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Barrenengoa-Cuadra MJ, Muñoa-Capron-Manieux M, Fernández-Luco M, Angón-Puras LÁ, Romón-Gómez AJ, Azkuenaga M, Etxebarria A, Orrantia G, Pikaza A, Uribe-Etxebarria L, Zorrilla A, Larrinaga G, Arana-Arri E, Gracia-Ballarín R. Effectiveness of a structured group intervention based on pain neuroscience education for patients with fibromyalgia in primary care: A multicentre randomized open-label controlled trial. Eur J Pain 2021; 25:1137-1149. [PMID: 33512028 PMCID: PMC8247853 DOI: 10.1002/ejp.1738] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/20/2021] [Indexed: 12/22/2022]
Abstract
Background There has been increased interest in pain neuroscience education (PNE) as a therapeutic approach for the management of fibromyalgia (FM). Methods A multicentre randomized, open‐label, controlled trial was conducted to assess the effectiveness of a structured group intervention based on PNE in patients with FM. A total of 139 patients were included in the study and randomized to the intervention group (7 group sessions of education in neurobiology of pain) or to the control group (treatment as usual only). The primary outcome was the improvement of functional status and pain measured with the Fibromyalgia Impact Questionnaire (FIQ), and secondary outcomes were the reduction in the impact of pain and other symptoms (catastrophizing, anxiety and depression) and number of patients reaching no worse than moderate functional impairment (FIQ score <39). Differences between groups were calculated by linear mixed‐effects (intention‐to‐treat approach) and mediational models through path analyses. Results At 1 year, improvements in FIQ scores were higher in the intervention group with moderate or high effect size, and decreases of ≥20% in 69.1% of patients (20.9% in the control group) and of ≥50% in 39.7% (4.5% in the control group). Also, 52.9% of patients had a FIQ <39 points (13.4% in the control group). Conclusions In this sample of patients with FM, the improvement in quality of life and control of symptoms obtained by adding a PNE intervention showed promising results, equalling or surpassing previously reported outcomes. Significance A structured group intervention based on pain neuroscience education for 1 year in patients with fibromyalgia was associated with significant amelioration of the impact of the disease on scores of the Fibromyalgia Impact Questionnaire, the Health Assessment Questionnaire, the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale and the Polysymptomatic Distress Scale as compared with only treatment as usual. These findings are clinically relevant considering the challenges posed by fibromyalgia to clinicians and patients alike.
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Affiliation(s)
- María Jesús Barrenengoa-Cuadra
- Primary Health Care Center Sáenz de Buruaga, Osakidetza Basque Health Service, OSI Bilbao-Basurto, Bilbao, Spain.,Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain
| | - María Muñoa-Capron-Manieux
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Working Group on Central Hypersensitivity and Generalized Pain, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain.,Primary Health Care Center Alango, Osakidetza Basque Health Service, OSI Uribe, Getxo, Spain.,Department of Medicine, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Marian Fernández-Luco
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Working Group on Central Hypersensitivity and Generalized Pain, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain.,Primary Health Care Center Begoña, Osakidetza Basque Health Service, OSI Bilbao-Basurto, Bilbao, Spain
| | - Luis Ángel Angón-Puras
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Primary Health Care Center Areeta, Osakidetza Basque Health Service, Getxo, Spain
| | - Ana J Romón-Gómez
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Pedagogía Terapéutica, Bilbao, Spain
| | - Maider Azkuenaga
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Department of Physical Therapy, Osakidetza Basque Health Service, OSI, Bilbao-Basurto, Spain
| | - Amaia Etxebarria
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Department of Physical Therapy, Osakidetza Basque Health Service, OSI, Bilbao-Basurto, Spain
| | - Gixane Orrantia
