Association between initial opioid use and response to a brief interdisciplinary treatment program in fibromyalgia.

BACKGROUND: To evaluate the association between opioid use and treatment outcome (symptom severity, quality of life [QOL]) after a brief interdisciplinary fibromyalgia treatment program (FTP). METHOD: Subjects (n = 971) with fibromyalgia participated in the FTP. They filled out the Fibromyalgia Impact Questionnaire (FIQ) and the Short Form-36 Health Status Questionnaire (SF-36) at baseline and 6 to 12 months after the FTP. Post-treatment changes in FIQ and SF-36 scores were compared after stratifying the participants into opioid user and non-opioid user groups. RESULTS: A total of 236 patients (24.3%) were opioid users. Compared with non-opioid users, the opioid users had worse symptom severity measured using FIQ total score (p < .001) and all subscales at baseline and post treatment, as well as worse QOL measured using all SF-36 subscales and physical and mental components. Comparison of least-square means of mean change of QOL between opioid users and non-opioid users after analysis of covariance adjusted patient characteristics and baseline scores showed that the FIQ subscale scores of physical impairment (p < .05), job ability (p < .05), and fatigue (p < .05) were significantly less improved in the opioid users compared with the non-opioid users. Moreover, the SF-36 subscale score of general health perception (p < .05) was significantly less improved in the opioid users compared with non-opioid users. However, post-treatment changes in mean scores for QOL subscale generally did not significantly differ in both groups. CONCLUSIONS: Opioid use did not affect response to the FTP, as measured using the FIQ total score or SF-36 physical and mental component summary scores. Furthermore, the opioid user group showed less improvement in the FIQ subscale scores of physical impairment, job ability, and fatigue and in the SF-36 subscale scores of general health perception.

Physical Trauma and Infection as Precipitating Factors in Patients with Fibromyalgia.

OBJECTIVE: The objective of this study was to evaluate both precipitating factors in patients with fibromyalgia and any differences in clinical presentation, symptom severity, and quality-of-life between those with and without precipitating physical trauma or infection. DESIGN: In a retrospective cross-sectional study, the authors compared patient characteristics and fibromyalgia symptom severity and quality-of-life with the Fibromyalgia Impact Questionnaire and the Short Form-36 Health Survey in patients seen in a fibromyalgia treatment program. RESULTS: Of 939 patients, 27% reported precipitating factors (trauma, n = 203; infection, n = 53), with the rest having idiopathic fibromyalgia (n = 683). Patients with precipitating trauma were more likely to have worse Fibromyalgia Impact Questionnaire physical function than patients with idiopathic onset (P = 0.03). Compared with patients with idiopathic onset and precipitating trauma, patients with precipitating infection were more likely to have worse Short Form-36 Health Survey physical component summary (P = 0.01 and P = 0.003) but better role emotional (P = 0.04 and P = 0.005), mental health index (P = 0.02 and P = 0.007), and mental component summary (P = 0.03 and P = 0.004), respectively. CONCLUSIONS: One-fourth of this study's patients with fibromyalgia had precipitating physical trauma or infection. Patients with precipitating infection had different sociodemographic characteristics, clinical presentation, and quality-of-life from the idiopathic and trauma groups. Further studies are needed to look into the relationships between precipitating events and fibromyalgia.

Association of abuse history with symptom severity and quality of life in patients with fibromyalgia.

A high prevalence of abuse has been reported in patients with fibromyalgia. We aimed to examine the association between self-reported abuse history and symptom severity and quality of life (QOL) in 962 patients with fibromyalgia. All patients completed the Fibromyalgia Impact Questionnaire (FIQ) and the Short Form 36 health survey (SF-36). Multivariate regression analyses were performed. In total, 289 patients (30%) reported a history of abuse. Of those who specified abuse types, 161 patients (59%) reported more than 1 type of abuse (36% emotional, 32% physical, 25% sexual, and 7% verbal). Patients in the abuse group were younger and more likely to be female, unemployed, unmarried, and current smokers compared with patients who reported no abuse. After adjusting for these differences, abuse history was associated with worse symptoms, as indicated by a higher FIQ total score (P < .001) and higher FIQ subscale scores in physical function (P = .001), work missed (P < .001), job ability (P < .001), pain (P = .02), depression (P < .001), and anxiety (P < .001). Similarly, abuse history was associated with worse QOL, with lower SF-36 scores in all domains except the physical component summary. In conclusion, abuse history in patients with fibromyalgia was associated with worse symptoms and QOL compared with those patients without abuse history. Future studies are needed to assess whether additional tailored interventions as part of fibromyalgia treatment are helpful for patients with a history of abuse.

