 786.01, 786.05, 786.09
Gastric-related symptoms 787.0, 787.01–787.03, 787.1–787.3, 787.9, 787.91, 787.99
Other 780.02–796.X, 799–799.X
Painful neuropathic disorders
Diabetic neuropathy 250.6X, 357.2
Post-herpetic neuralgia 53.1X
Back pain with
neuropathic involvement
721.41, 721.42, 721.91, 722.1, 722.10, 722.11, 722.2, 722.70,
722.72, 722.73, 724.0X, 724.3, 724.4
Neck pain with neuropathic
involvement
721.1, 722.0, 722.71, 723.0, 723.4
Cancer with neuropathic pain Malignant neoplasms (140.XX–172.XX, 174.XX–208.XX) in conjunction with neuropathy
337.2X, 353.2, 353.3, 353.4, 354.4, 355.7X, 355.9, 729.2, 353.0, 353.1, 353.8, 353.9,
354.0, 354.1, 354.2, 354.3, 354.5, 354.8, 354.9, 355.0, 355.1, 355.2, 355.3, 355.4,
355.5, 355.6, 355.8, 357.3, 357.8, 357.9
Causalgia 337.2X, 353.2, 353.3, 353.4, 354.4, 355.7X, 355.9, 729.2
Phantom limb pain 353.6
Trigeminal neuralgia 350.1
Atypical facial pain 350.2, 352.1
Other painful neuropathies 353.0, 353.1, 353.8, 353.9, 354.0, 354.1, 354.2, 354.3, 354.5, 354.8, 354.9, 355.0, 355.1,
355.2, 355.3, 355.4, 355.5, 355.6, 355.8
Sleep disorders 780.51, 780.52, 307.41, 307.42, 307.49, 780.53, 780.57, 786.03, 347.0X, 347.1X, V69.4,
780.5, 780.50, 780.54, 780.55, 780.56, 780.58, 780.59
*ICD-9-CM diagnosis codes may be three, four or five digits; ‘X’ for the fourth or fifth digit indicates a wildcard. Codes with fewer
than five digits and no Xs in the fourth or fifth digit were selected only if recorded without subsequent digits.
Characteristics and costs of patients with fibromyalgia 1501
ª 2007 The Authors
Journal compilation ª 2007 Blackwell Publishing Ltd Int J Clin Pract, September 2007, 61, 9, 1498–1508
Table 2 Demographic and clinical characteristics of study subjects*
Characteristic
FMS patients
(
n
¼
33,176)
Comparison group
(
n
¼
33,176) OR (95% CI) p-Value
Age, mean (SD), years 45.5 (10.2) 45.5 (10.2) N/A
Sex
Male 8471 (25.5) 8471 (25.5) N/A
Female 24,705 (74.5) 24,705 (74.5)
Comorbidities
Neoplasms 2569 (7.7) 1702 (5.1) 1.6 (1.5–1.7) < 0.001
Diabetes 1945 (5.9) 1296 (3.9) 1.5 (1.4–1.6) < 0.001
Mental and mood disorders
Anxiety 1800 (5.4) 441 (1.3) 4.3 (3.8–4.7) < 0.001
Depression 4073 (12.3) 926 (2.8) 4.9 (4.5–5.2) < 0.001
Tension headache 385 (1.2) 23 (0.1) 16.9 (11.1–25.8) < 0.001
Migraine 1478 (4.5) 222 (0.7) 6.9 (6.0–8.0) < 0.001
Diseases of the circulatory system 7284 (22.0) 4000 (12.1) 2.1 (2.0–2.1) < 0.001
Diseases of the respiratory system 8696 (26.2) 3288 (9.9) 3.2 (3.1–3.4) < 0.001
Diseases of the digestive system
Irritable bowel syndrome 484 (1.5) 79 (0.2) 6.2 (4.9–7.9) < 0.001
GERD 1785 (5.4) 495 (1.5) 3.8 (3.4–4.2) < 0.001
Gastritis 201 (0.6) 61 (0.2) 3.3 (2.5–4.4) < 0.001
Other 4111 (12.4) 1424 (4.3) 3.2 (3.0–3.4) < 0.001
Any of above 5371 (16.2) 1806 (5.4) 3.4 (3.2–3.5) < 0.001
Diseases of the musculoskeletal system and connective tissue
Back pain 10,518 (31.7) 1051 (3.2) 14.2 (13.3–15.2) < 0.001
Cervical pain 6692 (20.2) 506 (1.5) 16.3 (14.9–17.9) < 0.001
Arthritis 3743 (11.3) 659 (2.0) 6.3 (5.8–6.8) < 0.001
Other body/joint pain 12,560 (37.9) 1962 (5.9) 9.7 (9.2–10.2) < 0.001
