Heightened Healthcare Utilization Among Patients With Fibromyalgia

Results of a retrospective analysis demonstrated patients with fibromyalgia visited more hospitals and outpatient clinics when compared with controls, according to research published in Agri.¹ Investigators urge patients and physicians to recognize these statistics to reduce unnecessary health costs.

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“The fact that patients with fibromyalgia visit the outpatient clinic more than other patients may lead to additional economic burden, and unnecessary diagnosis and treatment,” wrote Mehmet Okçu, MD, associated with the Division of Pain Medicine, Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, İstanbul, Turkey, and colleagues. “Ghavidel-Parsa et al reported that the expenses incurred for the diagnosis and treatment of fibromyalgia are the tip of the iceberg for the total economic burden of fibromyalgia, and the additional costs of disability and lack of physician information and additional symptoms increase this burden.² They reported that better informing patients and physicians about fibromyalgia could reduce this burden.”

Fibromyalgia, more commonly diagnosed in women, is characterized by chronic widespread pain, exercise intolerance, headaches, fatigue, tenderness, sleep disturbances, and symptoms generally known to impair quality of life. Other symptoms, such as depression, anxiety, gastrointestinal ailments, dermatological symptoms, hearing difficulties, dry mouth, and blurred vision, are also seen in this patient population.

Although the pathogenesis and pathophysiology of the condition is not fully known, an increased pain sensitivity in central and peripheral pathways is the most popular hypothesis. With such a wide spectrum of symptoms, the complex nature of fibromyalgia and the low level of knowledge of the condition can result in overdiagnoses, therefore leading to higher economic burden and unnecessary diagnosis and treatment.³

To compare the number of outpatient visits of patients with fibromyalgia with those without fibromyalgia, as well as their diagnoses, 140 patients (70 with fibromyalgia and 70 age- and gender-matched controls) who visited the Physical Medicine and Rehabilitation Department outpatient clinic of Kırşehir Ahi Evran University Medical Faculty Hospital were included in the study and retrospectively analyzed. Information on outpatient visits, diagnoses, and the specific departments of the outpatient clinics were also collected.

A significantly higher number of total outpatient clinic visits was observed in patients with fibromyalgia when compared with controls. These included a significantly higher number of visits to the Physical Medicine and Rehabilitation, Obstetrics and Gynecology, Internal Medicine, Psychiatry, and General Surgery clinics. A noticeably higher, but not statistically significant, number of admissions were observed in other departments for this patient population.

Further, the number of diagnoses of mental, neurodevelopmental, and behavioral disorders, as defined by the Internal Classification of Diseases-10, was significantly higher in patients with fibromyalgia when compared with the control cohort.

Investigators noted the retrospective nature of the analysis coupled with the small sample size as limitations of the study. Additionally, they did not evaluate the functional status, disease activities, and health expenses of analyzed patients. Diagnostic criteria used by clinicians could not be determined or standardized based on information collected and controls could not be assessed in detail for a possible fibromyalgia diagnosis.

“Since it is the first study to compare the departments visited by patients with fibromyalgia and the number of visits compared to those without fibromyalgia, this study may shed light on studies on this subject,” investigators concluded.

References

1. ^{Okçu M, Ayhan MY, Tuncay F, et al. Comparison of the diagnoses, the outpatient clinics they visited, and the number of visits of patients with and without a diagnosis of fibromyalgia syndrome: Do patients with fibromyalgia syndrome come to the hospital more often?. Fibromiyalji sendromu tanısı olan ve olmayan hastaların başvurdukları poliklinik bölümleri, başvuru sayıları ve aldıkları tanıların karşılaştırılması: Fibromiyalji sendromu tanısı olan hastalar, hastaneye daha mı sık geliyor?. Agri. 2023;35(3):148-152. doi:10.14744/agri.2022.99076}
2. ^{Ghavidel-Parsa B, Bidari A, Amir Maafi A, Ghalebaghi B. The iceberg nature of fibromyalgia burden: The clinical and economic aspects. Korean J Pain 2015;28:169–76}
3. ^{Lee LK, Ebata N, Hlavacek P, DiBonaventura M, Cappelleri JC, Sadosky A. Humanistic and economic burden of fibromyalgia in Japan. J Pain Res 2016;9:967–78}