Psychological Resilience, Affective Mechanisms and Symptom Burden in a Tertiary-care Sample of Patients with Fibromyalgia.

Research demonstrates that patients with fibromyalgia who have higher positive and lower negative affect have lower symptom burden. Affect has been shown to be associated with resilience. This study examined the relationship between affect, resilience and fibromyalgia symptom burden in a clinical sample of patients with fibromyalgia. We hypothesized that (a) positive and negative affect would be associated with fibromyalgia symptom burden; (b) resilience would be associated with positive and negative affect; (c) resilience would be associated with fibromyalgia symptom burden; and (d) the connection between resilience and fibromyalgia symptom burden would be mediated by both positive and negative affect. A sample of 858 patients with fibromyalgia completed questionnaires. Mediation modelling revealed statistically significant direct effects of resilience on fibromyalgia symptom burden (ß = -0.10, P < 0.001) and statistically significant indirect effects of resilience on fibromyalgia symptom burden through affect (ß = -0.36, P < 0.001), suggesting that both resilience and affect influence fibromyalgia symptom burden. Our results suggest that improving affect through resiliency training could be studied as a modality for improving fibromyalgia symptom burden.

Unique barriers and needs in weight management for obese women with fibromyalgia.

RESEARCH QUESTION: The aim of this study was to identify barriers, needs, and preferences of weight management intervention for women with fibromyalgia (FM). THEORETICAL FRAMEWORK: Obesity appears in higher rates in women with fibromyalgia compared to the population at large, and no study to date has taken a qualitative approach to better understand how these women view weight management in relation to their disease and vice versa. METHODOLOGY: We designed a qualitative interview study with women patients with FM and obesity. CONTEXT: Women (N = 15) were recruited by their participation in a fibromyalgia treatment program (FTP) within the year prior. SAMPLE SELECTION: The women approached for the study met the following inclusion criteria: confirmed diagnosis of FM, age between 30 and 60 years (M = 51 ± 6.27), and body mass index (BMI) ≥ 30 (M = 37.88 ± 4.87). DATA COLLECTION: Patients completed questionnaire data prior to their participation in focus groups (N = 3), including weight loss history, physical activity data, the Revised Fibromyalgia Impact Questionnaire (FIQR), and the Patient Health Questionnaire 9-item (PHQ-9). Three focus group interviews were conducted to collect qualitative data. ANALYSIS AND INTERPRETATION: Consistent themes were revealed within and between groups. Patients expressed the complex relationships between FM symptoms, daily responsibilities, and weight management. Weight was viewed as an emotionally laden topic requiring compassionate delivery of programming from an empathetic leader who is knowledgeable about fibromyalgia. Patients view themselves as complex and different, requiring a specifically tailored weight management program for women with FM. MAIN RESULTS: Women with FM identify unique barriers to weight management, including the complex interrelationships between symptoms of FM and health behaviors, such as diet and exercise. They prefer a weight management program for women with FM that consists of an in-person, group-based approach with a leader but are open to a tailored conventional weight management program. Feasibility may be one of the biggest barriers to such a program both from an institutional and individual perspective.

A Comparison of Fibromyalgia Symptoms in Patients with Healthy versus Depressive, Low and Reactive Affect Balance Styles.

