In 2004, the American Pain Society (APS) issued evidence-based fibromyalgia treatment recommendations.
The objective of this claims database analysis is to describe prescription and medical use in patients with newly diagnosed and established fibromyalgia.
Privately insured patients with 2+ myalgia/myositis claims (1999 to 2005) were categorized as newly diagnosed or established; this dichotomy involves comparisons:
• Between prediagnosis (S1) and postdiagnosis (S2) stages in the newly diagnosed,
• And between newly diagnosed (S2) and established patients (S3).
Use of American Pain Society guideline medications increased across stages:
• Selective serotonin reuptake inhibitors (SSRIs) (prediagnosis, postdiagnosis/newly diagnosed, established patients: 20.6%, 22.9%, 25.3%),
• Serotonin norepinephrine reuptake inhibitors (SNRIs) (4.5%, 6.4%, 8.9%),
• Pregabalin/gabapentin (5.4%, 7.4%, 8.8%),
• Benzodiazepines (19.0%, 21.1%, 24.2%),
• Non-benzodiazepine sedatives (9.1%, 11.5%, 13.7%) (all P < .0001),
• And opioids (39.5%, 43.3%, 43.9%; prediagnosis vs postdiagnosis/newly diagnosed, P < .0001; newly diagnosed vs established patients, P = .2835).
Use of multiple therapeutic classes also increased across stages: 3+ classes (7.1%, 9.6%, 11.8%) (all P < .0001).
Office visits to providers increased, on average, after diagnosis:
• Primary care (70.9%, 78.3%, 76.3%; all P < .0001),
• Chiropractors (28.8%, 51.1%, 53.3%; all P < .0001),
• Rheumatologists (4.2%, 9.9%, 10.5%; prediagnosis vs newly diagnosed, P < .0001; newly diagnosed vs established patients, P = .0595),
• Mental health (6.4%, 7.3%, 8.3%; prediagnosis vs newly diagnosed, p<.0001, newly diagnosed vs established patients, P = .0003).
Average health care costs rose after diagnosis in the newly diagnosed group (prediagnosis: $6,555 vs newly diagnosed: $8,654, P < .0001).
• This paper investigates prescription drug and medical care use with respect to stages of fibromyalgia diagnosis.
• Established fibromyalgia patients use more medical resources and have higher rates of concomitant medication use than newly diagnosed fibromyalgia patients.
• Findings can help educate providers regarding optimal drug treatment patterns in this population.
Source: Journal of Pain, Jun 25, 2009. White LA, Robinson RL, Yu AP, Kaltenboeck A, Samuels S, Mallett D, Birnbaum HG. Analysis Group, Inc, Boston, Massachusetts; Eli Lilly and Company, Indianapolis, Indiana; Ingenix, Inc, Rocky Hill, Connecticut, USA. [E-mail: email@example.com]