Do comorbid fibromyalgia diagnoses change after a functional restoration program in patients with chronic disabling occupational musculoskeletal disorders?

Meredith M. Hartzell, Randy Neblett, Yoheli Perez, Emily Brede, Tom G. Mayer, Robert Joseph Gatchel

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

STUDY DESIGN.: A retrospective study of prospectively collected data. OBJECTIVE.: To determine whether comorbid fibromyalgia, identified in patients with chronic disabling occupational musculoskeletal disorders (CDOMDs), resolves with a functional restoration program (FRP). SUMMARY OF BACKGROUND DATA.: Fibromyalgia involves widespread bodily pain and tenderness to palpation. In recent studies, 23% to 41% of patients with CDOMDs entering an FRP had comorbid fibromyalgia, compared with population averages of 2% to 5%. Few studies have examined whether fibromyalgia diagnoses resolve with any treatment, and none have investigated diagnosis responsiveness to an FRP. METHODS.: A consecutive cohort of patients with CDOMDs (82% with spinal disorders and all reporting chronic spinal pain) and comorbid fibromyalgia (N = 117) completed an FRP, which included quantitatively directed exercise progression and multimodal disability management. Diagnosis responsiveness, evaluated at discharge, created 2 groups: those who retained fibromyalgia and those who did not. These groups were compared with chronic regional lumbar pain only patients (LO group, n = 87), lacking widespread pain and fibromyalgia. RESULTS.: Of the patients with comorbid fibromyalgia, 59% (n = 69) retained the fibromyalgia diagnosis (RFM group) and 41% (n = 48) lost the fibromyalgia diagnosis (LFM group) at discharge. Although all 3 groups reported decreased pain intensity, disability, and depressive symptoms from admission to discharge, RFM patients reported higher symptom levels than the LFM and LO groups at discharge. The LFM and LO groups were statistically similar. At 1-year follow-up, LO patients demonstrated higher work retention than both fibromyalgia groups (P < 0.03). CONCLUSION.: Despite a significant comorbid fibromyalgia prevalence in a cohort of patients with CDOMDs entering an FRP, 41% of patients with an initial fibromyalgia diagnosis no longer met diagnostic criteria for fibromyalgia at discharge and were indistinguishable from LO patients on pain, disability, and depression symptoms. However, both fibromyalgia groups (LFM and RFM) had lower work retention than LO patients 1 year later, suggesting that an FRP may suppress symptoms of fibromyalgia in a subset of patients, but prolonged fibromyalgia-related disability may be more difficult to overcome.

Original languageEnglish
Pages (from-to)1393-1400
Number of pages8
JournalSpine
Volume39
Issue number17
DOIs
StatePublished - 1 Aug 2014

Fingerprint

Fibromyalgia
Pain
Depression
Patient Discharge
Palpation

Keywords

  • central sensitization
  • chronic disabling occupational musculoskeletal disorder
  • depression
  • disability
  • fibromyalgia
  • functional restoration
  • interdisciplinary treatment
  • outcomes
  • pain intensity
  • tender points
  • work return

