Background/Purpose: The clinical association of fibromyalgia with symptoms of anxiety and depression is well recognized [Uçar M, et al. J Int Med Res 2015;43(5):679-85]. Emotional distress is commonly associated with the use of pain-relieving substances but inherent factors to social behavior such as substance abuse [Ramírez Medina CR, et al. RMD Open 2024;10(2):e004232] have been little studied in fibromyalgia.

This study aims to describe the level of substance abuse in patients fulfilling the 2016 Wolfe diagnostic criteria for fibromyalgia in a cohort of patients recruited at a national heart disease referral center and compare it with the non-patients who come to our Institute accompanying patients during the waiting time for outpatient assessment.

Methods: Patients and non-patients who attend the outpatient clinic of the National Institute of Cardiology Ignacio Chávez were invited to answer the self-report forms to collect basic clinical and demographic information as well as the following clinimetric scales: widespread pain index, severity of fibromyalgia symptoms, polysymptomatic distress score of the 2016 fibromyalgia criteria published by Wolf et al, 10-item Drug Abuse Screening Test (DAST-10), Patient Health Questionnaire-9 for symptoms of depression, General Anxiety Disorder-7 for anxiety symptoms, the Brief Psychiatric Rating Scale, a visual violence scale, visual analog pain scale, and EuroQol for quality of life. The protocol was approved by the institutional review board. The analysis used the Kolmogorov-Smirnov, Mann-Whitney U, Chi-Square, or Fisher’s Exact Test. A p value less than 0.05 was statistically significant.

Results: Between October 19, 2023, and April 17, 2024, 1210 complete responses were received, 498 (41%) from patients and 712 (59%) from the non-patient population. 64% were women, age 41±15 years old, 39% had single marital status, 47% had basic education, and 63% had paid economic activity. In the complete cohort, 217 participants (17.9%) met the criteria for fibromyalgia and all the scales applied were different between participants who fulfilled the criteria and those who did not (p< 0.0001). There were no differences in the proportion of participants who met the fibromyalgia criteria between patients and non-patients (18.1% vs 17.8%, p=0.487). The DAST-10 total score was higher in participants who fulfilled fibromyalgia criteria (IQR, 1 (0-2) vs 0 (0-1), p=0.001). The frequency of consumption and severity of abuse was also greater in patients (p< 0.05). Participants fulfilling fibromyalgia criteria report higher consumption of alcohol, tobacco, and tranquilizers (p< 0.05) and show a tendency to consume more cannabis (p=0.082) or inhalants (p=0.088). The patients group self-reported having more hypertension, diabetes, and dyslipidemia than non-patients (p< 0.0001). Obesity was distributed similarly (p=0.524) in patients and non-patients surveyed.

Conclusion: Substance abuse is greater in patients who fulfill the 2016 fibromyalgia criteria. To our knowledge, this is the first report of scrutiny of drug abuse with DAST-10 in patients with fibromyalgia. The description of these consumption patterns will help plan a strategy for their holistic management.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/drug-abuse-screening-in-patients-who-fulfill-the-2016-fibromyalgia-criteria/