title: Evaluating Guideline-recommended Pain Medication Use Among Patients with Newly Diagnosed Fibromyalgia.
abstract: OBJECTIVE
  To compare pain medication treatment changes across cohorts of newly diagnosed patients with fibromyalgia (FM) treated with guideline-recommended medications or opioids.
  
  
  METHODS
  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.
authors.affiliation: Optum, Eden Prairie, Minnesota, U.S.A.
authors.forename: Rachel
authors.initials: R
authors.lastname: Halpern
authors.affiliation: Pfizer Inc, New York City, New York, U.S.A.
authors.forename: Sonali N
authors.initials: SN
authors.lastname: Shah
authors.affiliation: Pfizer Inc, Groton, Connecticut, U.S.A.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Cappelleri
authors.affiliation: Pfizer Inc, New York City, New York, U.S.A.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Masters
authors.affiliation: Pfizer Inc, New York City, New York, U.S.A.
authors.forename: Andrew
authors.initials: A
authors.lastname: Clair
keywords: adherence; fibromyalgia; guidelines; opioid use; pain; therapeutics