Trends in incidence, patient characteristics, healthcare use, and medication in fibromyalgia: A large Israeli cohort study

Background: Fibromyalgia (FM) is a common, multifaceted condition with evolving diagnostic criteria and limited effective treatment. Data on long-term trends in incidence, patient characteristics, healthcare utilization, and medication use remain limited. Purpose: To assess temporal trends in the incidence and prevalence of diagnosed FM and to evaluate changes in patient characteristics, healthcare utilization, and medication use between 2009 and 2024. Methods: This retrospective cohort study used the centralized database of Clalit Health Services in southern Israel. Patients aged 12–90 years diagnosed with FM between 2009 and 2024 were included. The study period was divided into eight two-year intervals. Trends in incidence, prevalence, sociodemographic characteristics, comorbidities, healthcare utilization, and medication use were analyzed. Results: Both incidence and prevalence increased significantly, with prevalence rising from 1.04% to 3.88%. The largest increases in incidence were observed among individuals aged 30–59 years, whereas rates declined among adolescents. The proportion of male patients increased, mean age at diagnosis decreased, and the proportion of patients without comorbid rheumatic disease increased. Psychiatric comorbidities, including anxiety, depression, and PTSD, increased, whereas the overall comorbidity burden remained stable. Healthcare utilization shifted toward fewer hospitalizations and specialist visits but increased imaging. Use of recommended medications remained limited, although prescriptions for pregabalin, duloxetine, and gabapentin increased, while amitriptyline and NSAID use declined. Opioid use increased until 2019–2020 and subsequently decreased. Conclusions: FM diagnoses have increased substantially over time, accompanied by evolving clinical and treatment patterns. Despite improved recognition, management remains suboptimal, highlighting the need for more effective and comprehensive strategies.