Use of Pharmacologic and Complementary and Alternative Treatments in Fibromyalgia: Results of an On-Line Survey

Background: Fibromyalgia (FM) patients experience various symptoms in addition to the primary symptom of pain. Overlap of FM symptoms with other disorders, presents challenges in accurate diagnosis and treatment. An integrative treatment approach comprising both pharmacological and complementary treatments is generally beneficial for patients with chronic pain.  The 2007 National Health Interview Survey estimated that 38% of adult population in the United States used complementary therapies.¹ Little is known about treatment outcomes of pharmacological versus complementary treatments, for FM patients.

Objectives: To study the use of pharmacological and complementary treatments among FM patients and evaluate differences in quality of life (QoL) and pain based on type of treatment.

Methods: A web-based survey of patients with FM was conducted.  Information regarding the use of prescription medications, over-the-counter (OTC) medications and complementary treatments was collected. The health outcomes measured were QoL and current pain. Descriptive statistics and one-way ANOVA were conducted.

Results: The survey resulted in 670 usable responses. Approximately, 90.7% of the respondents reported using prescription/OTC medications, 65.8% reported using complementary treatments, while 57.8% reported utilizing both. Cyclobenzaprine, duloxetine, and tramadol were the most commonly used prescription medications. Acetaminophen and ibuprofen were the most commonly used OTC medications. Vitamins, massage therapy, and meditation were the most commonly used complementary treatments. Approximately 58.0% of the respondents using vitamin supplements considered them ‘moderately effective’. Among those using massage therapy, 48.3% rated it ‘very effective’ while 37.3% rated it ‘moderately effective’. Meditation was reported as ‘moderately effective’ by 57% of respondents. Aerobic exercise was rated ‘moderately effective’ by 45.5% of the respondents. Approximately, nine percent of those who used massage therapy and 32.4% of those who used aerobic exercise reported that their symptoms worsened due to use of the respective treatments. Results indicated respondents using both prescription/OTC and complementary treatments had significantly higher QoL versus those using pharmacologic treatment alone, p= 0.011. Similarly, respondents using only complementary treatments reported significantly lower pain levels versus those using prescription/OTC treatment alone, p = 0.046. Among those who utilized complementary treatments, 41.0% (n=181) indicated they preferred complementary treatments over prescription and/or OTC medications. A majority (73.0% or n=322) of the survey respondents used complementary treatments without physician’s recommendation. With respect to health insurance, 49.1% of the respondents reported not having any health insurance coverage for complementary treatments. Approximately 25.4 % indicated partial insurance coverage for complementary treatments.

Conclusions: The study suggests incorporating complementary therapies into treatment regimens may offer beneficial effects in FM. Due to methodological constraints, the researchers could not rule out “placebo effect” associated with use of complementary therapies. The current study suggests the need for more clinical research to establish the efficacy of complementary treatments for FM. Evidence on clinical efficacy and effectiveness could have policy implications as most complementary treatments lack health insurance coverage. Educating physicians about the evidence for integrating complementary treatments, and encouraging open doctor-patient communication regarding complementary treatment use may encourage integrative treatment and lead to improved health outcomes (decreased pain and increased QoL) in FM.