Other 16,602 (50.0) 1596 (4.8) 19.8 (18.8–20.9) < 0.001
Any of above 25,718 (77.5) 4086 (12.3) 24.6 (23.5–25.6) < 0.001
Symptoms, signs and ill-defined conditions
Fatigue 2375 (7.2) 419 (1.3) 6.0 (5.4–6.7) < 0.001
Headache 3254 (9.8) 365 (1.1) 9.8 (8.8–10.9) < 0.001
Chest pain 2506 (7.6) 870 (2.6) 3.0 (2.8–3.3) < 0.001
Abdominal pain 3121 (9.4) 949 (2.9) 3.5 (3.3–3.8) < 0.001
Anxiety-related symptoms 2567 (7.7) 773 (2.3) 3.5 (3.2–3.8) < 0.001
Gastric-related symptoms 1866 (5.6) 442 (1.3) 4.4 (4.0–4.9) < 0.001
Other 10,933 (33.0) 3809 (11.5) 3.8 (3.6–3.9) < 0.001
Any of above 15,656 (47.2) 5701 (17.2) 4.3 (4.2–4.5) < 0.001
Painful neuropathic disorders
Diabetic neuropathy 162 (0.5) 43 (0.1) 3.8 (2.7–5.3) < 0.001
Post-herpetic neuralgia 51 (0.2) 9 (0.0) 5.7 (2.8–11.5) < 0.001
Back pain with neuropathic involvement 4421 (13.3) 512 (1.5) 9.8 (8.9–10.8) < 0.001
Neck pain with neuropathic involvement 2229 (6.7) 219 (0.7) 10.8 (9.4–12.5) < 0.001
Cancer with neuropathic pain 34 (0.1) 4 (0.0) 8.5 (3.0–24.0) < 0.001
Causalgia 1087 (3.3) 33 (0.1) 34.0 (24.1–48.1) < 0.001
Phantom limb pain 2 (0.0) 0 (0.0) < 0.001
Trigeminal neuralgia 30 (0.1) 6 (0.0) 5.0 (2.1–12.0) < 0.001
Atypical facial pain 34 (0.1) 2 (0.0) 17.0 (4.1–70.8) < 0.001
Other painful neuropathies 1259 (3.8) 186 (0.6) 7.0 (6.0–8.2) < 0.001
Any of above 7565 (22.8) 925 (2.8) 10.3 (9.6–11.0) < 0.001
Sleep disorders 1906 (5.7) 328 (1.0) 6.1 (5.4–6.9) < 0.001
Any of above 31,519 (95.0) 16,473 (49.7) 19.3 (18.3–20.4) < 0.001
Mean (SD) duration of follow-up (days) 334.6 (70.5) 305.6 (92.3) < 0.001
*Unless otherwise indicated, all values are n (%). FMS, fibromyalgia syndrome; OR, odds ratio; CI, confidence interval; GERD,
gastro-oesophageal reflux disease; SD, standard deviation.
1502 Characteristics and costs of patients with fibromyalgia
ª 2007 The Authors
Journal compilation ª 2007 Blackwell Publishing Ltd Int J Clin Pract, September 2007, 61, 9, 1498–1508
antidepressants [4.7 (4.5, 4.9)], opioids [4.3 (4.1–
4.5)] and NSAIDs (including COX-2 inhibitors) [3.3
(3.2–3.5)] (all p < 0.001). Thirty-four per cent of
FMS patients received some combination of pain-
related medications vs. only 7% in the comparison
group (p < 0.001) (Table 4). The most commonly
received combinations were antidepressants and
opioids [8.9 (8.3–9.5)], AEDs and antidepressants
[12.4 (11.0–14.1)], and sedatives/hypnotics and opi-
oids [8.2 (7.3–9.1)] (all p < 0.001).
Fibromyalgia syndrome patients also were signifi-
cantly more likely to have received various non-
pain-related medications, including antibiotics [2.6
(2.5–2.6)], ulcer medications [3.5 (3.3–3.6)], pre-
scription cough/cold/allergy medications [2.3 (2.2–
2.4)] and dermatologicals [2.3 (2.2–2.4)] (all
p < 0.001) (Table 5). Overall use of non-pain-
related pharmacotherapy among FMS patients was
substantially higher than that among patients in the
comparison group. For example, 37% of FMS
patients received four or more different types of
these medications compared with only 15% among
comparison patients.
