Service Members Often Fail to Receive Suitable Follow-up Care for Fibromyalgia

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A new study has found that nearly half of military service members diagnosed with fibromyalgia fail to receive follow-up care and those that did generally received highly variable care as according to treatment guidelines.¹

“Although the annual prevalence of fibromyalgia in active duty service members was estimated to be 0.015% in 2018, the likelihood of receiving a fibromyalgia diagnosis was 9 times greater in patients assigned female than male and twice as common in non-Hispanic Black than White service members,” lead investigator Germaine F Herrera, MS, Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, and Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, and colleagues wrote.¹

Herrera and colleagues analyzed medical record information from active duty service members who received a fibromyalgia diagnosis between 2015 and 2022 in the United States Military Health System (MHS). They used bivariate analyses to evaluate inequities in comorbid diagnoses, health care, and prescription receipt across race and ethnicity and assigned sex.

The investigators analyzed data from a total of 13,663 service members diagnosed with fibromyalgia. Participants had a median interquartile range age of 33 years (range, 27-39), most were assigned male (59%), and most were white (53%). Around half (52%) received a follow-up visit within 3 months of index diagnosis. Most people also received a cooccurring diagnosis of psychiatric disorders (35%), insomnia (24%), migraines (20%), or abdominal and pelvic pain diagnoses (19%).¹

Participants received health care including exercise classes (52%), behavioral health care (52%), or physical therapy (50%) within 3 months of diagnosis. Other therapies were less frequently utilized, including physical interventions (41%), chiropractic care (40%), massage therapy (40%), transcutaneous electrical nerve stimulation (33%), self-care education (29%), biofeedback and other muscle relaxation therapies (22%), and acupuncture or dry needling (14%).¹

In terms of prescriptions, non-opioid pain medications were most commonly prescribed(72%), followed by muscle relaxants (44%), opioids (32%), anxiolytics (31%), gabapentinoids (26%), serotonin-norepinephrine reuptake inhibitor (SNRI; 21%), selective serotonin reuptake inhibitors (SSRI; 20%), and tramadol (15%).¹ Notably, opioid prescription goes against current recommendations for treating fibromyalgia and tramadol use for fibromyalgia is only weakly supported.²

“Receiving a diagnosis of fibromyalgia can be a protracted, multiyear process. Both the initial fibromyalgia diagnosis and subsequent health care receipt are stymied by the lack of clarity in its developmental mechanisms and biomarkers, compounded by epistemic injustices. Given both the delay in diagnosis receipt and multisystem impact, it is important to evaluate care receipt patterns to enable targeted and responsive health care system improvements,” Herrera and colleagues wrote.¹

When analyzing pairwise comparisons, the investigators found significant differences based on race and gender in both health care access and prescription types. Black (62%) and Latinx (61%) patients assigned female received behavioral health care more frequently than white patients (54%), while similar trends were seen among male patients. Additionally, Latinx female patients (58%) engaged in exercise classes more than White female participants (51%).¹

In terms of prescriptions, Black female patients (36%) were more likely to receive anxiolytics compared to white female patients (32%), and black male patients received more muscle relaxants (49%) and SSRIs (20%) than white male patients (44% and 20%, respectively). Black and Latinx female patients received significantly more NSAID (77% and 74%) and acetaminophen prescriptions than white female patients (22%). Asian and pacific Islander female patients were less likely to receive SNRIs (22%) compared to white female participants (28%), and asian and pacific islander male patients (20%) were more likely to receive SSRIs compared to white male participants (16%).¹

“Overall, the present findings suggest a level of heterogeneity in fibromyalgia care that requires institutional attention. Currently, there is no unified MHS registry or meaningful programmatic efforts to enable patient-centered, patient-partnered collaborative research on fibromyalgia diagnostic and care pathways. Such a resource, informed by patient partners, could enhance value-based care and clinical discovery,” Herrera and colleagues concluded.¹

REFERENCES

1. Herrera GF, Carreño PK, Wondwossen Y, Velosky AG, Patzkowski MS, Highland KB. Fibromyalgia Diagnosis and Treatment Receipt in the U.S. Military Health System. Mil Med. Published online August 12, 2024. doi:10.1093/milmed/usae384

2. Macfarlane GJ, Kronisch C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017;76(2):318–28.doi: 10.1136/annrheumdis-2016-209724