Functional restoration programmes (FRPs) may help to suppress fibromyalgia in some patients with chronic disabling occupational musculoskeletal disorders (CDOMD), but more may need to be done to overcome longer-term related disability, research suggests.
The research team found that nearly half (41%) of 117 CDOMD patients with comorbid fibromyalgia no longer met criteria for the comorbidity at discharge from an FRP involving approximately 160 hours of physical and psychosocial rehabilitation.
And these patients showed similar improvements in pain, disability and depression as 87 patients with chronic regional lumbar pain but no fibromyalgia, whereas the 59% of patients who still had fibromyalgia at discharge showed significantly less improvement.
The CDOMD patients were diagnosed with comorbid fibromyalgia if they reported chronic widespread pain for at least 3 months and reported 11 out of a possible 18 tender points when digitally palpitated at 4 kg of pressure.
At admission, the three patient groups were similar with regard to psychosocial measures and all three significantly improved from admission to discharge on all measures.
The lumbar pain patients and those who no longer had comorbid fibromyalgia had similar decreases in scores on a pain visual analogue scale (2.2 and 2.4 points, respectively), the Patient Disability Questionnaire (35.3 and 36.2 points), the Oswestry Disability Index (18.1 and 16.1 points) and the Beck Depression Inventory (9.8 and 10.1 points).
But decreases were significantly smaller for patients who retained their fibromyalgia comorbidity, at an average of 1.6, 21.2, 6.8 and 5.7 points, respectively, and this group had significantly worse outcomes overall.
Despite the initial suppression of fibromyalgia for some patients, researcher Tom Mayer (PRIDE Research Foundation, Dallas, Texas, USA) and colleagues found that work retention rates a year after discharge were significantly lower for patients who initially had fibromyalgia than for those with lumbar pain only, irrespective of whether they retained or lost the diagnosis at discharge.
Lumbar pain patients had the highest retention rate, at 82%, followed by 60% for fibromyalgia patients who retained their diagnosis and 59% for those who did not.
“These findings suggest that physical and psychosocial management provided by an FRP may suppress symptoms of comorbid fibromyalgia in a subset of CDOMD patients, but these gains may not be durable, and prolonged disability may be more difficult to overcome”, the team concludes in Spine.
reference:Function restoration benefits for fibromyalgia in musculoskeletal disorders