The mean (SD) number of doctor office visits was
fourfold higher among FMS patients over 12 months
vs. that in the comparison group 17.8 (15.0) and
4.3 (7.0) respectively (p < 0.001). They also had
twice as many other outpatient visits [1.8 (4.6) vs.
0.9 (3.1)] and four times as many emergency room
visits [0.4 (1.5) vs. 0.1 (0.5)] (both p < 0.001)
(Table 6).
Mean (SD) total healthcare costs over 12 months
also were about three times higher among FMS
patients vs. patients in the comparison group [$9573
($20,135) vs. $3291 ($13,643) respectively;
p < 0.001] (Figure 1); median healthcare costs were
fivefold higher among FMS patients ($4247 vs. 822;
p < 0.001). Inpatient care represented about one-
quarter of total healthcare costs in both groups;
pain-related medications represented 11% and 4.3%
of total healthcare costs among FMS patients and
comparison group patients respectively.
Table 3 Number of study subjects receiving pain-related medications*
Pain-related medication FMS patients (
n
¼
33,176) Comparison group (
n
¼
33,176) OR (95% CI) p-Value
Antiepileptics 3925 (11.8) 534 (1.6) 8.2 (7.5–9.0) < 0.001
Benzodiazepines 6669 (20.1) 1912 (5.8) 4.1 (3.9–4.3) < 0.001
Corticosteroids 4819 (14.5) 1655 (5.0) 3.2 (3.1–3.4) < 0.001
COX-2 inhibitors and other prescription NSAIDs
COX-2 inhibitors 3863 (11.6) 914 (2.8) 4.7 (4.3–5.0) < 0.001
Other NSAIDs 7479 (22.5) 3042 (9.2) 2.9 (2.8–3.0) < 0.001
Any of above 9719 (29.3) 3662 (11.0) 3.3 (3.2–3.5) < 0.001
Muscle relaxants 7422 (22.4) 1290 (3.9) 7.1 (6.7–7.6) < 0.001
Sedatives and hypnotics 4120 (12.4) 1069 (3.2) 4.3 (4.0–4.6) < 0.001
Opioids
Short-acting opioids 12,300 (37.1) 4106 (12.4) 4.2 (4.0–4.3) < 0.001
Long-acting opioids 2258 (6.8) 92 (0.3) 4.3 (4.1–4.5) < 0.001
Any of above 12,541 (37.8) 4123 (12.4) 4.3 (4.1–4.5) < 0.001
Antidepressants
TCAs 3711 (11.2) 468 (1.4) 8.8 (8.0–9.7) < 0.001
MAOs 7 (0.0) 4 (0.0) 1.8 (0.5–6.0) 0.366
SSRIs 7450 (22.5) 2,597 (7.8) 3.4 (3.3–3.6) < 0.001
Other antidepressants 6516 (19.6) 1,503 (4.5) 4.7 (4.5–4.9) < 0.001
Any of above 12,842 (38.7) 3935 (11.9) 4.7 (4.5–4.9) < 0.001
Antimigraines
Triptans 1881 (5.7) 438 (1.3) 4.5 (4.0–5.0) < 0.001
Other antimigraines 493 (1.5) 116 (0.3) 4.3 (3.5–5.3) < 0.001
Any of above 2248 (6.8) 539 (1.6) 4.4 (4.0–4.8) < 0.001
Miscellaneous 3623 (10.9) 1513 (4.6) 2.6 (2.4–2.7) < 0.001
Any of above 21,402 (64.5) 11,243 (33.9) 3.5 (3.4–3.7) < 0.001
*Unless otherwise indicated, all values are n (%). FMS, fibromyalgia syndrome; OR, odds ratio; CI, confidence interval;
COX, cyclo-oxygenase; NSAID, non-steroidal anti-inflammatory drug; TCA, tricyclic antidepressant; MAO, monoamine oxidase;
SSRI, selective serotonin reuptake inhibitor.
