澳大利亚纤维肌痛患者队列中大量使用非循证治疗方法。
Significant use of non-evidence-based therapeutics in a cohort of Australian fibromyalgia patients.
机构信息
School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
Department of Rheumatology, Monash Health, Melbourne, Victoria, Australia.
出版信息
Intern Med J. 2024 Apr;54(4):568-574. doi: 10.1111/imj.16257. Epub 2023 Oct 23.
BACKGROUND
Fibromyalgia is a common condition characterised by chronic widespread musculoskeletal pain and central sensitivity features. Appropriate management requires a multidisciplinary approach prioritising non-pharmacological strategies. Evidence-based fibromyalgia medications are not always easily available, effective or tolerated.
AIM
To characterise actual medication usage in Australian fibromyalgia patients.
METHODS
Demographic and clinical data, including medication use information, were gathered by chart review from patients attending the Monash Fibromyalgia Clinic between January 2019 and June 2022. Eligible patients were invited to complete an anonymous questionnaire between June and August 2022 to assess current therapeutic use. The questionnaire assessed fibromyalgia clinical features by using the Revised Fibromyalgia Impact Questionnaire and the 2016 modified American College of Rheumatology Fibromyalgia criteria.
RESULTS
The chart review included 474 patients, and 108 participants completed the questionnaire. Most chart review (78.7%) and questionnaire participants (85.2%) reported using at least one medication for their fibromyalgia. 48.5% of chart review patients and 58.3% of questionnaire participants reported using at least one evidence-based medication, usually amitriptyline, duloxetine or pregabalin. However, the most common individual medications for questionnaire participants were non-steroidal anti-inflammatory drugs (48.2%), paracetamol (59.3%) and opioids (34.3%), with most opioids being typical opioids. Among questionnaire participants, 14.8% reported using cannabinoids, and 70.4% reported using at least one supplement, vitamin or herbal/naturopathic preparation. Not all medication or substance use was recorded during clinic appointments.
CONCLUSION
Fibromyalgia patients engage in various pharmacotherapeutic strategies that are not always evidence-based or disclosed to their treating clinicians.
背景
纤维肌痛是一种常见病症，其特征为慢性广泛性肌肉骨骼疼痛和中枢敏化特征。适当的管理需要多学科方法，优先考虑非药物策略。基于证据的纤维肌痛药物并不总是易于获得、有效或耐受。
目的
描述澳大利亚纤维肌痛患者的实际用药情况。
方法
通过对 2019 年 1 月至 2022 年 6 月期间在莫纳什纤维肌痛诊所就诊的患者进行图表审查，收集人口统计学和临床数据，包括用药信息。邀请符合条件的患者在 2022 年 6 月至 8 月之间填写匿名问卷，以评估当前的治疗用途。该问卷通过使用修订后的纤维肌痛影响问卷和 2016 年美国风湿病学会纤维肌痛修订标准评估纤维肌痛的临床特征。
结果
图表审查纳入了 474 名患者，其中 108 名参与者完成了问卷。大多数图表审查（78.7%）和问卷参与者（85.2%）报告为治疗纤维肌痛至少使用了一种药物。48.5%的图表审查患者和 58.3%的问卷参与者报告使用了至少一种基于证据的药物，通常是阿米替林、度洛西汀或普瑞巴林。然而，问卷参与者最常用的个别药物是非甾体抗炎药（48.2%）、对乙酰氨基酚（59.3%）和阿片类药物（34.3%），其中大多数阿片类药物为典型阿片类药物。在问卷参与者中，14.8%报告使用大麻素，70.4%报告使用至少一种补充剂、维生素或顺势疗法制剂。并非所有药物或物质的使用都在就诊时记录。
结论
纤维肌痛患者采用了各种药物治疗策略，这些策略并不总是基于证据，也未向治疗医生透露。
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