Background/Purpose: There are few studies on the long-term prognosis of fibromyalgia. This study assessed the natural history of fibromyalgia in patients receiving usual medical care and identified predictors of outcome.

Methods: Over about 3 years, patients from the Fibromyalgia Treatment Program completed questionnaires for demographics, pain, mood, fatigue, sleep, health-related quality of life, coping mechanisms, stressful life events, and global assessments. Clinicians evaluated pain thresholds, psychiatric comorbidity, medical history, and global assessments. Patient Global Impression of Improvement (PGI) at endpoint was used to define two groups:  1) definitely improved (much or very much better); and 2) not markedly improved (minimally improved, no change, or worse).  Spearman correlation coefficients were calculated for baseline variables versus PGI endpoint scores.  A general linear model was used to examine the relationship between baseline variables and PGI score at endpoint.

Results: Sixty-nine patients completed the baseline assessment and had at least 1 follow-up visit.  About half (n=34) of the patients definitely improved. There were no significant differences in any demographic variable between the two groups. Among those who reported global improvement, there was significant improvement in fatigue.  Having baseline maladaptive coping (catastrophizing), lower pain thresholds, more negative fibromyalgia impact, and impairment in quality of life were correlated with poorer global assessment at endpoint. In the regression analysis, only baseline catastrophizing remained a significant predictor of endpoint PGI.

Conclusion: Fibromyalgia patients who improved were less likely to use catastrophizing at baseline.  Interventions directed at improving pain coping skills should be a major component of fibromyalgia management.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-outcomes-in-fibromyalgia/