Interdisciplinary Fibromyalgia Treatment Benefits Sustained

Nancy A. Melville

March 14, 2014

PHOENIX, Arizona — Patients with fibromyalgia treated with an intensive disciplinary rehabilitation program show clinically significant improvements as long as 12 months after discharge from the program, according to a new study.

"This interdisciplinary approach doesn't cure fibromyalgia, but we have shown in this work that it allows patients to become functional and have results to be sustained even as long as a year after discharge — and that is huge," said lead author Brinder Vij, MD, from the Cleveland Clinic in Ohio.

Whereas there is substantial evidence that patients with fibromyalgia can benefit from a multidisciplinary treatment approach, most research has involved a combination of 2 or 3 treatment modalities, and few studies have evaluated the longer-term sustainability of the benefits, the authors noted.

For the new study, presented here at the American Academy of Pain Medicine (AAPM) 30th Annual Meeting, Dr. Vij and his colleagues evaluated clinical outcomes for 366 patients with fibromyalgia who received treatment through the interdisciplinary program at the Cleveland Clinic's Neurological Center for Pain.

The 3- to 4-week program involves treatment from a combination of multiple disciplines, including pain physicians, pain psychologists, physical and occupational therapists, group therapy, individual therapy, biofeedback, and other disciplines.

Patients in the outpatient program participate in the treatment daily, Mondays through Fridays, from 7:30 a.m. to about 5 p.m.

Follow-up data available on 100 participants showed significant improvements at discharge from the program, compared with baseline, including decreases in pain, normalization of depression, normalization of anxiety, and decreases in functional impairment (all P < .01).

In looking at maintenance of the results at 12 months out, the researchers found slight increases in patient pain severity, depression, anxiety, and pain-related functional impairment compared with discharge levels. However, gains in all of the domains, as well as those for functional disability, nevertheless remained clinically significant compared with baseline admission data (P < .01).

"We see that patients are showing improvements in functional impairment, which is important because it means they are probably spending less time in the hospital and using fewer health care services and probably living their life much better, so it's a win-win situation," Dr. Vij told Medscape Medical News.

"All aspects of fibromyalgia care are important, but functional improvement is a very critical outcome measure of overall improvement in condition."

In terms of any components of the interdisciplinary therapy that stood out as being particularly effective, Dr. Vij said it came down to the individual patient.

"All fibromyalgia patients have different manifestations and not every person needs the same things," he said.

"If the patient has more pain issues than psychological issues, then those aspects of the intensive therapy will be more effective, but if the patient is discussing personal or psychological aspects, then you know that patient likely needs more focus on those areas. But that's the beauty of an interdisciplinary pain program — you can individualize the care."

The findings underscore that expanding fibromyalgia treatment to include a variety of specialties can be a worthwhile endeavor, Dr. Vij added.

"Physicians treating fibromyalgia should team with other disciplines, including psychologists and physiotherapists, to help these patients achieve optimal outcomes."

Results Impressive

Pain specialist Ann Vincent, MD, who presented an innovative cluster analysis of fibromyalgia symptoms at the meeting, commented that the findings showing improvements 12 months after the interdisciplinary therapy were impressive.

"I think to see that after a 3-week interdisciplinary therapy program is pretty phenomenal," said Dr. Vincent, who is an internist in the Division of General Internal Medicine at Mayo Clinic in Rochester, Minnesota.

"It's an intense program involving physical and cognitive reconditioning and we have a similar interdisciplinary therapy program for fibromyalgia at the Mayo Clinic," she said.

"In the 17 days of continuing therapy, you can really make a difference in changing the patient's physiology and they are taught better coping skills."

"One of the only drawbacks is that it can be expensive; the billing is complicated, but otherwise I think it can be very successful."

The authors and Dr. Vincent have disclosed no relevant financial relationships.

American Academy of Pain Medicine (AAPM) 30th Annual Meeting. Abstract 213. Presented March 7, 2014.


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