Fibromyalgia syndrome care of Iraq- and Afghanistan-deployed Veterans in Veterans Health Administration

Abstract

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, teambased 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 loglink, 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 painrelated 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.

What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta‐regression of observational studies

“…The majority of studies were from USA ( n = 28) , followed by UK ( n = 4 studies) , Spain ( n = 3 studies) and Canada ( n = 3 studies) , with single studies from Norway , Denmark , Australia and India . There were no studies that compared data from multiple countries.…”

“…There were 5 059 098 patients with chronic noncancer pain across the 42 studies. Twenty‐seven studies (64%) included specific subgroups of chronic noncancer pain such as chronic low back pain , osteoarthritis , rheumatoid arthritis and fibromyalgia . The mean age of participants was 58.6 years (SD 13.1, n = 29 studies).…”

“No one wants to look after the fibro patient”. Understanding models, and patient perspectives, of care for fibromyalgia: reviews of current evidence

“…They compared PROMs and healthcare usage over a three-month period across primary care and three community-based clinical specialties (rheumatology, neurology and psychiatry) in the US. Mohanty's cross-sectional study focused on PROMS and healthcare usage by US Veterans in their first year after diagnosis with fibromyalgia in primary, secondary/specialist and complementary care settings [50]. Ryan's retrospective service evaluation compared healthcare usage pre-and post-introduction of a nurse-led chronic pain management clinic for patients with fibromyalgia in the UK [57].…”

Impact of Deployment on Reproductive Health in U.S. Active-Duty Servicewomen and Veterans

“…According to some studies of OEF/OIF/OND Veterans, multisystem medically unexplained symptoms, such as fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome, among others, may be at least twice as prevalent among female (8.4%) versus male (4.2%) Veterans. 76–78 Several studies among civilian populations suggest that these conditions, broadly termed “chronic multisymptom illness,” may be associated with a higher risk of adverse reproductive health outcomes, 79–81 but there are limited studies of these associations among military personnel. Another understudied area, but one with significant risks for mental and reproductive health, is traumatic brain injury (TBI) in servicewomen.…”