Date:
Fibromyalgia
Background
- Fibromyalgia is a disorder of unknown etiology characterized by widespread pain, abnormal pain processing, sleep disturbance, fatigue and often psychological distress. People with fibromyalgia may also have other symptoms, such as, o Morning stiffness o Tingling or numbness in hands and feet o Headaches, including migraines o Irritable bowel syndrome o Problems with thinking and memory (sometimes called "fibro fog") o Painful menstrual periods and other pain syndromes.
- The American College of Rheumatology (ACR) 1990 criteria are used for clinical diagnosis classification. Diagnosis is based on the presence of widespread pain (at least 3 months duration) and tenderness on 11 of 18 pressure points. Full criteria.
- May often co-occur (up to 25-65%) with other rheumatic conditions such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and ankylosing spondylitis (AS).
Prevalence
- The prevalence of fibromyalgia is about 2%, affecting an estimated 5.0 million adults in 2005. Prevalence was much higher among women than men (3.4% versus 0.5%).1
- Most people with fibromysialgia are women (Female: Male ratio 7:1). However, men and children also can have the disorder.
- Most people are diagnosed during middle age and prevalence increases with age.
Incidence
- No incidence data found.
NOTE: for the following sections using data based on ICD9-CM codes,
there is no specific single code for fibromyalgia. According to coding
rules, fibromyalgia is coded to 729.1 which is labeled "Myocitis and
Myalgia, unspecified" and can include other conditions. Thus, numbers
based on ICDM9-CM code 729.1 for mortality, ambulatory care and
hospitalizations may be overestimates.
Mortality
- 23 deaths per year from 1979-1998. [Unpublished CDC data] o Crude numbers of deaths coded as underlying cause-of-death as 729.1 rose from 8 in 1979 to a high of 45 in 1997. o In 1998,"Myositis and Myalgia, Unspecified" accounted for only 0.45% (42/9367) of all deaths attributed to arthritis and other rheumatic conditions.
Hospitalizations
- In 1997, 7,440 hospitalizations listed ICD9-CM code 729.1 as the principal diagnosis.2
- People with fibromyalgia have approximately 1 hospitalization every 3 years.3
Ambulatory Care
- 2.2 million ambulatory care visits.4 o 1.8 million Physician Office visits. o 187,000 Outpatient Department visits. o 266,000 Emergency Department visits.
- Medical and psychiatric co-morbidity are stronger determinants of high physician use than functional co-morbidity among patients with fibromyalgia.5
Costs
- Average yearly service utilization costs/person = $2,274.3 Total annual costs (direct and indirect)/person = $5,945.6
- Medications, complimentary and alternative medicine and diagnostic tests are the largest components of direct medical costs among women with fibromyalgia.7
Impact on health-related quality of life (HRQOL)
- Fibromyalgia patients scored lowest on 7 of 8 subscales (except role-emotional) of the SF-36 compared to patients with other chronic diseases.8,9
- Fibromyalgia patients scoring their perceived "present quality of life" averaged a score of 4.8 (1 = low to 10 = highest).10
- Standard, generic HRQOL instruments may not be sensitive enough to capture quality-of-life issues for many people with fibromyalgia.
- Adults with fibromyalgia are 3.4 times more likely to have major depression than peers without fibromyalgia.11
Unique characteristics
- Causes and/or risk factors for fibromyalgia are unknown, but some things have been loosely associated with disease onset: o Stressful or traumatic events, such as car accidents, post traumatic stress disorder (PTSD) o Repetitive injuries o Illness (e.g. viral infections) o Certain diseases (i.e., SLE, RA, chronic fatigue syndrome) o Genetic predisposition12,13
- People with fibromyalgia react strongly (abnormal pain perception processing) to things that other people would not find painful.
- Multidisciplinary treatment is recommended, including screening and treatment for depression, although evidence is insufficient to make global recommendations o Aerobic exercise and anti-depressant therapy have scientific evidence for effectiveness in reducing disease symptoms.14
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