Treatment data from the Brazilian fibromyalgia registry (EpiFibro)

Abstract

Background: EpiFibro (Brazilian Epidemiological Study of Fibromyalgia) was created to study patients with fibromyalgia (FM). Patients were included since 2011 according to the classification criteria for FM of the American College of Rheumatology of 1990 (ACR1990). Objective: To analyze the therapeutic measures prescribed by Brazilian physicians. Materials and methods: Cross-sectional study of a multicenter cohort. The therapeutic measures were described using descriptive statistics. Results: We analyzed 456 patients who had complete data in the registry. The mean age was 54.0 ± 11.9 years; 448 were women (98.2%). Almost all patients (98.4%) used medications, 62.7% received health education, and less than half reported practicing physical exercise; these modalities were often used in combination. Most patients who practiced exercises practiced aerobic exercise only, and a significant portion of patients combined it with flexibility exercises. The most commonly used medication was amitriptyline, followed by cyclobenzaprine, and a minority used medication specifically approved for FM, such as duloxetine and pregabalin, either alone or in combination. Combinations of two or three medications were observed, with the combination of fluoxetine and amitriptyline being the most frequent (18.8%). Conclusion: In this evaluation of the care of patients with FM in Brazil, it was found that the majority of patients are treated with a combination of pharmacological measures. Non-pharmacological methods are underused, with aerobic exercise being the most commonly practiced exercise type. The most commonly prescribed single drug was amitriptyline, and the most commonly prescribed combination was fluoxetine and amitriptyline. Drugs specifically approved for FM are seldom prescribed.

Treatment patterns in fibromyalgia including the use of opioids

“…The average age of the patients in this study was similar to that found in other studies (49.4–54.0 years) (de Assis et al., 2020; Jiao et al., 2021; Robinson et al., 2012; Salaffi et al., 2021; Valentini et al., 2020) and contrasts with other reports where age was higher (59.4–64.4) (Turner et al., 2016; Vincent et al., 2015). On the other hand, the majority of patients in this study were women, similar to other published studies (74.6%–94.6%) (Jiao et al., 2021; Robinson et al., 2012; Salaffi et al., 2021; Turner et al., 2016; Valentini et al., 2020; Vincent et al., 2015).…”

“…Nonpharmacological management includes aerobic exercise, cognitive behavioural therapy, and education, which are recommended in clinical practice guidelines as initial approach strategies or adjuncts to pharmacological treatment (Fitzcharles et al., 2013; Macfarlane et al., 2017). However, this management was used for less than half of the subjects of the present study; physical activity predominated, consistent with previous reports (de Assis et al., 2020; Valentini et al., 2020). For example, in Brazil, de Assis et al.…”

“…The prevalence of opioid use in this group of patients is higher than that found in previous reports from Europe (34.3%-40.0%) (Rico-Villademoros et al, 2020;Valentini et al, 2020)), South America (11.6%-39.7%) (de Assis et al, 2020;Fernández-Avila et al, 2020), and even North America (24.2%-50.8%) (Kaouk et al, 2018;Robinson et al, 2012;Turner et al, 2016;Vincent et al, 2015); in these regions, opioid use has been decreasing in recent years (Sarmento et al, 2019). Hydrocodone was the most commonly prescribed opioid in this study, while in other local and international studies, tramadol was the most common opioid (de Assis et al, 2020;Fernández-Avila et al, 2020;Rico-Villademoros et al, 2020;Robinson et al, 2012;Valentini et al, 2020). Clinical practice guidelines do not recommend the use of opioids in patients with fibromyalgia because there is insufficient evidence of their effectiveness, and they increase the risk of adverse drug reactions, including dependence (Fitzcharles et al, 2013;Macfarlane et al, 2017;Rivera Redondo et al, 2022).…”

“…While cognitivebehavioural therapy relieves pain, improves quality of life and mood, and reduces disability and fatigue (Bernardy, et al, 2018). With respect to pharmacological management, it was found that almost all patients were receiving acetaminophen, in contrast with other reports in which its use was much lower (3.4%-40.5%) (de Assis et al, 2020;Robinson et al, 2012;Valentini et al, 2020). According to clinical practice guidelines, the first-line drugs that have shown efficacy are gabapentinoids and some antidepressants (Fitzcharles et al, 2013;Macfarlane et al, 2017;Rivera Redondo et al, 2022).…”

Analysis of the Muscular Activity, Peak Torque in the Lower Limbs, and Static Balance after Virtual Rehabilitation in Women with Fibromyalgia: A Randomized Controlled Study

“…The CG received a flexibility exercise that has been used in the treatment of fibromyalgia. 31,32 The chosen exercises included standing, sitting, and lying positions to stretch all of the muscle groups in an overall manner. Each position was maintained for four deep and prolonged exhales.…”