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Department of Physical Therapy, Osakidetza Basque Health Service, OSI Barrualde, Amurrio, Spain
| | - Ainhoa Pikaza
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Primary Health Care Center Begoña, Osakidetza Basque Health Service, OSI Bilbao-Basurto, Bilbao, Spain
| | - Lourdes Uribe-Etxebarria
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Primary Health Care Center Bidezabal, Osakidetza Basque Health Service, Getxo, Spain
| | - Ana Zorrilla
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Primary Health Care Center Alango, Osakidetza Basque Health Service, OSI Uribe, Getxo, Spain.,Department of Medicine, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Gorka Larrinaga
- Department of Nursing, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Eunate Arana-Arri
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | - Rafael Gracia-Ballarín
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Primary Health Care Center Amurrio, Osakidetza Basque Health Service, OSI Barrualde, Amurrio, Spain
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Barrenengoa-Cuadra MJ, Angón-Puras LÁ, Moscosio-Cuevas JI, González-Lama J, Fernández-Luco M, Gracia-Ballarín R. [Effectiveness of pain neuroscience education in patients with fibromyalgia: Structured group intervention in Primary Care]. Aten Primaria 2020; 53:19-26. [PMID: 32033824 PMCID: PMC7752966 DOI: 10.1016/j.aprim.2019.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/10/2019] [Accepted: 10/21/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of a group intervention in Primary Care in patients with fibromyalgia (FM) based on pain neuroscience education (PNE). DESIGN Pre-post study. LOCATION Urban Primary Health Centre in Bilbao. PARTICIPANTS Patients with FM (2010 American College of Rheumatology Diagnostic Criteria for fibromyalgia), ≥18 years. INTERVENTION 5 weekly sessions (2hours each), and a reminder session one month later. MAIN MEASUREMENTS Compliance with FM criteria, assessed using the WPI (Widespread Pain Index, number of pain areas) and the SS (severity of symptoms) questionnaires. An assessment was also made on the impact of FM on functional capacity (FIQ:≥20% and ≥50% reduction in the FIQ total score from baseline to after treatment, and proportion of patients with FIQ<39 at the end of the study). Assessments were made at baseline, one month following the 5th session, and during the 6- and 12-month follow-up. RESULTS All the study evaluations were completed by 85/98 patients. A statistically significant improvement was observed in the 3 studied categories (WPI, SS, and FIQ) since the first visit, and was maintained until the final visit (12 months later). A total of 45 patients (53%, 95% CI: 42%-63%), more than those at baseline, scored FIQ<39 (no worse than mild functional impairment). One month following the 5th session there were 44 patients (52%, 95% CI: 41%-62%) that no longer met FM criteria and, at the end of follow-up, there were 56 patients (66%, 95% CI: 55%-75%). CONCLUSIONS An intervention based on PNE has shown to be feasible in Primary Care, with results in the upper range of those published with other treatments for FM.
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Affiliation(s)
- María Jesús Barrenengoa-Cuadra
- Centro de Salud Sáenz de Buruaga (Osakidetza), Bilbao, Vizcaya, España; Grupo de Trabajo de Fibromialgia, Migraña y Dolor crónico de Osatzen, Sociedad Vasca de MFyC, Bilbao, Vizcaya, España
| | - Luis Ángel Angón-Puras
- Grupo de Trabajo de Fibromialgia, Migraña y Dolor crónico de Osatzen, Sociedad Vasca de MFyC, Bilbao, Vizcaya, España; Centro de salud Las Arenas (Osakidetza), Getxo, Vizcaya, España
| | - José Ignacio Moscosio-Cuevas
- Centro de Salud Fuensanta, Distrito de AP Córdoba-Guadalquivir (Servicio Andaluz de Salud), Córdoba, España; Grupo Programa Comunicación y Salud -GPCyS- (semFYC), Barcelona, España
| | - Jesús González-Lama
- Grupo Programa Comunicación y Salud -GPCyS- (semFYC), Barcelona, España; Unidad de Gestión Clínica de Cabra, Centro de salud Matrona Antonia Mesa Fernández, Área de Gestión Sanitaria Sur de Córdoba (Servicio Andaluz de Salud), Cabra, Córdoba, España; Programa de Actividades Preventivas y de Promoción de la Salud -PAPPS- (semFYC), Barcelona, España; Grupo de investigación Clínico-Epidemiológica en Atención Primaria (GICEAP), Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba, Córdoba, España.
