Background & Aims
Fibromyalgia patients present with multiple symptoms and numerous medical comorbidities. Determining the significance of associated comorbidities and whether independent treatment of comorbidities is of importance remains challenging. This study was designed to determine the prevalence and impact of medical comorbidities in a large well-defined sample of Fibromyalgia patients who participated in an intensive multicomponent clinical program in a tertiary care center. The study aimed to assess Fibromyalgia associated comorbidities and their impact on treatment outcome that included level of functioning, pain, and depression.
Methods
Participants included a sample of 411 patients diagnosed with Fibromyalgia at a large tertiary medical center using the 2016 ACR (American College of Rheumatology) criteria. The participants were enrolled in an intensive 2-day cognitive behavioral multicomponent treatment program at the time of their participation in the study. Comorbidities were assessed utilizing analyses of electronic medical records and physician chart review. Measures completed at the time of admission to the intensive program and at 6-month follow-up included: the Fibromyalgia Impact Questionnaire Revised (FIQR), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Pain Catastrophizing Scale (PCS). Analyses included T-tests to determine differences between the presence or absence of select comorbidities for the three outcomes at follow-up. Statistically significant comorbidities (P < 0.05) were used as predictors in multivariable logistic regression models.
Results
The top ten comorbidities identified for this sample were determined by review of the electronic medical record and verification by a physician. The data revealed that neurologic (headaches), rheumatologic (osteoarthritis), and cardiovascular diseases (hypertension) were the most common comorbidities associated with Fibromyalgia in our study. The Fibromyalgia associated comorbidities in this cohort that had significant impact on the measured outcome domains after treatment program completion were Obesity (FIQR P=0.024), Hypothyroidism (CES-D P=0.023, PCS P=0.035), Gastroesophageal reflux disease GERD (PCS P < 0.001), Osteoarthritis (CES-D P=0.047). Interestingly, Headache, the most frequent Fibromyalgia associated comorbidity in this cohort (33.6%), did not have a significant impact on the outcome domains at follow-up. Obesity (18.2%) was found to impact functioning at follow-up.
Conclusions
The present study suggests that comorbidities have an impact on response to treatment in Fibromyalgia. Addressing these comorbidities may further improve outcomes in patients with Fibromyalgia. For example, estimates of the prevalence of obesity in patients with Fibromyalgia are high. There appears to be a bidirectional relationship between obesity and pain reflecting the possibility of biomechanical overload in patients with obesity leading to increased pain, as well as the presence of neurohumoral mechanisms and pro-inflammatory states. Additionally, the chronic pain in Fibromyalgia may lead to obesity as a consequence of decreased activity or exercise. Treatment programs that target obesity may find that modifying this comorbidity will yield improvement in functioning.
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