BACKGROUND AND AIMS: Affect balance reflects relative levels of negative affect (NA) and positive affect (PA) and includes four styles: Healthy (low NA/high PA), Depressive (high NA/low PA), Reactive (high NA/high PA) and Low (low NA/low PA). These affect balance styles may have important associations with clinical outcomes in patients with fibromyalgia. Herein, we evaluated the severity of core fibromyalgia symptom domains as described by the Outcomes Research in Rheumatology-Fibromyalgia working group in the context of the four affect balance styles. METHODS: Data from735 patients with fibromyalgia who completed the Brief Pain Inventory, Multidimensional Fatigue Inventory, Profile of Mood States, Medical Outcomes Sleep Scale, Multiple Ability Self-Report Questionnaire, Fibromyalgia Impact Questionnaire-Revised, Medical Outcomes Study Short Form-36, and Positive and Negative Affect Schedule were included in this analysis. RESULTS: The majority (51.8%) of patients in our sample had a Depressive affect balance style; compared to patients with a Healthy affect balance style, they scored significantly worse in all fibromyalgia symptom domains including pain, fatigue, sleep disturbance, dyscognition, depression, anxiety, stiffness, and functional status (P = <.001 - .004). Overall, patients with a Healthy affect balance style had the lowest level of symptoms, while symptom levels of those with Reactive and Low affect balance styles were distributed in between those of the Depressive and Healthy groups. CONCLUSIONS AND IMPLICATIONS: The results of our cross-sectional study suggest that having a Healthy affect balance style is associated with better physical and psychological symptom profiles in fibromyalgia. Futures studies evaluating these associations longitudinally could provide rationale for evaluating the effect of psychological interventions on affect balance and clinical outcomes in fibromyalgia.

Decreased physical activity attributable to higher body mass index influences fibromyalgia symptoms.

BACKGROUND: Although previous studies report associations between increased body mass index (BMI) and fibromyalgia symptoms, there is uncertainty as to whether this relationship is driven by physical factors, psychological factors, or both. OBJECTIVE: To assess these relationships in a clinical sample of patients with fibromyalgia. DESIGN: Cross-sectional study. SETTING: Tertiary care facility. PATIENTS: A total of 686 patients from an existing national fibromyalgia registry. METHODS: Patients completed a demographic form and self-report questionnaires including the Fibromyalgia Impact Questionnaire-Revised (FIQ-R), the Medical Outcomes Study Short Form-36 (SF-36), the Brief Pain Inventory (BPI), and the 30-item Profile of Mood States (30-item POMS). MAIN OUTCOME MEASUREMENTS: FIQ-R overall impact subscale. RESULTS: BMI was significantly correlated with fibromyalgia impact (P < .001). The relationship between BMI and fibromyalgia impact was almost fully accounted for by physical factors and not by psychological factors. CONCLUSIONS: Despite patient report that pain hinders physical activity, clinicians who encounter patients with fibromyalgia, particularly patients with increased BMI, should be cognizant of the need to invest time and resources to counsel patients on physical factors (ie, physical activity) that could improve the patients' symptom experience.

Relation of age with symptom severity and quality of life in patients with fibromyalgia.

OBJECTIVE: To examine the relation of age with symptom severity and quality of life (QOL) in patients with fibromyalgia, and to compare physical and mental health of our female patients with those of the US female general population. PATIENTS AND METHODS: We studied 978 patients with fibromyalgia from May 1, 2001 through April 30, 2004, and divided them into age groups of young (≤39 years), middle-aged (40-59 years), and older (≥60 years). They completed the Fibromyalgia Impact Questionnaire and the Short Form-36 Health Status Questionnaire (SF-36). Standardized SF-36 physical and mental health summary scores were compared with those of the US female general population of similar age. One-way analysis of variance and post hoc paired t test analyses were performed to detect differences across age groups. RESULTS: Pairwise comparison found young and middle-aged patients having worse fibromyalgia symptoms in all subscales except the anxiety subscale compared with older patients (P≤.01). Similarly, these young and middle-aged patients had worse QOL in the SF-36 mental component summary, as well as SF-36 general health perceptions, vitality, social functioning, and mental health index, compared with older patients (all P<.001). When the QOL of our female patients was compared with that of the US female general population of similar age with standardized SF-36 scores, all age groups had lower QOL in physical, as well as mental, health, with more reduction in physical health, particularly in young patients. CONCLUSION: Our study shows that symptom severity and QOL differ across age groups in patients with fibromyalgia, with young and middle-aged patients having poorer QOL and worse fibromyalgia symptoms than do older patients. QOL in physical health was reduced more than in mental health, particularly in young patients, compared with the general population.

Early experience with a brief, multimodal, multidisciplinary treatment program for fibromyalgia.