| | - Marian Fernández-Luco
- Grupo de Trabajo de Fibromialgia, Migraña y Dolor crónico de Osatzen, Sociedad Vasca de MFyC, Bilbao, Vizcaya, España; Centro de Salud de Begoña (Osakidetza), Bilbao, Vizcaya, España
| | - Rafael Gracia-Ballarín
- Grupo de Trabajo de Fibromialgia, Migraña y Dolor crónico de Osatzen, Sociedad Vasca de MFyC, Bilbao, Vizcaya, España; Centro de Salud de Amurrio (Osakidetza), Amurrio, Álava, España
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3
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Pérez-Aranda A, D'Amico F, Feliu-Soler A, McCracken LM, Peñarrubia-María MT, Andrés-Rodríguez L, Angarita-Osorio N, Knapp M, García-Campayo J, Luciano JV. Cost-Utility of Mindfulness-Based Stress Reduction for Fibromyalgia versus a Multicomponent Intervention and Usual Care: A 12-Month Randomized Controlled Trial (EUDAIMON Study). J Clin Med 2019; 8:jcm8071068. [PMID: 31330832 PMCID: PMC6678679 DOI: 10.3390/jcm8071068] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 12/18/2022] Open
Abstract
Fibromyalgia (FM) is a prevalent, chronic, disabling, pain syndrome that implies high healthcare costs. Economic evaluations of potentially effective treatments for FM are needed. The aim of this study was to analyze the cost-utility of Mindfulness-Based Stress Reduction (MBSR) as an add-on to treatment-as-usual (TAU) for patients with FM compared to an adjuvant multicomponent intervention ("FibroQoL") and to TAU. We performed an economic evaluation alongside a 12 month, randomized, controlled trial; data from 204 (68 per study arm) of the 225 patients (90.1%) were included in the cost-utility analyses, which were conducted both under the government and the public healthcare system perspectives. The main outcome measures were the EuroQol (EQ-5D-5L) for assessing Quality-Adjusted Life Years (QALYs) and improvements in health-related quality of life, and the Client Service Receipt Inventory (CSRI) for estimating direct and indirect costs. Incremental cost-effectiveness ratios (ICERs) were also calculated. Two sensitivity analyses (intention-to-treat, ITT, and per protocol, PPA) were conducted. The results indicated that MBSR achieved a significant reduction in costs compared to the other study arms (p < 0.05 in the completers sample), especially in terms of indirect costs and primary healthcare services. It also produced a significant incremental effect compared to TAU in the ITT sample (ΔQALYs = 0.053, p < 0.05, where QALYs represents quality-adjusted life years). Overall, our findings support the efficiency of MBSR over FibroQoL and TAU specifically within a Spanish public healthcare context.
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Affiliation(s)
- Adrián Pérez-Aranda
- Group of Psychological Research in Fibromyalgia & Chronic Pain (AGORA), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain
- Department of Clinical Psychology and Psychobiology (Section Personality, Assessment and Psychological Treatments), University of Barcelona, 08193 Barcelona, Spain
| | - Francesco D'Amico
- The London School of Economics and Political Science (LSE), London WC2A 2AE, UK
| | - Albert Feliu-Soler
- Group of Psychological Research in Fibromyalgia & Chronic Pain (AGORA), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain.
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain.
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain.
| | - Lance M McCracken
- Department of Psychology, Uppsala University, SE-751 05 Uppsala, Sweden
| | - María T Peñarrubia-María
- Primary Health Centre Bartomeu Fabrés Anglada, SAP Delta Llobregat, Unitat Docent Costa de Ponent, Institut Català de la Salut, 08850 Gavà, Spain
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
- Fundació IDIAP Jordi Gol I Gurina, 08007 Barcelona, Spain
| | - Laura Andrés-Rodríguez
- Group of Psychological Research in Fibromyalgia & Chronic Pain (AGORA), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain
| | - Natalia Angarita-Osorio
- Group of Psychological Research in Fibromyalgia & Chronic Pain (AGORA), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
| | - Martin Knapp
- The London School of Economics and Political Science (LSE), London WC2A 2AE, UK
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
| | - Javier García-Campayo
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain
- Department of Psychiatry, Miguel Servet Hospital, Aragon Institute of Health Sciences (I+CS), 50009 Zaragoza, Spain
| | - Juan V Luciano
- Group of Psychological Research in Fibromyalgia & Chronic Pain (AGORA), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain.
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain.
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain.