Characteristics and costs of patients with fibromyalgia 1503
ª 2007 The Authors
Journal compilation ª 2007 Blackwell Publishing Ltd Int J Clin Pract, September 2007, 61, 9, 1498–1508
Discussion
Patients with FMS often were seen for other medical
problems, including back pain, cervical pain, painful
neuropathic disorders, respiratory infections, hyper-
tension and sleep disorders; they were also com-
monly seen for mood disorders, including depression
and anxiety. Almost one-half of FMS patients had
encounters with diagnoses of ‘symptoms, signs and
ill-defined conditions’, including headache, abdom-
inal pain, chest pain, fatigue and gastric-related
symptoms. Without exception, the prevalence of
these medical and psychiatric comorbidities was sig-
nificantly higher among FMS patients than among
age- and sex-matched patients without diagnoses of
FMS.
Fibromyalgia syndrome is difficult to diagnose. In
fact, some clinicians believe that FMS does not truly
exist, and that resolution of FMS symptoms will
result from proper treatment of all other, better-
established conditions. Unfortunately, it is beyond
the scope of our study to ascertain whether or not
patients actually had FMS (the database does not
contain patients’ medical records), or whether FMS
is in fact an actual disease. However, we note that in
addition to the higher frequency with which other
conditions were noted among FMS patients, all such
patients in our study also had at least one encounter
for the treatment of FMS in each consecutive year of
a 3-year period. This finding is perhaps suggestive
that the clinicians of these patients were not satisfied
that these conditions fully explained their symptoms.
It is important to note that these differences in the
prevalence of various medical and psychiatric comor-
bidities are not necessarily suggestive of an aetiologi-
cal link between these other conditions and FMS.
Various possible explanations exist for this finding.
For one, as FMS is characterized by widespread pain,
Table 4 Number of study subjects receiving selected combinations of pain-related medications*
Measure
FMS patients
(
n
¼
33,176)
Comparison group
(
n
¼
33,176) OR (95% CI) p-Value
Number receiving
No combinations 22,000 (66.3) 30,932 (93.2) 0.1 (0.1–0.1) < 0.001
One combination 4168 (12.6) 1474 (4.4) 3.1 (2.9–3.3)
Two combinations 2008 (6.1) 385 (1.2) 5.5 (4.9–6.1)
Three combinations 1551 (4.7) 184 (0.6) 8.8 (7.5–10.3)
Four combinations 1106 (3.3) 86 (0.3) 13.3 (10.6–16.5)
Five combinations 705 (2.1) 58 (0.2) 12.4 (9.5–16.2)
6 combinations 1638 (4.9) 57 (0.2) 30.2 (23.2–39.3)
Number receiving
AEDs and antidepressants 3146 (9.5) 277 (0.8) 12.4 (11.0–14.1) < 0.001
TCAs and sedatives/hypnotics 880 (2.7) 68 (0.2) 13.3 (10.4–17.0) < 0.001
TCAs and SSRIs 1406 (4.2) 106 (0.3) 13.8 (11.3–16.8) < 0.001
TCAs and NSAIDs 1580 (4.8) 137 (0.4) 12.1 (10.1–14.4) < 0.001
Benzodiazepines and sedatives/hypnotics 2010 (6.1) 297 (0.9) 7.1 (6.3–8.1) < 0.001
AEDs and sedatives/hypnotics 1216 (3.7) 75 (0.2) 16.8 (13.3–21.2) < 0.001
Antidepressants and opioids 7937 (23.9) 1132 (3.4) 8.9 (8.3–9.5) < 0.001
Muscle relaxants and sedatives/hypnotics 1914 (5.8) 143 (0.4) 14.1 (11.9–16.8) < 0.001
Benzodiazepines and NSAIDs 2507 (7.6) 408 (1.2) 6.6 (5.9–7.3) < 0.001
AEDs and antidepressants and opioids 2589 (7.8) 133 (0.4) 21.0 (17.7–25.0) < 0.001
Sedatives/hypnotics and opioids 2971 (9.0) 395 (1.2) 8.2 (7.3–9.1) < 0.001
Corticosteroids and AEDs 1093 (3.3) 82 (0.2) 13.7 (11.0–17.2) < 0.001
Miscellaneous and AEDs 879 (2.6) 68 (0.2) 13.3 (10.3–17.0) < 0.001
Miscellaneous and TCAs 672 (2.0) 56 (0.2) 12.2 (9.3–16.1) < 0.001
Miscellaneous and opioids 2148 (6.5) 395 (1.2) 5.7 (5.2–6.4) < 0.001
Antimigraine and AEDs 174 (0.5) 11 (0.0) 15.9 (8.6–29.2) < 0.001
Antimigraine and TCAs 137 (0.4) 17 (0.1) 8.1 (4.9–13.4) < 0.001
Antimigraine and opioids 361 (1.1) 42 (0.1) 8.7 (6.3–12.0) < 0.001
Sedatives/hypnotics and AEDs and TCAs 329 (1.0) 17 (0.1) 19.5 (12.0–31.8) < 0.001
*Unless otherwise indicated, all values are n (%). FMS, fibromyalgia syndrome; OR, odds ratio; CI, confidence interval; AEDs, antiepi-
leptic drugs; NSAID, non-steroidal anti-inflammatory drugs; SSRI, selective serotonin reuptake inhibitors; TCAs, tricyclic antidepressants.
