Fibromyalgia is one of the most difficult conditions to diagnose because its symptoms – chronic pain, fatigue and mood changes – are often mistaken by doctors for other conditions. According to research published in Arthritis Care & Research, only one in twenty men who have the disease are being treated.
Fibromyalgia affects more than five million Americans and is characterized by bouts of chronic widespread pain and tenderness lasting for three or more months. Researchers at the Mayo Clinic looked at over 3,000 patients over the course of two studies and consistently found that people who have fibromyalgia are going undiagnosed.
The discrepancy was greatest among men. Researchers say as many as twenty times more men appeared to have fibromyalgia based on their survey response than had been diagnosed, while three times more women reported fibromyalgia symptoms than were diagnosed.
But why that prevalence of under reporting among men exists may have something to do with a lack of understanding of the disease among some health care providers, said lead author Dr. Ann Vincent, medical director of the Mayo Clinic’s Fibromyalgia and Chronic Fatigue Clinic.
“Health care providers may not think of this diagnosis when face to face with a male patient with musculoskeletal pain and fatigue,” said Dr. Vincent. “These findings need to be explored further.”
Studies also show that properly diagnosing people with fibromyalgia reduces health care costs, because they often need far less diagnostic testing and fewer referrals looking for the cause of their pain.
“It is important to diagnose fibromyalgia because we have effective treatments for the disorder,” said co-author Daniel Clauw, MD, director of the University of Michigan Health System Chronic Pain & Fatigue Research Center.
Researchers first looked at data from a comprehensive medical records pool in Olmsted County, Minnesota known as the Rochester Epidemiology Project to find the number of people over age 21 with fibromyalgia.
A second study surveyed the county’s adults using criteria that included the hallmarks of fibromyalgia: widespread pain and tenderness, fatigue, feeling unrested after waking, problems with memory or thinking clearly and depression or anxiety, among other symptoms.
Based on their findings, researchers estimate that more than 6% of people 21 and older in Olmsted County have fibromyalgia; far more than have been officially diagnosed with it.
One of the more significant findings, researchers say, was that incidents of fibromyalgia were somewhat higher in younger age groups in contrast to the trend of increasing prevalence of diagnosed fibromyalgia with older age groups.
According to Dr. Vincent, the spike in younger people reporting the disease may have something to do with what she described as “participation bias.”
“This is contrary to what is previously reported and observed and could be related to a low response rate in this [younger age] category, with only sicker people responding.”
Another surprising finding was that incidents of the disease in women was not significantly higher than in men, especially since it generally believed that fibromyalgia is more common in women. But that may be due to a change in the American College of Rheumatology (ACR) diagnostic criteria, said Dr. Vincent.
“The old ACR criteria had some inherent issues and were partly responsible for the big gender difference. The hope of the new criteria was to comprehensively assess presence of fibromyalgia based on all its key symptoms by patient report, and the assumption was that this would correct some of the previously reported gender discrepancy.”
“Our results suggest that this is correct: Men do report symptoms of fibromyalgia. Whether they getting diagnosed is another question.”