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- Title
Evaluating Guideline-recommended Pain Medication Use Among Patients with Newly Diagnosed Fibromyalgia.
- Authors
Halpern, Rachel; Shah, Sonali N.; Cappelleri, Joseph C.; Masters, Elizabeth T.; Clair, Andrew
- Abstract
Objectives To compare pain medication treatment changes across cohorts of newly diagnosed patients with fibromyalgia ( FM) treated with guideline-recommended medications or opioids. Methods and Design Retrospective claims data analysis examined adult commercial health plan members newly diagnosed with FM (initial diagnosis = index date) from January 2008 to February 2012. Patients had 6-month pre-index and 12-month postindex periods and received pain medication within 6 months postindex; cohorts were based on the first postindex medication. Guideline-recommended medication cohorts were anti-epileptic drug ( AED), serotonin-norepinephrine reuptake inhibitor ( SNRI), selective serotonin reuptake inhibitor ( SSRI), and tricyclic antidepressant ( TCA). Short-acting and long-acting opioid ( SAO, LAO) cohorts were also identified. Pairwise comparisons with the SAO cohort were conducted. Cox proportional hazards regressions modeled the likelihood of receiving guideline-recommended therapy. Results The final sample was 96,175 patients (mean age 47.3 years; 72.5% female), distributed into SAO (57%), SSRI (22%), AED (10%), SNRI (6%), TCA (3%), and LAO (2%) cohorts. The SAO cohort had the most discontinuation (49% vs. 6% to 22%, P < 0.01) and the least augmentation (29% vs. 35% to 50%, P < 0.01). Regression analyses indicated that patients with (vs. without) pre-index guideline-recommended medications were 2 to 4 times more likely to receive them postindex. Patients in the opioid cohorts were about half as likely to receive subsequent guideline-recommended medications. Conclusions Opioid use was widespread among patients with FM. Once patients received opioids postdiagnosis, the likelihood of receiving guideline-recommended medications was small. These real-world results indicate an opportunity may exist for improved FM management using recommended therapies in clinical practice.
- Subjects
LAOS; ANTICONVULSANTS; ANTIDEPRESSANTS; FIBROMYALGIA; HEALTH planning; PAIN; REGRESSION analysis; SEROTONIN uptake inhibitors; PROPORTIONAL hazards models; RETROSPECTIVE studies; DESCRIPTIVE statistics
- Publication
Pain Practice, 2016, Vol 16, Issue 8, p1027
- ISSN
1530-7085
- Publication type
Article
- DOI
10.1111/papr.12364