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Treatment outcomes after multidisciplinary pain rehabilitation with analgesic medication withdrawal for patients with Fibromyalgia

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By WM Hooten, et al • • February 7, 2007

Journal: Pain Medicine. 2007 Jan-Feb;8(1):8-16. Authors and affiliation: Hooten WM, Townsend CO, Sletten CD, Bruce BK, Rome JD. Departments of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. PMID: 17244099 Objective. This study of patients with a diagnosis of Fibromyalgia (FM) was conducted to test the hypothesis that immediate post-treatment measures of psychosocial functioning, health attributes, negative pain-related emotions, and depressive symptoms improve significantly during multidisciplinary pain rehabilitation while concurrently withdrawing analgesic medications. Design: Prospective case series. Setting: Multidisciplinary pain rehabilitation center at a tertiary referral medical center. Patients: In total, 159 consecutive patients with a diagnosis of FM admitted to the pain rehabilitation program from January 2002 to December 2003. Interventions: A 3-week outpatient multidisciplinary pain rehabilitation program based on a cognitive-behavioral model that incorporates analgesic medication withdrawal. Outcome Measures: Multidimensional Pain Inventory (MPI), Short Form-36 Health Status Questionnaire (SF-36), Coping Strategies Questionnaire-Catastrophizing subscale (CSQ-C), and the Center for Epidemiologic Studies-Depression scale (CES-D) were administered at admission and dismissal and the mean differences in scores were compared using paired t-tests. The number of patients using opioid analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), benzodiazepines, and muscle relaxants at admission and dismissal were compared using chi-squared analyses. Results: The difference in admission and dismissal scores from the MPI, SF-36, CSQ-C, and CES-D demonstrated a favorable response to treatment (P < 0.001). Compared with admission, the number of patients using opioids (P < 0.001), NSAIDs (P < 0.001), benzodiazepines (P < 0.001), and muscle relaxants (P < 0.01) at program dismissal was significantly reduced. Conclusion: The results of this study support the hypothesis that immediate post-treatment measures of physical and emotional functioning are favorable for patients with FM following multidisciplinary pain rehabilitation that incorporates withdrawal of analgesic medications.

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