A pilot study of complementary and alternative medicine use in patients with fibromyalgia syndrome
Fibromyalgia syndrome (FMS) is a complex disorder, with primary symptoms of sleep disturbances, pain, and fatigue. FMS is one of the most common reasons for patient visits to a rheumatologist. Previous studies have suggested that complementary and alternative medicine (CAM) use in patients with rheumatic diseases is common, but such data specific to FMS patients is limited.
Objective: The following study sought to describe the prevalence of CAM use in a primary care practice of patients with FMS and assess whether these patients discuss CAM use with their physician, physician-extender, and/or pharmacist.
Methods: A one-group cross-sectional survey design was implemented in a large, community-based, private physician practice of patients diagnosed with FMS. A self-administered questionnaire was distributed during clinic visits. It solicited information related to demographic characteristics; FMS-specific health background; whether CAM use had been discussed with a health care provider; and the “ever-use” of common types of CAM. Respondents returned the questionnaire via US mail in a postage-paid, self-addressed envelope.
Results: A total of 115 surveys were distributed with 54 returned for analysis (47% completion rate). The sample was predominantly female, well educated and had a mean age of 55.6 years. All respondents were White. Most respondents (92.6%) reported using some type of CAM. Exercise (92.2%), chiropractic treatment (48.1%), lifestyle and diet (45.8%), relaxation therapy (44.9%), and dietary and herbal supplements (36.5%) were most commonly reported CAM therapies “ever-used” by respondents. Dietary and herbal supplements with the highest prevalence of “ever-use” were magnesium (19.2%), guaifenesin (11.5%), and methylsulfonylmethane (MSM) (9.6%). Respondents most commonly discussed CAM with the clinic rheumatologist and the primary care physician (53.7% and 38.9%, respectively). Only 14.8% of respondents discussed CAM with a pharmacist. However, a significantly higher proportion of respondents who “ever-used” dietary and herbal supplements discussed CAM with a pharmacist compared to those who never used dietary and herbal supplements [chi square=6.03, p=0.014].
Conclusion: This pilot study suggests that CAM use is common in patients diagnosed with FMS. Compared to other healthcare providers, respondents were least likely to discuss CAM with a pharmacist. However, respondents who used dietary and herbal supplements were more likely to discuss CAM with a pharmacist compared to those who did not, suggesting the potential influence of pharmacist intervention.
2 Robinson RL, Birnbaum HG, Morley MA, Sisitsky T, Greenberg PE, Claxton AJ. Economic cost and epidemiological characteristics of patients with fibromyalgia claims. J Rheumatol. 2003;30:1318-25.
3 Solomon DH, Liang MH. Fibromyalgia: scourge of humankind or bane of a rheumatologist's existence? Arthritis Rheum. 1997 ;40:1553-5.
4 Littlejohn GO, Walker J. A realistic approach to managing patients with fibromyalgia. Curr Rheumatol Rep. 2002 ;4:286-92.
5 Rao JK, Mihaliak K, Kroenke K, Bradley J, Tierney WM, Weinberger M. Use of Complementary Therapies for Arthritis among Patients of Rheumatologists Ann Intern Med. 1999;131:409-416.
6 Mannel M. Drug Interactions with St John's Wort : Mechanisms and Clinical Implications. Drug Saf. 2004;27:773-97.
7 Barbour C. Use of complementary and alternative treatments by individuals with fibromyalgia syndrome. J Am Acad Nurse Pract. 2000;12:311-6.
8 StataCorp. (2003). Stata Statistical Software: Release 8.0. College Station, TX: Stata Corporation.
9 Wahner-Roedler DL, Elkin PL, Vincent A, Thompson JM, Oh TH, Loehrer LL, et al. Use of complementary and alternative medical therapies by patients referred to a fibromyalgia treatment program at a tertiary care center. Mayo Clin Proc. 2005 Jan;80(1):55-60.
10 Sarac AJ, Gur A. Complementary and alternative therapies in fibromyalgia. Curr Pharm Des. 2006;12:47-57.
11 Russell IJ, Michalek JE, Flechas JD, Abraham GE. Treatment of fibromyalgia syndrome with Super Malic: a randomized, double blind, placebo controlled, crossover pilot study. J Rheumatol. 1995;22:953-8.
12 Bennett RM, DeGarmo P, Clark SR A 1 year double blind placebo-controlled study of guaifenesin in fibromyalgia". Arthritis and Rheumatism 1996;39: S212.
13 Rao JK, Mihaliak K, Kroenke K, Bradley J, et al. Use of complementary therapies for arthritis among patients of rheumatologists. Ann Intern Med. 1999;131:409-16.
14 Visser GJ, Peters L, Rasker JJ. Rheumatologists and their patients who seek alternative care: an agreement to disagree. Br J Rheumatol. 1992;31:485-90.
15 Vecchio PC. Attitudes to alternative medicine by rheumatology outpatient attenders. J Rheumatol. 1994;21:145-7.
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