1504 Characteristics and costs of patients with fibromyalgia
ª 2007 The Authors
Journal compilation ª 2007 Blackwell Publishing Ltd Int J Clin Pract, September 2007, 61, 9, 1498–1508
tenderness and fatigue, patients with this condition
may present more frequently to their medical provid-
ers than would otherwise be the case. More frequent
visits may lead to opportunistic case finding and
hence a higher prevalence of diagnosed medical and
psychiatric comorbidities. Another possible explan-
ation is the difficulty in making a diagnosis of FMS;
patients might receive a variety of other diagnoses as
various diseases and conditions are considered as
possible explanations for the overlapping symptoms
with which patients present.
During the year of study, FMS patients were nearly
twice as likely as those in the comparison group to
have received pain-related medications, and they
were approximately fivefold more likely to have
received multiple pain-related medications (primar-
ily, antidepressants and opioids); use of non-pain-
related medications was also higher. Given their
higher levels of comorbidities and use of medica-
tions, it is not surprising that levels of utilization of
healthcare services were much greater among FMS
patients than patients in the comparison group;
compared with the latter, the former averaged four
times as many doctor office visits, twice as many
other outpatient visits and four times more emer-
gency room visits during the 12-month period of
study. Mean healthcare costs were nearly three times
higher among FMS patients vs. comparison patients.
Our findings therefore indicate that patients with
FMS are generally in poorer health and have greater
levels of healthcare utilization and cost than patients
of similar age and sex without this condition.
Table 5 Number of study subjects receiving non-pain-related medications*
Medication type
FMS patients
(
n
¼
33,176)
Comparison group
(
n
¼
33,176) OR (95% CI) p-Value
Antibiotics 15,236 (45.9) 8331 (25.1) 2.6 (2.5–2.6) < 0.001
Cough/cold/allergy 6870 (20.7) 3431 (10.3) 2.3 (2.2–2.4) < 0.001
Ulcer drugs 7465 (22.5) 2575 (7.8) 3.5 (3.3–3.6) < 0.001
Antihistamines 4841 (14.6) 2000 (6.0) 2.7 (2.5–2.8) < 0.001
Dermatologicals 6687 (20.2) 2191 (6.6) 2.3 (2.2–2.4) < 0.001
Miscellaneous anti-infective agents 3848 (11.6) 1703 (5.1) 2.4 (2.3–2.6) < 0.001
Nasal agents 4449 (13.4) 1790 (5.4) 2.7 (2.6–2.9) < 0.001
Antiasthmatic and bronchodilators 4243 (12.8) 1825 (5.5) 2.5 (2.4–2.7) < 0.001
Oestrogens 4260 (12.8) 1759 (5.3) 2.6 (2.5–2.8) < 0.001
Antihyperlipidemics 5042 (15.2) 3252 (9.8) 1.6 (1.6–1.7) < 0.001
Ophthalmic agents 2718 (8.2) 1566 (4.7) 1.8 (1.7–1.9) < 0.001
Antihypertensives 4839 (14.6) 3556 (10.7) 1.4 (1.4–1.5) < 0.001
Diuretics 4061 (12.2) 2173 (6.5) 2.0 (1.9–2.1) < 0.001
Antifungals 2767 (8.3) 971 (2.9) 3.0 (2.8–3.3) < 0.001
Tetracyclines 2039 (6.1) 888 (2.7) 1.9 (1.8–2.1) < 0.001
Beta blockers 3430 (10.3) 1866 (5.6) 2.1 (2.0–2.3) < 0.001
Thyroid agents 3697 (11.1) 1838 (5.5) 1.3 (1.2–1.4) < 0.001
Contraceptives 2196 (6.6) 1727 (5.2) 2.1 (1.9–2.2) < 0.001
Vaginal products 1658 (5.0) 825 (2.5) 2.8 (2.5–3.1) < 0.001
Laxatives 1532 (4.6) 562 (1.7) 2.1 (2.0–2.3) < 0.001
Antivirals 1711 (5.2) 826 (2.5) 3.2 (2.8–3.5) < 0.001
Mouth/throat/dental agents 1294 (3.9) 422 (1.3) 3.8 (3.4–4.3) < 0.001
Miscellaneous gastrointestinal agents 1464 (4.4) 394 (1.2) 1.7 (1.5–1.8) < 0.001
Calcium channel blockers 1858 (5.6) 1146 (3.5) 2.5 (2.3–2.8) < 0.001
Urinary anti-infectives 1128 (3.4) 454 (1.4) 2.5 (2.2–2.8) < 0.001
Any of above 24,714 (74.5) 17,141 (51.7) 2.7 (2.6–2.8) < 0.001
Number receiving
None of the above 8462 (25.5) 16,035 (48.3) 0.4 (0.4–0.4) < 0.001
One of the above 4097 (12.3) 5156 (15.5) 0.8 (0.7–0.8)
Two of the above 4372 (13.2) 4096 (12.3) 1.1 (1.0–1.1)
Three of the above 3995 (12.0) 2971 (9.0) 1.4 (1.3–1.5)
4 of the above 12,250 (36.9) 4918 (14.8) 3.4 (3.2–3.5)
*Unless otherwise indicated, all values are n (%). FMS, fibromyalgia syndrome; OR, odds ratio; CI, confidence interval.