Cite this

Hartzell, Meredith M. ; Neblett, Randy ; Perez, Yoheli ; Brede, Emily ; Mayer, Tom G. ; Gatchel, Robert Joseph. / Do comorbid fibromyalgia diagnoses change after a functional restoration program in patients with chronic disabling occupational musculoskeletal disorders?. In: Spine. 2014 ; Vol. 39, No. 17. pp. 1393-1400.
@article{52035cd4f06f42c6afade0054319f5ea,
title = "Do comorbid fibromyalgia diagnoses change after a functional restoration program in patients with chronic disabling occupational musculoskeletal disorders?",
abstract = "STUDY DESIGN.: A retrospective study of prospectively collected data. OBJECTIVE.: To determine whether comorbid fibromyalgia, identified in patients with chronic disabling occupational musculoskeletal disorders (CDOMDs), resolves with a functional restoration program (FRP). SUMMARY OF BACKGROUND DATA.: Fibromyalgia involves widespread bodily pain and tenderness to palpation. In recent studies, 23{\%} to 41{\%} of patients with CDOMDs entering an FRP had comorbid fibromyalgia, compared with population averages of 2{\%} to 5{\%}. Few studies have examined whether fibromyalgia diagnoses resolve with any treatment, and none have investigated diagnosis responsiveness to an FRP. METHODS.: A consecutive cohort of patients with CDOMDs (82{\%} with spinal disorders and all reporting chronic spinal pain) and comorbid fibromyalgia (N = 117) completed an FRP, which included quantitatively directed exercise progression and multimodal disability management. Diagnosis responsiveness, evaluated at discharge, created 2 groups: those who retained fibromyalgia and those who did not. These groups were compared with chronic regional lumbar pain only patients (LO group, n = 87), lacking widespread pain and fibromyalgia. RESULTS.: Of the patients with comorbid fibromyalgia, 59{\%} (n = 69) retained the fibromyalgia diagnosis (RFM group) and 41{\%} (n = 48) lost the fibromyalgia diagnosis (LFM group) at discharge. Although all 3 groups reported decreased pain intensity, disability, and depressive symptoms from admission to discharge, RFM patients reported higher symptom levels than the LFM and LO groups at discharge. The LFM and LO groups were statistically similar. At 1-year follow-up, LO patients demonstrated higher work retention than both fibromyalgia groups (P < 0.03). CONCLUSION.: Despite a significant comorbid fibromyalgia prevalence in a cohort of patients with CDOMDs entering an FRP, 41{\%} of patients with an initial fibromyalgia diagnosis no longer met diagnostic criteria for fibromyalgia at discharge and were indistinguishable from LO patients on pain, disability, and depression symptoms. However, both fibromyalgia groups (LFM and RFM) had lower work retention than LO patients 1 year later, suggesting that an FRP may suppress symptoms of fibromyalgia in a subset of patients, but prolonged fibromyalgia-related disability may be more difficult to overcome.",
keywords = "central sensitization, chronic disabling occupational musculoskeletal disorder, depression, disability, fibromyalgia, functional restoration, interdisciplinary treatment, outcomes, pain intensity, tender points, work return",
author = "Hartzell, {Meredith M.} and Randy Neblett and Yoheli Perez and Emily Brede and Mayer, {Tom G.} and Gatchel, {Robert Joseph}",
year = "2014",
month = "8",
day = "1",
doi = "10.1097/BRS.0000000000000406",
language = "English",
volume = "39",
pages = "1393--1400",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins Ltd.",
number = "17",

}

Do comorbid fibromyalgia diagnoses change after a functional restoration program in patients with chronic disabling occupational musculoskeletal disorders? / Hartzell, Meredith M.; Neblett, Randy; Perez, Yoheli; Brede, Emily; Mayer, Tom G.; Gatchel, Robert Joseph.

In: Spine, Vol. 39, No. 17, 01.08.2014, p. 1393-1400.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Do comorbid fibromyalgia diagnoses change after a functional restoration program in patients with chronic disabling occupational musculoskeletal disorders?

AU - Hartzell, Meredith M.

AU - Neblett, Randy

AU - Perez, Yoheli

AU - Brede, Emily

AU - Mayer, Tom G.

