Treatment outcomes after multidisciplinary pain rehabilitation with analgesic medication withdrawal for patients with fibromyalgia.
OBJECTIVE
This study of patients with a diagnosis of fibromyalgia (FM) was conducted to test the hypothesis that immediate posttreatment measures of psychosocial functioning, health attributes, negative pain-related emotions, and depressive symptoms improve significantly during multidisciplinary pain rehabilitation while concurrently withdrawing analgesic medications.


METHODS
Prospective case series.


METHODS
Multidisciplinary pain rehabilitation center at a tertiary referral medical center.


METHODS
In total, 159 consecutive patients with a diagnosis of FM admitted to the pain rehabilitation program from January 2002 to December 2003.


METHODS
A 3-week outpatient multidisciplinary pain rehabilitation program based on a cognitive-behavioral model that incorporates analgesic medication withdrawal.


METHODS
Multidimensional Pain Inventory (MPI), Short Form-36 Health Status Questionnaire (SF-36), Coping Strategies Questionnaire-Catastrophizing subscale (CSQ-C), and the Center for Epidemiologic Studies-Depression scale (CES-D) were administered at admission and dismissal and the mean differences in scores were compared using paired t-tests. The number of patients using opioid analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), benzodiazepines, and muscle relaxants at admission and dismissal were compared using chi-squared analyses.


RESULTS
The difference in admission and dismissal scores from the MPI, SF-36, CSQ-C, and CES-D demonstrated a favorable response to treatment (P < 0.001). Compared with admission, the number of patients using opioids (P < 0.001), NSAIDs (P < 0.001), benzodiazepines (P < 0.001), and muscle relaxants (P < 0.01) at program dismissal was significantly reduced.


CONCLUSIONS
The results of this study support the hypothesis that immediate posttreatment measures of physical and emotional functioning are favorable for patients with FM following multidisciplinary pain rehabilitation that incorporates withdrawal of analgesic medications.
Hooten
W Michael
WM
Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. hooten.william@mayo.edu
Townsend
Cynthia O
CO
Sletten
Christopher D
CD
Bruce
Barbara K
BK
Rome
Jeffrey D
JD
D000700:Analgesics / Q000627:therapeutic use*; D005260:Female; D005356:Fibromyalgia / Q000534:rehabilitation* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology / Q000523:psychology*; D018710:Pain Clinics; D010147:Pain Measurement; D011584:Psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000700:Analgesics