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Khanna R, Patwardhan A, Yang X, Li W, Cai S, Ji Y, Chew LA, Dorame A, Bellampalli SS, Schmoll RW, Gordon J, Moutal A, Vanderah TW, Porreca F, Ibrahim MM. Development and Characterization of An Injury-free Model of Functional Pain in Rats by Exposure to Red Light. THE JOURNAL OF PAIN 2019; 20:1293-1306. [PMID: 31054915 DOI: 10.1016/j.jpain.2019.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/23/2019] [Accepted: 04/15/2019] [Indexed: 12/19/2022]
Abstract
We report the development and characterization of a novel, injury-free rat model in which nociceptive sensitization after red light is observed in multiple body areas reminiscent of widespread pain in functional pain syndromes. Rats were exposed to red light-emitting diodes (RLED) (LEDs, 660 nm) at an intensity of 50 Lux for 8 hours daily for 5 days resulting in time- and dose-dependent thermal hyperalgesia and mechanical allodynia in both male and female rats. Females showed an earlier onset of mechanical allodynia than males. The pronociceptive effects of RLED were mediated through the visual system. RLED-induced thermal hyperalgesia and mechanical allodynia were reversed with medications commonly used for widespread pain, including gabapentin, tricyclic antidepressants, serotonin/norepinephrine reuptake inhibitors, and nonsteroidal anti-inflammatory drugs. Acetaminophen failed to reverse the RLED induced hypersensitivity. The hyperalgesic effects of RLED were blocked when bicuculline, a gamma-aminobutyric acid-A receptor antagonist, was administered into the rostral ventromedial medulla, suggesting a role for increased descending facilitation in the pain pathway. Key experiments were subjected to a replication study with randomization, investigator blinding, inclusion of all data, and high levels of statistical rigor. RLED-induced thermal hyperalgesia and mechanical allodynia without injury offers a novel injury-free rodent model useful for the study of functional pain syndromes with widespread pain. RLED exposure also emphasizes the different biological effects of different colors of light exposure. PERSPECTIVE: This study demonstrates the effect of light exposure on nociceptive thresholds. These biological effects of red LED add evidence to the emerging understanding of the biological effects of light of different colors in animals and humans. Understanding the underlying biology of red light-induced widespread pain may offer insights into functional pain states.
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Affiliation(s)
- Rajesh Khanna
- Department of Anesthesiology, University of Arizona, Tucson, Arizona; Department of Pharmacology, University of Arizona, Tucson, Arizona; Department of Graduate Interdisciplinary Program in Neuroscience College of Medicine, University of Arizona, Tucson, Arizona
| | - Amol Patwardhan
- Department of Anesthesiology, University of Arizona, Tucson, Arizona; Department of Pharmacology, University of Arizona, Tucson, Arizona
| | - Xiaofang Yang
- Department of Pharmacology, University of Arizona, Tucson, Arizona
| | - Wennan Li
- Department of Pharmacology, University of Arizona, Tucson, Arizona
| | - Song Cai
- Department of Pharmacology, University of Arizona, Tucson, Arizona
| | - Yingshi Ji
- Department of Pharmacology, University of Arizona, Tucson, Arizona
| | - Lindsey A Chew
- Department of Pharmacology, University of Arizona, Tucson, Arizona
| | - Angie Dorame
- Department of Pharmacology, University of Arizona, Tucson, Arizona
| | | | - Ryan W Schmoll
- Department of Anesthesiology, University of Arizona, Tucson, Arizona
| | - Janalee Gordon
- Department of Anesthesiology, University of Arizona, Tucson, Arizona
| | - Aubin Moutal
- Department of Pharmacology, University of Arizona, Tucson, Arizona
| | - Todd W Vanderah
- Department of Pharmacology, University of Arizona, Tucson, Arizona
| | - Frank Porreca
- Department of Anesthesiology, University of Arizona, Tucson, Arizona; Department of Pharmacology, University of Arizona, Tucson, Arizona
| | - Mohab M Ibrahim
- Department of Anesthesiology, University of Arizona, Tucson, Arizona; Department of Pharmacology, University of Arizona, Tucson, Arizona.
