Brown, Cara E (2021) Pain Management, Lifestyle, and Dietary Choices by Australians with Fibromyalgia. Research Master thesis, Victoria University.

Abstract

Background: Fibromyalgia is a disease which is associated with widespread pain. Individuals with fibromyalgia self-report varied effectiveness for medications that target pain and lifestyle choices, physical activity and diet. However, there is no available data on the choices made by Australians with fibromyalgia. This study aimed to investigate pharmacotherapies for pain management, and lifestyle habits, physical activity and dietary choices used by Australians to manage their fibromyalgia symptoms. Methods: An observational, cross-sectional study comprising an online questionnaire (Qualtrics) was conducted in Australia from August 2020 to September 2020. A link to the online questionnaire was distributed via social media forums and a local pain clinic. Participants completed screening questions to assess eligibility to undertake the questionnaire. Inclusion criteria were diagnosis of fibromyalgia, residing in Australia, and over 18 years old. Subsequent questions gathered information about participant demographic, fibromyalgia symptoms, medication use and satisfaction, and exercise and dietary habits. A total of n = 185 participants consented and started the questionnaire. A small proportion of participants did not meet the inclusion criteria (did not have fibromyalgia, n = 4; did not live in Australia, n = 13), leaving a total of n = 162 included for analysis. As participants progressed through the questionnaire there were sequential dropouts, with n = 129 respondents completing the final question regarding incidental exercise. For the purposes of maximising the sample size for each question, all complete responses are included regardless of whether a respondent completed the full questionnaire. Ethical approval was obtained by the Victoria University Human Research Ethics Committee (HRE20-095). Results: Females comprised almost all of respondents initiating the questionnaire (female, n = 154; male, n = 6; other, n = 2), which decreased to 129 participants completing the survey. The age categories selected by respondents were: 18-24 years, 8%; 25-34 years, 17%; 35-44 years, 21%; 45-54 years, 31%; 55-64 years, 15%; 65-74 years, 7%; and 75+ years, 1%. Respondents reported experiencing pain for 7 days a week (67%), 5-6 days a week (19%), or 3 days a week or less (13%). Other significant symptom characteristics reported by this cohort were depression (74%), suicidal thoughts (39%), and thoughts of self-harm (32%). Respondents reported medications prescribed for symptoms of pain: paracetamol (66%), amitriptyline (59%), duloxetine (39%), pregabalin (31%), and tramadol (30%). The average number of pain medications prescribed was 3.3 (standard deviation, 2.1) per respondent. The magnitude of self-reported pain after taking the prescribed medications were no pain (3%), low level mild pain (9%), moderate pain (59%), distressing pain (29%), or extreme pain (1%). All respondents reported the use non-prescribed therapies with an average of 3.5 (SD 2.9) per respondent, which included magnesium (73%), vitamin D (59%), vitamin B (50%), probiotics (49%), cannabidiol (19%) and, cannabis sativa (16%). Pain rating reported following cannabis plant or cannabidiol use was no pain (14%), low level pain (27%), moderate pain (18%), distracting pain (18%), or distressing pain (5%). Respondents reported whether they met or exceeded the dietary guidelines for each food group: vegetables, 21.8% ate five serves or more per day; fruit, 29.3% ate 2 serves or more per day; grains and cereals, 2.3% ate six serves or more per day; lean meats and alternatives, 78.2% ate two serves or more per day; dairy and alternatives, 52.6% ate two serves or more per day; and discretionary items, 82% ate two serves or less per day. Respondents reported the dietary fats regularly consumed in the diet: extra virgin olive oil (79%), animal butter (61%), coconut oil (36%), nut butter (21%), canola oil (21%), and margarine (21%). Diets reported to be trialled by participants were low sugar (81%), no alcohol (75%), gluten free (64%), reduced red meat (58%), low fat (53%), vegetarian (41%), whole foods (38%), and paleo (22%). Regular exercise was reported by 81% of respondents, with the preferred exercise being short walks (70%). Respondents reported their mean exercise intensity 2.8 (1-10 numeric score rating, NRS), and the mean exercise duration reported was 15-30 minutes (55%). Incidental exercise for ten minutes or longer for 3 or more times each week was reported by 37% of respondents. Conclusion: Those diagnosed with fibromyalgia in Australia are commonly prescribed more than three pain medication for the management of their symptoms. Despite the high use of prescribed and non-prescribed therapies, respondents reported regular and high levels of pain and poor mental health. More research is needed to understand the therapeutic value of prescribed and non-prescribed pharmacotherapy combinations for the management of fibromyalgia signs and symptoms in Australians with the condition. Additionally, responses to exercise and diet questions suggest Australians with fibromyalgia report poor adherence to Australian guideline recommendations for exercise and diet, with a small number of respondents reporting to consume adequate intake of all food groups and many trialling multiple diets for symptom management, alongside and low exercise volume and intensity and, a lack of resistance exercise. These lifestyle factors may contribute to fibromyalgia pain and other symptoms and may increase the use of pharmacotherapies and risk of developing comorbidities. To reduce the overall burden of the disease more research into physical activity, in particular resistance exercise at moderate intensities and, certain dietary modifications and the associated reduction in pain symptoms for Australians with fibromyalgia is required.

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