Managed Care - December 2008 - (Page 9)

MEDICATION MANAGEMENT Fibromyalgia Coverage Uneven Despite Recent Drug Approvals Health plans continue to push patients towards off-label use of pain relievers and alternative treatments for symptom pain By Martin Sipkoff A “We need to convince insurers that by getting a diagnosis and getting treatment, we are reducing overall health costs,” says Lynne Matallana, president of the National Fibromyalgia Association. bout 10 million people suffer from fibromyalgia, a painful, persistent, and incurable disease that for too many years many physicians believed was entirely psychological. “There has always been a lot of misunderstanding about the disease, making it hard for patients to receive the help they need,” says Lynne Matallana, president and founder of the not-for-profit National Fibromyalgia Association (NFA). “But that is changing. Today more is known about the disease, and with the FDA approval of specific drugs for treatment, we hope insurers will make the drugs accessible and affordable.” People with fibromyalgia typically have turned to opioids, antidepressants, muscle relaxants, and sleep medications — treatments with often limited effect. In June 2007, pregabalin (Lyrica) became the first FDA-approved drug specifically for treating fibromyalgia. Then this June, duloxetine hydrochloride (Cymbalta) became the second. Lyrica and Cymbalta do a better job of reducing pain and improving functionality in people with fibromyalgia than most off-label drugs, says Jeffrey Siegel, MD, clinical team leader in the FDA’s division of anesthesia, analgesia, and rheumatology products. Using single photon emission computed tomography (SPECT), researchers in France detected functional abnormalities in regions within the brains of patients diagnosed with fibromyalgia, “reinforcing the idea that symptoms of the disorder are related to a dysfunction in those parts of the brain where pain is processed.” The abnormalities were directly correlated with the severity of the disease. “Fibromyalgia may be related to a global dysfunction of cerebral pain processing,” says study author Eric Guedj, MD, of Centre HospitaloUniversitaire de la Timone, in Marseille, France. “We found that these functional abnormalities were independent of anxiety and depression status. This study demonstrates that these patients exhibit modifications of brain perfusion not found in healthy subjects and reinforces the idea that fibromyalgia is a real disease.” According to the FDA’s position paper on fibromyalgia, its sufferers appear to experience pain differently from other people. The American College of Rheumatology diagnostic criteria for fibromyalgia include a history of widespread pain in all four quadrants of the body for a minimum duration of three months, and pain in at least 11 of 18 designated tender points when a specified amount of pressure is applied. The ACR lists additional A real disease In what may be the most significant finding yet, a study in the November 2008 issue of the Journal of Nuclear Medicine concluded that fibromyalgia is related to abnormalities of blood flow in the brain. Researchers studied 20 women diagnosed with fibromyalgia and 10 healthy women as a control group. The participants responded to questionnaires to determine levels of pain, disability, anxiety, and depression. Contributing Editor Martin Sipkoff is a long-time health care journalist. What Is fibromyalgia? It is a non-life-threatening chronic disorder of the muscles and surrounding soft tissue, including ligaments and tendons. Its main symptoms are muscle pain, fatigue, sleep disturbances, and tender points at certain parts of the body. Many people describe fibromyalgia as feeling like a persistent flu. DECEMBER 2008 / MANAGED CARE 9

Table of Contents Feed for the Digital Edition of Managed Care - December 2008

Managed Care - December 2008 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor ICD-10 Offers Huge Opportunity, Challenge Part D at a Crossroads Plans Can Weather the Financial Crisis DM vs. Medical Home? Tackle Prediabetes Reasonable Approach to Morning Sickness Formulary Files Tomorrow's Medicine Outlook

Managed Care - December 2008

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