Characteristics and costs of patients with fibromyalgia 1505
ª 2007 The Authors
Journal compilation ª 2007 Blackwell Publishing Ltd Int J Clin Pract, September 2007, 61, 9, 1498–1508
In epidemiological studies, which generally require
patients to meet ACR criteria for FMS, women have
constituted between 86% and 95% of study samples
(1,17–19,38). In our study, the number was only
75%. However, the proportion of women in studies
such as ours, which used FMS diagnoses on health
insurance claims, was 61–81% consistent with the
75% reported in our study (21,22).
Our study has several limitations. First and most
important is our case-selection algorithm. Given the
difficulty in making a correct diagnosis of FMS, it is
likely that some patients who in fact do not have
FMS receive a diagnosis of the disease on at least
one occasion. To increase the specificity, we required
that all patients in our sample have at least one
encounter with a diagnosis of FMS in each of three
consecutive years. One consequence of this decision is
that we may have selected a cohort of FMS patients
with relatively high levels of utilization. In the data-
base, a total of 253,556 patients (6.8% of all patients
in the database) had at least one claim with a diag-
nosis of FMS in any one year of the 3-year period
that was used to identify FMS patients; 71,549
(1.9%) had claims with diagnoses of FMS in 2 years
of the 3-year period. While it is unlikely that all
253,556 of these patients had FMS, it is entirely
Table 6 Use of healthcare services
FMS patients
(
n
¼
33,176)
Comparison group
(
n
¼
33,176) p-Value
Number of office visits
0 251 (0.8) 10,543 (31.8) < 0.001
1 680 (2.0) 4907 (14.8)
2 1105 (3.3) 3934 (11.9)
3 1300 (3.9) 3122 (9.4)
4 29,840 (89.9) 10,670 (32.2)
Mean (SD) 17.8 (15.0) 4.3 (7.0) < 0.001
Median (IQR) 14 (8–23) 2 (0–5)
Number of other outpatient visits
0 20,477 (61.7) 24,765 (74.6) < 0.001
1 4149 (12.5) 3961 (11.9)
2 2468 (7.4) 1837 (5.5)
3 1594 (4.8) 957 (2.9)
4 4488 (13.5) 1656 (5.0)
Mean (SD) 1.8 (4.6) 0.9 (3.1) < 0.001
Median (IQR) 0 (0–2) 0 (0–1)
Number of ED visits
0 26,656 (80.3) 30,235 (91.1) < 0.001
1 4294 (12.9) 2304 (6.9)
2 1211 (3.7) 476 (1.4)
3 451 (1.4) 110 (0.3)
4 564 (1.7) 51 (0.2)
Mean (SD) 0.4 (1.5) 0.1 (0.5) < 0.001
Median (IQR) 0 (0–0) 0 (0–0)
Number of hospitalizations
0 30,146 (90.9) 31,934 (96.3) < 0.001
1 2431 (7.3) 1094 (3.3)
2 403 (1.2) 115 (0.3)
3 104 (0.3) 21 (0.1)
4 92 (0.3) 12 (0.0)
Mean (SD) 0.1 (0.6) 0.1 (0.4) < 0.001
Median (IQR) 0 (0–0) 0 (0–0)
Inpatient days
Mean (SD) 0.7 (4.7) 0.2 (2.0) < 0.001
Median (IQR) 0 (0–0) 0 (0–0)
*Unless otherwise indicated, all values are n (%). Mean values and medians annualized to account for differential follow-up.