Fibromyalgia is a complex heterogeneous disorder for which a multidisciplinary individualized approach is currently advocated. We executed a 1-week multidisciplinary fibromyalgia clinical program with seven patients, based on our experience with our existing 1.5-day multidisciplinary fibromyalgia program that has demonstrated both short- and long-term benefits. The current expanded program was not designed as a clinical study, but rather as a clinical feasibility assessment, and it was multidisciplinary in nature, with cognitive behavioral therapy, activity pacing, and graded exercise therapy as major components. We assessed changes in individual patients at 1 week and 3 months after the program with the use of validated self-report measures of pain, fatigue, and self-efficacy. All patients indicated at least small improvements in pain and physical symptoms at both 1 week and 3 months, and all but one patient showed improvement in self-efficacy at 1 week and 3 months. Similar trends were observed for fatigue. Based on our early clinical experience, we conclude that the 1-week multidisciplinary fibromyalgia program is logistically feasible and has potential for clinical efficacy. Further research is needed and is planned to test the clinical efficacy of this program and compare it with other interventions.

Construction of a US fibromyalgia registry using the Fibromyalgia Research Survey criteria.

Utilizing billing records, we identified patients seen at Mayo Clinic with a diagnosis or history of fibromyalgia who were then contacted for enrollment in a fibromyalgia research registry. Fibromyalgia was confirmed through medical record review. Eligible patients were mailed an invitation that included a demographic questionnaire and the Fibromyalgia Research Survey. The Fibromyalgia Research Survey yields a widespread pain score (scale range 0-19) and a symptom severity score (scale range 0-12). A total of 4,034 patients returned the completed survey; 92.8% were female, their mean age was 57.4 (±13.4), and 83.7% were from the Midwest region of the United States. The mean widespread pain score for all participants was 11.3 (±4.5) and the mean symptom severity score was 8.2 (±2.4), indicating moderate-to-severe fibromyalgia symptoms, which is not unusual for patients presenting to a tertiary care center. Using a systematic process, we describe the creation of a fibromyalgia registry for future research.

Association between alcohol consumption and symptom severity and quality of life in patients with fibromyalgia.

INTRODUCTION: Although alcohol consumption is a common lifestyle behavior with previous studies reporting positive effects of alcohol on chronic pain and rheumatoid arthritis, no studies to this date have examined alcohol consumption in patients with fibromyalgia. We examined the association between alcohol consumption and symptom severity and quality of life (QOL) in patients with fibromyalgia. METHODS: Data on self-reported alcohol consumption from 946 patients were analyzed. Subjects were grouped by level of alcohol consumption (number of drinks/week): none, low (≤ 3), moderate (>3 to 7), and heavy (>7). RESULTS: Five hundred and forty-six subjects (58%) did not consume alcohol. Low, moderate, and heavy levels of alcohol consumption were reported for 338 (36%), 31 (3%), and 31 patients (3%), respectively. Employment status (P <0.001), education level (P = 0.009), body mass index (P = 0.002) and opioid use (P = 0.002) differed significantly among groups with drinkers having higher education, a lower BMI, and a lower frequency of unemployment and opioid use than nondrinkers. After adjusting for these differences, the measures including the number of tender points (P = 0.01), FIQ total score (P = 0.01), physical function (P <0.001), work missed (P = 0.005), job ability (P = 0.03), and pain (P = 0.001) differed across groups, as did the SF-36 subscales of physical functioning (P <0.001), pain index (P = 0.002), general health perception (P = 0.02), social functioning (P = 0.02), and the physical component summary (P <0.001). Pairwise comparison among the 4 groups showed that the moderate and low alcohol drinkers had lower severity of fibromyalgia symptoms and better physical QOL than nondrinkers. CONCLUSIONS: Our study demonstrates that low and moderate alcohol consumption was associated with lower fibromyalgia symptoms and better QOL compared to no alcohol consumption. The reasons for these results are unclear. Since recent studies have demonstrated that γ-Aminobutyric Acid (GABA) levels are low in fibromyalgia, and alcohol is known to be a GABA-agonist, future studies should examine whether alcohol could have a salutary effect on pain and other symptoms in fibromyalgia.

Prevalence of fibromyalgia: a population-based study in Olmsted County, Minnesota, utilizing the Rochester Epidemiology Project.