AU - Gatchel, Robert Joseph

PY - 2014/8/1

Y1 - 2014/8/1

N2 - STUDY DESIGN.: A retrospective study of prospectively collected data. OBJECTIVE.: To determine whether comorbid fibromyalgia, identified in patients with chronic disabling occupational musculoskeletal disorders (CDOMDs), resolves with a functional restoration program (FRP). SUMMARY OF BACKGROUND DATA.: Fibromyalgia involves widespread bodily pain and tenderness to palpation. In recent studies, 23% to 41% of patients with CDOMDs entering an FRP had comorbid fibromyalgia, compared with population averages of 2% to 5%. Few studies have examined whether fibromyalgia diagnoses resolve with any treatment, and none have investigated diagnosis responsiveness to an FRP. METHODS.: A consecutive cohort of patients with CDOMDs (82% with spinal disorders and all reporting chronic spinal pain) and comorbid fibromyalgia (N = 117) completed an FRP, which included quantitatively directed exercise progression and multimodal disability management. Diagnosis responsiveness, evaluated at discharge, created 2 groups: those who retained fibromyalgia and those who did not. These groups were compared with chronic regional lumbar pain only patients (LO group, n = 87), lacking widespread pain and fibromyalgia. RESULTS.: Of the patients with comorbid fibromyalgia, 59% (n = 69) retained the fibromyalgia diagnosis (RFM group) and 41% (n = 48) lost the fibromyalgia diagnosis (LFM group) at discharge. Although all 3 groups reported decreased pain intensity, disability, and depressive symptoms from admission to discharge, RFM patients reported higher symptom levels than the LFM and LO groups at discharge. The LFM and LO groups were statistically similar. At 1-year follow-up, LO patients demonstrated higher work retention than both fibromyalgia groups (P < 0.03). CONCLUSION.: Despite a significant comorbid fibromyalgia prevalence in a cohort of patients with CDOMDs entering an FRP, 41% of patients with an initial fibromyalgia diagnosis no longer met diagnostic criteria for fibromyalgia at discharge and were indistinguishable from LO patients on pain, disability, and depression symptoms. However, both fibromyalgia groups (LFM and RFM) had lower work retention than LO patients 1 year later, suggesting that an FRP may suppress symptoms of fibromyalgia in a subset of patients, but prolonged fibromyalgia-related disability may be more difficult to overcome.

AB - STUDY DESIGN.: A retrospective study of prospectively collected data. OBJECTIVE.: To determine whether comorbid fibromyalgia, identified in patients with chronic disabling occupational musculoskeletal disorders (CDOMDs), resolves with a functional restoration program (FRP). SUMMARY OF BACKGROUND DATA.: Fibromyalgia involves widespread bodily pain and tenderness to palpation. In recent studies, 23% to 41% of patients with CDOMDs entering an FRP had comorbid fibromyalgia, compared with population averages of 2% to 5%. Few studies have examined whether fibromyalgia diagnoses resolve with any treatment, and none have investigated diagnosis responsiveness to an FRP. METHODS.: A consecutive cohort of patients with CDOMDs (82% with spinal disorders and all reporting chronic spinal pain) and comorbid fibromyalgia (N = 117) completed an FRP, which included quantitatively directed exercise progression and multimodal disability management. Diagnosis responsiveness, evaluated at discharge, created 2 groups: those who retained fibromyalgia and those who did not. These groups were compared with chronic regional lumbar pain only patients (LO group, n = 87), lacking widespread pain and fibromyalgia. RESULTS.: Of the patients with comorbid fibromyalgia, 59% (n = 69) retained the fibromyalgia diagnosis (RFM group) and 41% (n = 48) lost the fibromyalgia diagnosis (LFM group) at discharge. Although all 3 groups reported decreased pain intensity, disability, and depressive symptoms from admission to discharge, RFM patients reported higher symptom levels than the LFM and LO groups at discharge. The LFM and LO groups were statistically similar. At 1-year follow-up, LO patients demonstrated higher work retention than both fibromyalgia groups (P < 0.03). CONCLUSION.: Despite a significant comorbid fibromyalgia prevalence in a cohort of patients with CDOMDs entering an FRP, 41% of patients with an initial fibromyalgia diagnosis no longer met diagnostic criteria for fibromyalgia at discharge and were indistinguishable from LO patients on pain, disability, and depression symptoms. However, both fibromyalgia groups (LFM and RFM) had lower work retention than LO patients 1 year later, suggesting that an FRP may suppress symptoms of fibromyalgia in a subset of patients, but prolonged fibromyalgia-related disability may be more difficult to overcome.

KW - central sensitization

KW - chronic disabling occupational musculoskeletal disorder

KW - depression

KW - disability

KW - fibromyalgia

KW - functional restoration

KW - interdisciplinary treatment

KW - outcomes

KW - pain intensity

KW - tender points

KW - work return

UR - http://www.scopus.com/inward/record.url?scp=84905463568&partnerID=8YFLogxK

U2 - 10.1097/BRS.0000000000000406

DO - 10.1097/BRS.0000000000000406

M3 - Article

C2 - 24831498

AN - SCOPUS:84905463568

VL - 39

SP - 1393

EP - 1400

JO - Spine

JF - Spine

SN - 0362-2436

IS - 17

ER -