Outcomes of a Comprehensive Pain Rehabilitation Program for Patients With Fibromyalgia

Erica Engelberg-Cook; Danqing Hu; Svetlana Kurklinsky; Anwar Mack; Christopher D Sletten; Wenchun Qu; Michael D Osborne

doi:10.1016/j.mayocpiqo.2021.08.008

Outcomes of a Comprehensive Pain Rehabilitation Program for Patients With Fibromyalgia

Mayo Clin Proc Innov Qual Outcomes. 2021 Nov 10;5(6):1056-1065. doi: 10.1016/j.mayocpiqo.2021.08.008. eCollection 2021 Dec.

Authors

Erica Engelberg-Cook¹, Danqing Hu², Svetlana Kurklinsky³, Anwar Mack¹, Christopher D Sletten¹, Wenchun Qu¹, Michael D Osborne¹

Affiliations

¹ Department of Pain Medicine, Mayo Clinic, Jacksonville, FL.
² Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, FL.
³ Center for Health Sciences, Oklahoma State University, Tulsa, OK.

Abstract

Objective: To analyze opioid intake interference with psychological, well-being, and functional outcomes and medication tapering in patients with fibromyalgia admitted to the Mayo Clinic Pain Rehabilitation Program (MCPRP) in Florida.

Patients and methods: A retrospective study on MCPRP outcomes was conducted. We reviewed the health records of 150 patients with fibromyalgia who participated in the program from May 1, 2014, to May 1, 2015. All patients were asked to fill out a survey at admission to and dismissal from the program. Surveys contained questions from the numeric pain score, Multidimensional Pain Inventory (perceived life control and interference of pain subscales), Center for Epidemiological Studies-Depression Scale, Pain Catastrophizing Scale, 36-Item Short-Form Health Status Survey (general health perceptions subscale), and Pain Self-Efficacy Questionnaire. A medical record review identified categories and number of medications at program admission and dismissal. Patients were divided in 2 groups: those whose concomitant medication did not include opioids at admission (no opioids group) and those whose concomitant medication included opioids at admission (opioids group).

Results: By dismissal from the MCPRP, patients with fibromyalgia in the no opioids group had a significant (P<.05) improvement in all the self-reported scores. Medication, including opioids, were effectively tapered at a substantially higher percentage in the opioids group.

Conclusion: Benefit of the comprehensive pain rehabilitation program in patients with fibromyalgia was indicated by clinical improvements in pain severity, physical and emotional health, and functional capacity while successfully tapering medication. Opioid intake at admission may modify the program outcomes.

Keywords: CESD, Center for Epidemiological Studies–Depression Scale; CSS, central sensitization syndrome; FM, fibromyalgia; MCPRP, Mayo Clinic Comprehensive Pain Rehabilitation Program; MPI, Multidimensional Pain Inventory; NO, no opioids on admission; NSAID, nonsteroidal anti-inflammatory drug; OME, oral morphine equivalent; OP, opioids on admission; PCS, Pain Catastrophizing Scale; PSEQ, Pain Self-Efficacy Questionnaire; SF-36, 36-Item Short-Form Health Status Survey; SS, Symptom Severity Scale; WPI, Widespread Pain Index.