Background/Purpose:

In the last decade, interest in fibromyalgia (FM) has increased with the publication of revised diagnostic criteria and clinical guidelines. The 2010 and revised 2011 ACR criteria emphasized the polysymptomatic nature of FM. National FM guidelines (Germany, Canada & Israel) showcased the importance of sustained functionality, multimodal therapy ideally targeting the primary symptom/s and cautioned the likely modest effect for most drug treatments.  Whether recommendations influenced clinical care remains speculative. We examined the profile and clinical care of FM Canadian patients in two time periods to assess the effect of this paradigm change.

Methods:

FM patients followed prospectively at a Montreal university based tertiary care pain clinic from 2005 to 2013 were recruited. Disease severity was measured with pain visual analog scale (VAS), patient global assessment (PGA), McGill Pain Questionnaire (MPQ), Pain Disability Index (PDI), Pain Catastrophizing Scale (PCS), Fibromyalgia Impact Questionnaire (FIQ), Health Assessment Questionnaire (HAQ) and Arthritis Impact Measurement Scales (AIMS) the latter including anxiety and depression subscales. Differences between enrolment period groups (2005-08 vs 2009-13) were assessed for statistical significance with the chi-square test for categorical variables and the independent-samples t-test for continuous variables.

Results:

Table 1 presents the profile of 248 FM patients stratified by enrolment period: 147 patients in 2005-08 and 101 patients in 2009-13. The mean ± SD age of patients was 47.9 ± 10.3 years (2005-08 vs 2009-13: 49.3 ± 9.71 vs 45.9 ± 10.94; p=0.012). The majority (91.1%) of patients were female (p=0.179). Mean ± SD disease duration was 10.8 ± 9.80 years (p=0.851). Significant between-group differences (2005-08 vs 2009-13) of mean ± SD scores were observed for PDI (36.1 ± 15.10 vs 40.0 ± 13.21; p=0.036), FIQ (65.1 ± 18.24 vs 69.8 ± 14.18; p=0.029) and AIMS depression (5.1 ± 1.64 vs 4.5 ± 2.05; p=0.005). Statistical trends were observed in regard to medication use: 2005-08 patients used more analgesics (24.5% vs 15.8%; p=0.114) and NSAIDs (26.5% vs 17.8%, p=0.126) but less antiepileptics (27.9% vs 38.6%, p=0.097). Exercise activity was more prevalent among 2009-13 patients (23.8% vs 39.6%; p=0.011). The 2009-13 group had lower disability rates (39.5% vs 18.8%; p=0.001), higher employment rates in manual and service areas (37.2% vs 16.3%) and lower rates in health care or educational areas (31.9% vs 58.1%) (p<0.001).

Conclusion: FM patient profile changes in the past decade may have been informed by recent guidelines. Despite similar pain durations at presentation and generally greater symptom severity, FM management has trended away from traditional analgesic medication use. Maintained function with more patients employed and participating in exercise activity reflects the evolving concept of FM care.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessment-of-the-temporal-variation-of-the-fibromyalgia-patient-profile-between-2005-and-2013-do-guidelines-inform-clinical-care/