Patients turn to OTC medication because evidence-based drugs are “unaffordable”, Australian research finds.
Less than half of fibromyalgia patients are using evidence-based medication to manage their symptoms due to the high costs of the drugs, research has shown.
The Monash University study found that 48.5% of participants whose medical charts were reviewed used at least one evidence-based medication to manage their symptoms.
“Australian fibromyalgia patients use a wide variety of therapeutics to manage their symptoms and are more likely to use medications that are not evidence-based,” the researchers said in Internal Medicine Journal.
“This may reflect the modest efficacy and varying tolerability of evidence-based medications and can lead to significant polypharmacy.”
The researchers reviewed medical charts of more than 470 patients, and more than 100 of those patients also completed a questionnaire.
The most commonly used medications were low-dose amitriptyline, duloxetine and pregabalin, which the researchers said were guideline-recommended medications with the strongest supporting evidence.
Among the questionnaire respondents, 48% reported using non-steroidal anti-inflammatory drugs, 59% used paracetamol, 15% used cannabinoids and 70% used at least one vitamin or herbal supplement.
The study also found that 37% of chart review patients and 34% of questionnaire respondents used opioids to manage their fibromyalgia, which the researchers said was “unexpectedly high”.
A quarter of chart review patients and 11% of questionnaire participants who reported using opioids also said they took multiple opioids.
Among questionnaire participants, 14.8% reported using cannabinoids, and 70.4% reported using at least one supplement, vitamin or herbal/naturopathic preparation.
The researchers found that overall, 87% of participants were taking some form of medication to help manage fibromyalgia symptoms, and 77% were taking over-the-counter medicines such as paracetamol.
“Patients do not always disclose all of their management strategies and use of pharmacologically active substances, and chart records may not be current or complete even in a specialist clinic,” the researchers said.
“Awareness of this can foster a safer pharmacotherapeutic environment with more insightful prescribing habits, reminding clinicians to inquire about all possible management strategies.”
The researchers also found that 18% of questionnaire respondents reported smoking cigarettes, 38% drank alcohol, and 12% used non-medicinal cannabis.
Lead researcher Dr Zachary Warren from Monash University said many fibromyalgia patients used over-the-counter medication due to the high costs of evidence-based prescription drugs, which he said were “very expensive and unaffordable”.
“None of the evidence-based drugs are currently subsidised by the Pharmaceutical Benefits Scheme, meaning that patients have to buy them at full price should they wish to access them,” he said in a statement.
“There is broad consensus amongst the medical community that while fibromyalgia patients benefit significantly from non-pharmacological strategies, evidence-based medicines play a vital role in providing them with much-needed pain relief.
“However, accessing evidence-based pharmaceuticals remains unaffordable for many fibromyalgia patients, leaving them to rely on potentially ineffective over-the-counter medicines such as paracetamol.”
Dr Warren said fibromyalgia could be highly disabling and cause debilitating pain. Over-the-counter medication such as paracetamol can help in some cases, he said, but “they cannot be relied upon on their own”.
Less than half of fibromyalgia patients had access to evidence-based drugs to manage symptoms, he said.
“Improving the affordability of scientifically proven drugs such as amitriptyline, duloxetine and pregabalin, will enable a greater majority of fibromyalgia patients to access them.
“Getting these drugs added to the PBS will make them more affordable for a significant percentage of patients, and will help ensure that costs are not a barrier for patients wanting to access them.”