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Wortman MSH, Lokkerbol J, van der Wouden JC, Visser B, van der Horst HE, olde Hartman TC. Cost-effectiveness of interventions for medically unexplained symptoms: A systematic review. PLoS One 2018; 13:e0205278. [PMID: 30321193 PMCID: PMC6188754 DOI: 10.1371/journal.pone.0205278] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/22/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In primary and secondary care medically unexplained symptoms (MUS) or functional somatic syndromes (FSS) constitute a major burden for patients and society with high healthcare costs and societal costs. Objectives were to provide an overview of the evidence regarding the cost-effectiveness of interventions for MUS or FSS, and to assess the quality of these studies. METHODS We searched the databases PubMed, PsycINFO, the National Health Service Economic Evaluation Database (NHS-EED) and the CEA registry to conduct a systematic review. Articles with full economic evaluations on interventions focusing on adult patients with undifferentiated MUS or fibromyalgia (FM), irritable bowel syndrome (IBS) and chronic fatigue syndrome (CFS), with no restrictions on comparators, published until 15 June 2018, were included. We excluded preventive interventions. Two reviewers independently extracted study characteristics and cost-effectiveness data and used the Consensus on Health Economic Criteria Checklist to appraise the methodological quality. RESULTS A total of 39 studies out of 1,613 articles met the inclusion criteria. Twenty-two studies reported costs per quality-adjusted life year (QALY) gained and cost-utility analyses (CUAs). In 13 CUAs the intervention conditions dominated the control conditions or had an incremental cost-effectiveness ratio below the willingness-to-pay threshold of € 50,000 per QALY, meaning that the interventions were (on average) cost-effective in comparison with the control condition. Group interventions focusing on MUS (n = 3) or FM (n = 4) might be more cost-effective than individual interventions. The included studies were heterogeneous with regard to the included patients, interventions, study design, and outcomes. CONCLUSION This review provides an overview of 39 included studies of interventions for patients with MUS and FSS and the methodological quality of these studies. Considering the limited comparability due to the heterogeneity of the studies, group interventions might be more cost-effective than individual interventions. REGISTRATION Study methods were documented in an international prospective register of systematic reviews (PROSPERO) protocol, registration number: CRD42017060424.
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Affiliation(s)
- Margreet S. H. Wortman
- ACHIEVE – Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- * E-mail:
| | - Joran Lokkerbol
- Centre of Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Johannes C. van der Wouden
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Bart Visser
- ACHIEVE – Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Henriëtte E. van der Horst
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Tim C. olde Hartman
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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Bhusal S, Diomampo S, Magrey MN. Clinical utility, safety, and efficacy of pregabalin in the treatment of fibromyalgia. DRUG HEALTHCARE AND PATIENT SAFETY 2016; 8:13-23. [PMID: 26937205 PMCID: PMC4762578 DOI: 10.2147/dhps.s95535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Fibromyalgia is a chronic debilitating medical syndrome with limited therapeutic options. Pregabalin, an anticonvulsant and α-2-Δ subunit receptor ligand, is one of the anchor drugs approved by the US Food and Drug Administration for the treatment of fibromyalgia. The drug has shown clinically meaningful benefits across multiple symptom domains of fibromyalgia. Efficacy of pregabalin in fibromyalgia pain has been evaluated in at least five high-quality randomized trials, two long-term extension studies, a meta-analysis, a Cochrane database systematic review, and several post hoc analyses. These studies also hint towards a meaningful benefit on sleep, functioning, quality of life, and work productivity. Side effects of pregabalin, although common, are mild to moderate in intensity. They are noted early during therapy, improve or disappear with dose reduction, and are not usually life- or organ threatening. In most patients, tolerance develops to the most common side effects, dizziness, and somnolence, with time. With close clinical monitoring at initiation or dose titration, pregabalin can be effectively used in primary care setting. Pregabalin is cost saving with long-term use and its cost-effectiveness profile is comparable, if not better, to that of other drugs used in fibromyalgia. In the present era of limited therapeutic options, pregabalin undoubtedly retains its role as one of cardinal drugs used in the treatment of fibromyalgia. This review intends to discuss the clinical utility of pregabalin in the management of fibromyalgia with a focus on efficacy, safety, and cost-effectiveness.
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Affiliation(s)
- Santosh Bhusal
- Division of Rheumatology, Metrohealth Medical Center, Cleveland OH, USA
| | - Sherilyn Diomampo
- Division of Rheumatology, Metrohealth Medical Center, Cleveland OH, USA
| | - Marina N Magrey
- Case Western Reserve University School of Medicine at Metrohealth Medical Center, Cleveland OH, USA
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