title: Fibromyalgia syndrome care of Iraq- and Afghanistan-deployed Veterans in Veterans Health Administration.
abstract: Little is known regarding fibromyalgia syndrome (FMS) care among Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn (OIF/OEF/OND) Veterans. Current recommendations include interdisciplinary, team-based combined care approaches and limited opioid use. In this study of OIF/OEF/OND Veterans who accessed Veterans Health Administration services between 2002 and 2012, we hypothesized that combined care (defined as at least 4 primary care visits/yr with visits to mental health and/or rheumatology) versus <4 primary care visits/yr only would be associated with lower risk of at least 2 opioid prescriptions 12 mo following an FMS diagnosis. Using generalized linear models with a log-link, the Poisson family, and robust standard errors, we estimated risk ratios (RRs) and 95% confidence intervals (CIs). We found that 1% of Veterans had at least 2 FMS diagnoses (International Classification of Diseases-9th Revision-Clinical Modification code 729.1) or at least 1 FMS diagnosis by rheumatology. Veterans with (vs without) FMS were more likely to be female, older, Hispanic, and never/currently married. Combined primary, mental health, and rheumatology care was associated with at least 2 opioid prescriptions (RR [95% CI] for males 2.2 [1.1-4.4] and females 2.8 [0.4-18.6]). Also, combined care was associated with at least 2 nonopioid pain-related prescriptions, a practice supported by evidence-based clinical practice guidelines. In tandem, these results provide mixed evidence of benefit of combined care for FMS. Future studies of healthcare encounter characteristics, care coordination, and benefits for Veterans with FMS are needed.
authors.forename: April F
authors.initials: AF
authors.lastname: Mohanty
authors.forename: Drew A
authors.initials: DA
authors.lastname: Helmer
authors.forename: Anusha
authors.initials: A
authors.lastname: Muthukutty
authors.forename: Lisa M
authors.initials: LM
authors.lastname: McAndrew
authors.forename: Marjorie E
authors.initials: ME
authors.lastname: Carter
authors.forename: Joshua
authors.initials: J
authors.lastname: Judd
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Garvin
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Samore
authors.forename: Adi V
authors.initials: AV
authors.lastname: Gundlapalli
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005356:Fibromyalgia / Q000453:epidemiology / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D054542:Iraq War, 2003-2011; D008297:Male; D008603:Mental Health; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D012189:Retrospective Studies; D013577:Syndrome; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
keywords: Afghanistan; Iraq; OIF/OEF/OND; PTSD; Veteran; fibromyalgia syndrome; healthcare setting; healthcare utilization; opioid; primary care; rheumatology