Journal article
Central nervous system-active medication polypharmacy among rural and urban veterans with fibromyalgia, migraine, or irritable bowel syndrome
American journal of health-system pharmacy
05/05/2026
DOI: 10.1093/ajhp/zxag136
PMID: 42083501
Appears in UI Libraries Support Open Access
Abstract
This study examined whether rural veterans with multisymptom chronic pain presentations, including those diagnosed with fibromyalgia, migraine, and/or irritable bowel syndrome (IBS), were at heightened risk for polypharmacy with central nervous system (CNS)-active medications, a potentially risky prescribing practice.
Administrative data were used to identify veterans receiving care for fibromyalgia, migraine, or IBS during 2022. Negative binomial regression models, conducted separately for fibromyalgia, migraine, and IBS, examined the impact of rural residence and rural site of care on number of concurrent CNS medications. Models were then adjusted for demographics and medical and psychiatric comorbidities.
A total of 250,533 veterans were treated for fibromyalgia (n = 30,462), migraine (n = 188,640), and/or IBS (n = 49,169) in the Veterans Health Administration in 2022. Rates of polypharmacy were 16.2% for those with fibromyalgia, 13.5% for those with migraine, and 8.2% for those with IBS. In fibromyalgia, rural veterans' mean number of concurrent CNS-active medications was 2.59 (SD, 1.92), compared to 2.63 (SD, 1.90) for urban veterans; in migraine, the mean (SD) number of concurrent medications was 2.43 (1.87) in rural veterans, compared to 2.40 (1.83) in urban veterans; and in IBS, the mean (SD) number of concurrent medications was 1.75 (1.75) in rural veterans, compared to 1.79 (1.75) in urban veterans. In adjusted analyses, minimal differences were found between rural and urban-dwelling veterans in the risk of an increased number of concurrent CNS medications (adjusted incident rate ratios [aIRRs] ranged from 1.01 to 1.03) and between those receiving primary care from rural clinics versus medical centers (aIRRs ranged from 0.95 to 0.97).
These findings do not support the hypothesis that rural veterans are at increased risk for CNS polypharmacy.
Details
- Title: Subtitle
- Central nervous system-active medication polypharmacy among rural and urban veterans with fibromyalgia, migraine, or irritable bowel syndrome
- Creators
- Katherine Hadlandsmyth - Iowa City VA Health Care SystemBrian C Lund - Iowa City VA Health Care System
- Resource Type
- Journal article
- Publication Details
- American journal of health-system pharmacy
- DOI
- 10.1093/ajhp/zxag136
- PMID
- 42083501
- NLM abbreviation
- Am J Health Syst Pharm
- ISSN
- 1079-2082
- eISSN
- 1535-2900
- Publisher
- Oxford University Press
- Grant note
- US Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, Veterans Rural Health Resource Center-Iowa City: 04244 US Department of Veterans Affairs Health Services Research and Development (HSR&D) Service through the Center for Access and Delivery Research and Evaluation (CADRE) Center: CIN 13-412
This material is based upon work supported by the US Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (award # 04244). The work reported here was also supported by the US Department of Veterans Affairs Health Services Research and Development (HSR&D) Service through the Center for Access and Delivery Research and Evaluation (CADRE) Center (CIN 13-412). The authors have declared no potential conflicts of interest.
- Language
- English
- Electronic publication date
- 05/05/2026
- Academic Unit
- Epidemiology; Nursing; Anesthesia
- Record Identifier
- 9985161444802771
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