Treatment Outcomes after Multidisciplinary Pain Rehabilitation with Analgesic Medication Withdrawal for Patients with Fibromyalgia

Abstract

The results of this study support the hypothesis that immediate posttreatment measures of physical and emotional functioning are favorable for patients with FM following multidisciplinary pain rehabilitation that incorporates withdrawal of analgesic medications.

Chronic pain rehabilitation in chronic headache disorders

“…In both of these studies, 10.7% of the chronic pain patients suffered from chronic headaches. Additional data exist for the effectiveness of chronic pain rehabilitation programs for chronic back pain [30][31][32][33], orofacial pain [34][35][36], fi bromyalgia, [37,38], whiplash and neck pain [39,40], repetitive strain disorders, and other various musculoskeletal disorders [41], as well as headache [42,43]. Outcomes in these studies include important variables related to activity and quality of life, in addition to pain and symptom improvement.…”

Tapering Long-term Opioid Therapy in Chronic Noncancer Pain

“…39 The Mayo Clinic Program uses a gradual, structured taper on a time-contingent basis during 3 weeks, with rates of completion that can be above 90%. 42,54,72,73 When open-label dose reduction controlled by patients (N¼63) was compared with a masked dose reduction controlled by study staff (N¼45), patients in the blinded group were more likely to not be taking opioids (89% vs 68.3%) at the 4-week outcome, but there were no significant differences in the proportion of patients not taking medication (55% in both groups) at 6 months. 40 However, nonrandom treatment attribution and baseline differences between groups may have biased outcomes.…”

“…To date, there is strong evidence supporting CBT and interdisciplinary approaches in patients with chronic pain, 85,86 moderate evidence for patients with OUD, 84 and low evidence specifically for taper support from long-term opioid treatment in CNCP. 39,40,[42][43][44]46,[71][72][73]89,91 However, considering the risks factors for dropout and adverse functional outcomes in these patients, as reviewed above, psychological support may be needed to address possible anxiety related to the taper, underlying depression, deficient pain-and stress-coping strategies (recommendation GRADE C). Simply removing a patient's main strategy for dealing with pain and perhaps mood (ie, their opioids) is unlikely to be well tolerated or allow for increased function if learning of adaptive coping mechanisms and treatment of any underlying negative affect are not encouraged.…”

“…The active treatment phases span approximately 1 month, on an inpatient 40,71 or outpatient basis, such as the Mayo Clinic Pain Rehabilitation program. [42][43][44]46,72,73 A recent systematic review of the body of literature studying CBT and interdisciplinary programs for patients with CNCP tapering from long-term opioid treatment pointed out its limitations 88 : only 2 studies are randomized clinical trials, both with small sample sizes or methodological issues. 89,90 Therefore, the authors of the review renounced drawing conclusions regarding the effectiveness of psychological, alternative, or interdisciplinary interventions to support patients tapering from opioids.…”

Psychopharmakotherapie somatoformer Störungen und funktioneller somatischer Syndrome

“…Da FibromyalgiePatienten oft langfristig mit zahlreichen unterschiedlichen Substanzklassen, speziell mit diversen nicht-steroidalen Antiphlogistika, Opiaten, Muskelrelaxantien und Benzodiazepinen behandelt sind und ebenso oft hiervon nicht entscheidend profitieren (Goldenberg 2007, empfiehlt es sich, diese "Schmerzmedikation" im Rahmen einer multidisziplinär ausgerichteten Schmerzambulanz zunächst sukzessiv abzusetzen. Bei diesem Vorgehen sind zum Teil erstaunliche Besserungen zu erzielen, in jedem Fall aber eine günstige Voraussetzung für die Erprobung rational begründeter, neuer Medikationen herzustellen (Hooten et al 2007).…”