OBJECTIVE: To estimate and compare the prevalence of fibromyalgia by 2 different methods in Olmsted County, Minnesota. METHODS: The first method was a retrospective review of medical records of potential cases of fibromyalgia in Olmsted County using the Rochester Epidemiology Project (from January 1, 2005, to December 31, 2009) to estimate the prevalence of diagnosed fibromyalgia in clinical practice. The second method was a random survey of adults in Olmsted County using the fibromyalgia research survey criteria to estimate the percentage of responders who met the fibromyalgia research survey criteria. RESULTS: Of the 3,410 potential patients identified by the first method, 1,115 had a fibromyalgia diagnosis documented in the medical record by a health care provider. The age- and sex-adjusted prevalence of diagnosed fibromyalgia by this method was 1.1%. By the second method, of the 2,994 people who received the survey by mail, 830 (27.6%) responded and 44 (5.3%) met the fibromyalgia research survey criteria. The age- and sex-adjusted prevalence of fibromyalgia in the general population of Olmsted County by this method was estimated at 6.4%. CONCLUSION: To the best of our knowledge, this is the first report of the rate at which fibromyalgia is being diagnosed in a community. This is also the first report of prevalence as assessed by the fibromyalgia research survey criteria. Our results suggest that patients, particularly men, who meet the fibromyalgia research survey criteria are unlikely to have been given a diagnosis of fibromyalgia.

Association between body mass index and response to a brief interdisciplinary treatment program in fibromyalgia.

OBJECTIVE: The aim of this study was to evaluate the association between baseline body mass index (BMI) and treatment outcome after a brief interdisciplinary fibromyalgia treatment program. DESIGN: Subjects (n = 477) with fibromyalgia participated in the fibromyalgia treatment program. They completed the Fibromyalgia Impact Questionnaire (FIQ) and the Short Form-36 Health Status Questionnaire (SF-36) at baseline and 6 to 12 mos after the fibromyalgia treatment program. Posttreatment changes in FIQ and SF-36 scores were compared after stratifying participants into four BMI groups: nonobese, overweight, moderately obese, and severely obese. RESULTS: All BMI groups achieved significant improvement in the FIQ total score; the FIQ subscales feel good, pain, fatigue, and morning tiredness; and the SF-36 subscales pain index, vitality, social functioning, and mental health index. Posttreatment changes in mean scores for each subscale generally did not differ significantly across BMI groups after adjusting for age and baseline scores. However, the SF-36 subscale scores of physical functioning and role-emotional were significantly less improved in the severely obese compared with the nonobese. CONCLUSIONS: Baseline BMI did not affect response to the fibromyalgia treatment program, as measured by the FIQ total score or SF-36 physical and mental component summary scores. However, the severely obese group showed less improvement compared with the nonobese group in the SF-36 physical functioning and role-emotional subscales.

Predictors of clinical outcome in fibromyalgia after a brief interdisciplinary fibromyalgia treatment program: single center experience.

OBJECTIVE: To determine which patient characteristics are closely associated with a positive response to a brief interdisciplinary fibromyalgia treatment program (FTP). DESIGN: A prospective cohort study. SETTING: FTP at a tertiary medical center. PARTICIPANTS: A total of 536 patients with a confirmed diagnosis of fibromyalgia who underwent the FTP and completed the Fibromyalgia Impact Questionnaire (FIQ) at baseline and 6-12 months after treatment. INTERVENTIONS: A brief 1.5-day interdisciplinary FTP, which included evaluation with a registered nurse and a physician for a diagnosis or confirmation of fibromyalgia, fibromyalgia education, interactive self management session, and physical and occupational therapy. MAIN OUTCOME MEASUREMENTS: The responder definition was an improvement of 14% or more in the FIQ total score from their baseline to 6-12 months after treatment. RESULTS: Mean (standard deviation) age of our patients was 50.3 ± 13.0 years; 515 women (96%) and 23 men (4%). Two hundred forty-eight patients (46%) met the responder definition at 6-12 months follow-up. In an univariate analysis, younger age (P = .008), college or higher education (P = .02), fewer tender points (P = .048), and higher FIQ depression subscore (P = .02) significantly predicted positive response. In a multivariate analysis, these factors all remained statistically significant. In addition, a positive abuse history became significant (P = .03). There was no significant association for gender, duration of symptoms, marital status, employment, smoking status, or 3 numeric rating scale pain scores. CONCLUSIONS: Patients with younger age, more years of education (with college or graduate degree), higher baseline FIQ depression score, lower tender point count, and absent abuse history experience greater benefit from a brief FTP.

Association of body mass index with symptom severity and quality of life in patients with fibromyalgia.

