Co-occurring chronic overlapping pain conditions and pain management engagement in veterans diagnosed with fibromyalgia: A comparison of women and men

OBJECTIVES: Examine the prevalence of co-occurring chronic overlapping pain conditions (COPCs) and utilization of recommended treatments for the management of fibromyalgia among VA-served Veterans. METHODS: Data from the Veteran Health Administration Corporate Data Warehouse were derived from a cohort diagnosed with fibromyalgia. Sociodemographic and clinical characteristics and the presence of nine COPCs were examined. Commonly recommended treatments for the management of fibromyalgia were assessed across two domains: Nonpharmacological and pharmacological. Multimodal treatment engagement was also examined. A series of logistic regressions were used to assess the impact of sex on treatment engagement, in both unadjusted models and models adjusting for sociodemographic and clinical characteristics. RESULTS: The 30,462 Veterans were majority female (58.9%), White (68.3%) and 45-64 years old (55.0%). Women were more likely to be diagnosed with a co-occurring COPC (aOR: 1.17, 95% CI: 1.11, 1.23). Women were more likely to engage in physical therapy, psychotherapy, or any complementary approaches (aOR range: 1.28-1.52). Women were also more likely to be prescribed cyclobenzaprine (aOR: 1.36, 95% CI: 1.28, 1.45) and less likely to be prescribed pregabalin relative to men (aOR: 0.80, 95% CI: 0.75, 0.85). Although women were more likely to engage in multimodal treatment (aOR: 1.29, 95% CI: 1.19, 1.40), overall rates for both women and men were between 9-12%. CONCLUSIONS: While women Veterans with fibromyalgia were more likely to receive nonpharmacological approaches, overall receipt for these approaches were low in both women and men. Future work in this area is needed to examine potential barriers to access and engagement.