Background/Purpose: In a rheumatology office practice, patients with fibromyalgia who improved significantly in their symptoms are seen commonly.  We evaluated patients whose pain, fatigue, fibrofog, and functional scores were significantly better over a 3-6 month period.

Methods: Patients who had significant improvement on visual analog scales in a rheumatology office practice were further assessed and responded to a questionnaire regarding reasons for improvement.

Results:   19 patients indicated significant improvement in their fibromyalgia symptoms and are included. The mean age of the participants was 42.2 (17 years old -71 years old).  17 of the 19 (89.5%) participants were female and 2 of 19 (10.5%) participants were male.  All patients met the 2010 ACR criteria for the diagnosis of fibromyalgia.  The mean pain score at the last office visit was 4.8 on a 1-10 visual analog scale.  The mean pain score at an office visit 3 months earlier was 7.7 and the mean pain score at an office visit 6 months earlier was 8.4.  Patients were asked to list the factors they attributed to their decrease in pain scores of at least 3 points on a 1-10 visual analog scale over the last 6 months.  15 of 19 (78.9%) of patients cited medication as a reason for their improvement.  These medications included cyclobenzaprine (9 of 19, 47.4%), amitriptyline (8 of 19, 42.1%), tizanidine (2 of 19, 10.5%), clonazepam (1 of 19, 5.3%), doxepin (1 of 19, 5.3%), hydrocodone (2 of 19, 10.5%), gabapentin (1 of 19, 5.3%), trazodone (1 of 19, 5.3%), chlorzoxazone (1 of 19, 5.3%), and mirtazepine ( 1 of 19, 5.3%). 

The other common reasons cited for improvement included weather changes (5 of 19, 26.3%), increased rest (5 of 19, 26.3%), decreased stress (3 of 19, 15.8%), and improved sleep (3 of 19, 15.8%).  Exercise, physical therapy, acupuncture, increased time off work, and increased knowledge about their diagnosis were other reasons occasionally cited as a reason for improvement.

Conclusion:   Patients with fibromyalgia who improve significantly generally attribute that improvement to a change in their medication, but other reasons are cited, such as weather and increased rest.  Medication, especially muscle relaxants and tricyclics, appears to be an effective strategy for patients with fibromyalgia who improve significantly.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-factors-that-might-be-responsible-for-the-improvement-of-fibromyalgia-patients-a-sub-group-that-improved-significantly-over-three-to-six-months/