OBJECTIVE: To examine the association between body mass index (BMI) and symptom severity and quality of life (QOL) in patients with fibromyalgia. METHODS: We assessed BMI status and its association with symptom severity and QOL in 888 patients with fibromyalgia who were seen in a fibromyalgia treatment program and who completed the Fibromyalgia Impact Questionnaire (FIQ) and the Short Form 36 (SF-36) health survey. RESULTS: The BMI distribution of nonobese (BMI <25.0 kg/m(2)), overweight (BMI 25.0-29.9 kg/m(2)), moderately obese (BMI 30.0-34.9 kg/m(2)), and severely obese (BMI ≥35.0 kg/m(2)) patients was 28.4% (n = 252), 26.8% (n = 238), 22.2% (n = 197), and 22.6% (n = 201), respectively. Age was significantly different among the 4 groups, with those having a greater BMI being older (P = 0.004). After adjustment for age, group differences were significant in the number of tender points (P = 0.003) and the FIQ and SF-36 scores. The groups with the greater BMI had greater fibromyalgia-related symptoms with worse FIQ total scores (P < 0.001), as well as worse scores in the FIQ subscales of physical function (P < 0.001), work missed (P = 0.04), job ability (P = 0.003), pain (P < 0.001), stiffness (P < 0.001), and depression (P = 0.03). These groups also had poorer SF-36 scores in physical functioning (P < 0.001), pain index (P = 0.005), general health perceptions (P = 0.003), role emotional (P = 0.04), and physical component summary (P < 0.001). Post hoc analysis among the 4 groups showed that differences resided primarily in the severely obese group compared with the other groups. CONCLUSION: In patients with fibromyalgia, severe obesity (BMI ≥35.0 kg/m(2)) is associated with higher levels of fibromyalgia symptoms and lower levels of QOL.

Pain and other symptom severity in women with fibromyalgia and a previous hysterectomy.

OBJECTIVE: Fibromyalgia is a troubling disease characterized by chronic pain. This study explored whether pain and other fibromyalgia symptoms are worse among women who had undergone a hysterectomy with or without an oophorectomy versus those who had not. METHODS: Consecutive women who were seen at the Fibromyalgia Treatment Program at a tertiary medical center between 2001 and 2004 and who completed the Fibromyalgia Impact Questionnaire (FIQ) and Short Form-36 Health Survey (SF-36) at initial evaluation were included in this study. RESULTS: A total of 813 women were included; 328 had had a hysterectomy. Total FIQ scores from women who had had a hysterectomy were higher (worse symptoms) than those who had not (58.1 vs 56.4, P = 0.002). FIQ subscale scores of pain (P = 0.003), fatigue (P = 0.030), stiffness (P = 0.035), and depression (P = 0.008) were also worse in women who had had a hysterectomy. Similar to the FIQ, SF-36 physical component scores were worse in women who had had a hysterectomy (P = 0.045). CONCLUSION: Pain and other fibromyalgia symptom severity was worse in women who had had a hysterectomy with or without an oophorectomy.

Direct medical costs in patients with fibromyalgia: Cost of illness and impact of a brief multidisciplinary treatment program.

OBJECTIVE: To compare the direct medical costs of clinically diagnosed patients with fibromyalgia with the medical costs of matched controls during a 4-yr period and to assess the impact of a fibromyalgia treatment program on healthcare utilization and associated medical costs. DESIGN: A retrospective comparison of economic outcomes in 87 patients who participated in a fibromyalgia treatment program between 2001 and 2004 and who were local residents for the entire 4-yr period spanning their participation in the program, with age and sex-matched controls. Costs for the 2 yrs before and 2 yrs after program participation were also compared. RESULTS: Four-year medical costs for controls were $7774 compared with $15,759 for those with fibromyalgia. There was no significant change in direct costs after participation in a brief fibromyalgia treatment program. Those with increased symptom severity averaged $2034 higher direct medical costs during the 4-yr period. CONCLUSIONS: Patients with clinically diagnosed fibromyalgia incur direct medical costs about twice that of their matched controls. This increased cost is related to the severity of their symptoms as measured by the Fibromyalgia Impact Questionnaire and was not impacted by participation in a brief cognitive behaviorally based fibromyalgia treatment program.

Brief interdisciplinary treatment program for fibromyalgia: six to twelve months outcome.