FMS, fibromyalgia syndrome; SD, Standard deviation; IQR, interquartile range.
1506 Characteristics and costs of patients with fibromyalgia
ª 2007 The Authors
Journal compilation ª 2007 Blackwell Publishing Ltd Int J Clin Pract, September 2007, 61, 9, 1498–1508
probably that our identified sample of 33, 176
patients is an underestimate of the total number of
FMS patients in the database during this period of
time. Accordingly, the generalizability of our findings
to the population of FMS patients as a whole is
unknown.
Second, information on medication use in health-
care claims databases is limited to prescription drugs,
and specifically to prescriptions that are filled at out-
patient (i.e. retail) pharmacies. Thus, to the extent
that patients with FMS self-medicate with over-the-
counter medications, we would have underestimated
their total use of medications. We also do not know
whether FMS patients in our study received pain-
related medications for the treatment of FMS or for
pain associated with other conditions (e.g. arthritis).
In addition, as some pain-related medications are
also used to treat conditions that are not commonly
considered painful (e.g. AEDs in seizure disorders,
antidepressants in depression), it would be incorrect
to infer that all use of such agents was necessarily for
the treatment of FMS pain. Because pharmacy
records do not contain information on diagnosis, the
extent to which pain-related medications were actu-
ally prescribed for the treatment of FMS is unknown.
We note further that the database records only whe-
ther or not a prescription for a particular medication
was filled; not how much, if any, the patient actually
took.
Finally, we were limited to examining healthcare
costs only. FMS is also associated with disability and
may negatively impact productivity. One previous
estimate, based on 4699 persons with at least one
claim with a diagnosis of FMS employed by a US
Fortune 100 manufacturer, estimated that FMS was
associated with approximately $1552 (1998 dollars)
in indirect costs (21). Another estimate, based on
180 women identified by rheumatologists as having
FMS using ACR criteria, estimated the 6-month
impact of FMS on indirect costs [including market
and non-market (i.e. household) work] to be $4335
(2001 dollars) (20). Accordingly, our estimate likely
understates the total economic burden of FMS.
In conclusion, our findings suggest that patients
with FMS have strikingly high levels of comorbidi-
ties, and high levels of healthcare utilization and
costs. Effective new treatments for FMS may lead to
reductions in utilization and costs to the extent that
these high levels are attributable to the disease.
Funding
Funding for this research was provided by Pfizer
Inc., New York, NY.
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1508 Characteristics and costs of patients with fibromyalgia
ª 2007 The Authors
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    • "Another study calculated adjusted yearly direct costs of $2417 and indirect costs of $10.001 in Germany [10]. In an US-sample, mean healthcare costs for FMS patients were three times higher than for other patients [11] . According to FMS guidelines [12][13][14], treatment should be multidisciplinary and combine different pharmacologic and non-pharmacologic therapies, with self-management patient education as one recommended component. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Fibromyalgia syndrome (FMS) is a complex chronic condition that makes high demands on patients’ self-management skills. Thus, patient education is considered an important component of multimodal therapy, although evidence regarding its effectiveness is scarce. The main objective of this study is to assess the effectiveness of an advanced self-management patient education program for patients with FMS as compared to usual care in the context of inpatient rehabilitation. Methods/Design We conducted a multicenter cluster randomized controlled trial in 3 rehabilitation clinics. Clusters are groups of patients with FMS consecutively recruited within one week after admission. Patients of the intervention group receive the advanced multidisciplinary self-management patient education program (considering new knowledge on FMS, with a focus on transfer into everyday life), whereas patients in the control group receive standard patient education programs including information on FMS and coping with pain. A total of 566 patients are assessed at admission, at discharge and after 6 and 12 months, using patient reported questionnaires. Primary outcomes are patients’ disease- and treatment-specific knowledge at discharge and self-management skills after 6 months. Secondary outcomes include satisfaction, attitudes and coping competences, health-promoting behavior, psychological distress, health impairment and participation. Treatment effects between groups are evaluated using multilevel regression analysis adjusting for baseline values. Discussion The study evaluates the effectiveness of a self-management patient education program for patients with FMS in the context of inpatient rehabilitation in a cluster randomized trial. Study results will show whether self-management patient education is beneficial for this group of patients. Trial registration German Clinical Trials Register, DRKS00008782, Registered 8 July 2015
