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Pain and pain relief in fibromyalgia
patients followed for three years
R. Poyhia, MD |
The pain experienced by patients with fibromyalgia (FM) is continuous,
diffuse, and is associated with fatigue. The pathologic mechanism is
poorly understood. Recent studies indicate that dysregulation of central
pain regulating mechanisms may be involved. Eleven to 18 tender points are
characteristically seen. Treatment of FM is challenging and frustrating.
The authors studied 82 women with FM over a period of three years. They
focused on their reports of pain, treatment interventions, and treatment
preferences.
All 82 patients had a confirmed diagnosis of FM per ACR criteria. Patients
were evaluated upon entering the study and then once a year for three
years (59 patients). Twenty-three patients were excluded for missing at
least one follow-up visit. Pain was measured by the visual analog scale,
tender point count, and the occurrence of widespread pain. Function was
measured by the Health Assessment Questionnaire (HAQ) and the Fibromyalgia
Impact Questionnaire (FIQ), and depression and anxiety by the Arthritis
Impact Measurement Scales (AIMS). Both pharmacologic and nonpharmacologic
treatments were recorded.
All pain parameters decreased over the duration of the study. Patients
were divided into three groups. Gp A reported a 30% or better improvement
in pain, Gp B remained unchanged or worsened from baseline, and Gp C had
improved pain by < 30%. The use of pharmacologic treatment did not differ
significantly between the pain groups. The overall use of pharmacologic
and nonprescribed medications decreased during the period of observation.
Simple analgesics were the most commonly used medications. A garden
variety of other drugs were used by some, including one who used
nonprescribed marijuana.
The most beneficial therapy was exercise. Relaxation, baths, and massage
were also among the most common preferred interventions. One patient used
an alternative medication and prescribed medications were beneficial to
only a few.
Pain remained a constant companion to most, but widespread pain was no
longer present in more than 30% of patients at three years.
A factor that may have contributed to the favorable outcome is that the
patients were being followed by a specialist who was perceived as
sympathetic. This may have had a positive impact on symptoms. Knowing they
were in a study of FM, the patients may have had a simple desire to please
and report fewer symptoms. Even assigning a definite diagnosis to their
condition may have decreased the stress of their ill-defined condition.
The authors found a positive correlation between TP count, the occurrence
of widespread pain, and overall intensity of pain. Changes in depression
and anxiety were only moderately related to changes in pain. A reduction
in medication use was observed. The authors believe the reason for the
above is that most drugs used to treat FM generally are not very
effective. Even alternative drugs chosen by patients were not very
effective, but exercise was. Long-term trials to determine the efficacy of
different physical therapies and exercise interventions may be of benefit.
Clearly the pharmacologic treatments that were offered to the patients
were not continued over time. Either the medications were not effective or
the complex improves requiring less medication use. As noted previously,
the patients in this study preferred exercise to medications. More studies
are needed to identify which factors are associated with a good outcome.
Refrences: Arthritis Rheum, 45(4):355-361, 2001. 24 References
Aug-01-2001
Pain Relief Unit, Dept of Anaesthesia and Intensive Care, Helsinki
University Central Hospital, FIN-00029 HYKS, Finland (R Poyhia, MD)
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