OBJECTIVE: To evaluate the impact and long-term benefit of a brief 1(1/2)-day fibromyalgia treatment program. DESIGN: We assessed 6-12-mo outcome of 521 participants who underwent a 1(1/2)-day interdisciplinary fibromyalgia treatment program in a tertiary medical center. We administered three self-reported instruments: the Fibromyalgia Impact Questionnaire, the Short Form-36 Health Status Questionnaire, and a satisfaction survey, at baseline, and 6-12 mos after completing the fibromyalgia treatment program. The difference in the Fibromyalgia Impact Questionnaire and Short Form-36 scores before and after the fibromyalgia treatment program was the main outcome measure. RESULTS: Compared with baseline, the Fibromyalgia Impact Questionnaire total score was decreased by a mean (SD) of 7.2 (17.7) points at follow-up (P < 0.001). All Fibromyalgia Impact Questionnaire subscales improved significantly at follow-up (all P < 0.001), except depression score (P = 0.67). The Short Form-36 scores improved significantly in all areas at follow-up (all P < 0.001), except general health perception (P = 0.58) and role emotional (P = 0.13). CONCLUSIONS: A brief 1(1/2)-day fibromyalgia treatment program improves symptoms and quality of life in patients with fibromyalgia for 6-12 mos. Further clinical investigations are needed to compare this fibromyalgia treatment program with other programs and interventions.

Impact of tobacco use in patients presenting to a multidisciplinary outpatient treatment program for fibromyalgia.

OBJECTIVES: This study examined the relationship between the severity of fibromyalgia symptoms and current tobacco use in patients evaluated at a specialized fibromyalgia treatment program. METHODS: Demographic and clinical data from 984 consecutive patients evaluated at the Mayo Clinic Fibromyalgia Treatment Program including the Fibromyalgia Impact Questionnaire (FIQ) were prospectively collected and stored in an electronic medical record and an electronic database. Univariate analyses were performed comparing tobacco users and nonusers. A post-hoc analysis of covariance was conducted for tobacco use, using group differences of confounding clinical and demographic variables. A P value < or = 0.05 was accepted as the level of significance. RESULTS: One hundred and forty-five patients were identified as tobacco users (14.7%). Tobacco use was associated with greater pain intensity as measured by pain scales and the pain component of the FIQ. Tobacco users had a greater FIQ composite score 70.0(15.1) versus 61.8(16.8), P<0.001. By univariate analysis, tobacco users had higher scores on all the FIQ components and fewer good days and more days of work missed per week. Tobacco use was associated with several confounding clinical and demographic variables including lower education, higher unemployment, not being married or widowed, and history of abuse. After adjusting for these confounding variables, tobacco users continued to have greater pain intensity, a higher total and component FIQ scores except for fatigue. Smoking was not associated with a higher number of tender points. DISCUSSION: Current tobacco use was associated with more severe fibromyalgia symptoms in patients presenting to a specialized fibromyalgia treatment program.

Dysphagia in inclusion body myositis: clinical features, management, and clinical outcome.

OBJECTIVE: To evaluate the clinical features, treatment strategies, and outcome of dysphagia in patients with inclusion body myositis. DESIGN: Retrospective review of all 26 patients (20 women, 6 men, mean age of 72.2 yrs) with inclusion body myositis-associated dysphagia seen in 1997-2001 at our institution. RESULTS: Twenty-four patients (92%) had a dysphagia evaluation. Cricopharyngeal muscle dysfunction was noted in all nine patients who had barium swallow studies. Eighteen patients (69%) underwent one or more interventional procedures: cricopharyngeal myotomy (10), pharyngoesophageal dilation (6), percutaneous endoscopic gastrostomy (6), and botulinum injection of the upper esophageal sphincter (2). Dysphagia tended to worsen with time. Symptomatic improvement was noted with cricopharyngeal myotomy (63%) and pharyngoesophageal dilation (33%). The Mendelsohn maneuver seemed helpful in maintaining oral intake in the three patients in whom it was recommended. Thirteen patients died during follow-up at a mean age of 81 yrs. The cause of death was identified in eight and in all cases was because of the respiratory complications of aspiration. CONCLUSIONS: Dysphagia is a progressive condition in patients with inclusion body myositis and often leads to death from aspiration pneumonia. Treatment targeting cricopharyngeal muscle dysfunction, such as the Mendelsohn maneuver, will benefit from further investigation.