    Full-text · Article · Dec 2016
    • "In one study, health care utilization, medication and work loss estimates for FM were $5163, relative to $2486 in overall employee samples from 1998 data [44]. In another study, Berger, et al., [45] reported that FM patients were more likely to have received various combinations of pain-related medication. They also found that the mean number of physician appointments was 4 times higher, and mean total direct costs 3 times higher, among patients with FM than in a comparison group ($9573 versus $3291). "
    [Show abstract] [Hide abstract] ABSTRACT: Background The purpose of this study was to test the hypothesis that a health and wellness coaching (HWC)-based intervention for fibromyalgia (FM) would result in sustained improvements in health and quality of life, and reductions in health care utilization. Methods Nine female subjects meeting American College of Rheumatology criteria for a diagnosis of primary FM were studied. The HWC protocol had two components, which were delivered telephonically over a twelve-month period. First, each patient met individually with a coach during the 12 month study at the patient’s preference of schedule and frequency (Range:22–32 × 45-min sessions). Coaches were health professionals trained in health and wellness coaching tasks, knowledge, and skills. Second, each patient participated in bimonthly (first six months) and monthly (second six months) group classes on self-coaching strategies during the 12 month study. Prior to the intervention, and after 6 months and 12 months of coaching, the Revised Fibromyalgia Impact Questionnaire (FIQR) was used to measure health and quality of life, and the Brief Pain Inventory-Short Form (BPI) was used to measure pain intensity and interference with function. Total and rheumatology-related health encounters were documented using electronic medical records. Data were analyzed using repeated measures ANOVA. Results All nine patients finished the HWC protocol. FIQR scores improved by 35 % (P = 0.001). BPI scores decreased by 32 % overall (P = 0.006), 31 % for severity (P = 0.02), and 44 % for interference (P = 0.006). Health care utilization declined by 86 % (P = 0.006) for total and 78 % (P < 0.0001) for rheumatology-related encounters. Conclusion The HWC program added to standard FM therapy produced clinically significant improvements in quality of life measures (FIQR), pain (BPI), and marked reductions in health care utilization. Such improvements do not typically occur spontaneously in FM patients, suggesting that HWC deserves further consideration as an intervention for FM.
    Full-text · Article · Nov 2016
    • "Health care costs associated with FMS are up to four times greater Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of the article is prohibited. than those for age-and sex-matched patients due to medical visits, pain medications, and specialist pain management [8]. The U.S Institute of Medicine indicated that costs related to FMS in the U.S are between $12-14 billion each year, and cause a loss of 1-2% of the nation's overall productivity [9]. "
    [Show abstract] [Hide abstract] ABSTRACT: Objectives. Although fibromyalgia syndrome (FMS) is considered a heterogeneous condition, there is no generally accepted subgroup typology. We used hierarchical cluster analysis (HCA) and latent profile analysis (LPA) to replicate Giesecke’s classification in Spanish FMS patients. The second aim was to examine whether the subgroups differed in socio-demographic characteristics, functional status, quality of life, and in direct and indirect costs. Methods. 160 FMS patients completed the following measures for cluster derivation: the Center for Epidemiological Studies-Depression Scale, the Trait Anxiety Inventory, the Pain Catastrophizing Scale, and the Control over Pain subscale. Pain threshold was measured with a sphygmomanometer. Additionally, the Fibromyalgia Impact Questionnaire Revised, the EuroQoL-5D-3L, and the Client Service Receipt Inventory were administered for cluster validation. Results. Two distinct clusters were identified using HCA (“hypersensitive” group, 69.8% and “functional” group, 30.2%). In contrast, the LPA goodness-of-fit indices supported the existence of three FMS patient profiles: (1) a “functional” profile (28.1%) defined as moderate tenderness, distress, and pain catastrophizing; (2) a “dysfunctional” profile (45.6%) defined by elevated tenderness, distress, and pain catastrophizing; (3) a “highly dysfunctional and distressed” profile (26.3%) characterised by elevated tenderness and extremely high distress and catastrophizing. We did not find significant differences in socio-demographic characteristics between the two clusters or among the three profiles. The functional profile was associated with less impairment, greater quality of life, and lower healthcare costs. Discussion. We identified three distinct profiles which accounted for the heterogeneity of FMS patients. Our findings might help to design tailored interventions for FMS patients.
    Full-text · Article · Sep 2016
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