Fibromyalgia Underdiagnosed, Especially in Men, According to Mayo Clinic Study

fibromyalgia underdiagnosed especially in men and younger patients

Are men, women, young and old all being offered the same diagnosis for fibromyalgia symptoms?

In a recent population study, the first of its kind, Mayo Clinic researchers found evidence that a possible cause of neck pain, fibromyalgia, may be more common than previously thought. Using the updated 2010 diagnostic criteria from the American College of Rheumatology (ACR), and comparing symptom prevalence to the prevalence of diagnosed fibromyalgia cases, the researchers found a vast difference suggestive of significant underdiagnosis, especially in male patients.

Diagnosing Fibromyalgia

Ann Vincent, MD, medical director of the Mayo Clinic’s Fibromyalgia and Chronic Fatigue Clinic, Rochester, Minnesota, worked with colleagues and used data from the Olmstead County, Rochester Epidemiology Project to identify potential patients with fibromyalgia and compare the numbers to those with the condition already diagnosed.

Vast Underdiagnosis of Fibromyalgia

Publishing the data in the November issue of Arthritis Care and Research, Vincent noted a 6.4% incidence of fibromyalgia in the general population of Olmstead County contrasting sharply with the 1.1% incidence of diagnosed fibromyalgia (when age- and sex-adjusted). Using a random survey of 830 adults in the county, the researchers estimated what percentage of the population met diagnostic criteria for fibromyalgia. Only 12 (1.45%) had been diagnosed with the condition but 44 respondents (5.3%) met the criteria.

No Significant Gender Difference in Fibromyalgia Cases

Fibromyalgia is a condition more commonly diagnosed in women but the researchers’ results found that the prevalence of fibromyalgia was not statistically significant between the sexes, a finding that could shake up current thinking on the disease. The age-adjusted prevalence of fibromyalgia in men was 4.88% in the general population but only 0.15% in diagnosed cases. In women the 7.71% prevalence in the general population contrasted with a 2% prevalence of diagnosed cases.

Do Older People Suffer More with Fibromyalgia?

Another stock assumption about fibromyalgia, namely that prevalence increases with age, was also thrown asunder by the research. Those between the ages of 21 and 39 had a prevalence of 8.45%, compared with 6.02% in 40-59 year-olds and 3.79% in those over 60. The reason for the perception of fibromyalgia being more of a problem for older patients may simply be due to participation bias, in that older people volunteer for medical surveys more frequently than their younger counterparts.

Fibromyalgia in Younger Patients

Neck pain and other symptoms of fibromyalgia, such as fatigue, cognitive issues, sleep and mobility problems may be dismissed as a product of stress in younger patients who are wary of having a diagnosis of a chronic condition that may affect employment opportunities. In contrast, those nearing retirement or retired may feel that they have less to lose with such a diagnosis and be more amenable to prolonged investigation of their symptoms.

Why More Women Are Diagnosed with Fibromyalgia

As regards the view of women making up a significantly higher proportion of cases than men, the researchers suggest that this may be due to women having a higher sensitivity to pain and, therefore, more tender points allowing for easier diagnosis. It may also be that women express concern over their pain and accept a diagnosis of fibromyalgia more readily while men can be more reticent about communicating pain and suffering and/or may pursue a different diagnosis that avoids perceptions of emotional of psychological involvement in their pain. The researchers found that men do report symptoms of fibromyalgia but are often not diagnosed with the condition, ensuring a comprehensive assessment of all symptoms would help correct this gender discrepancy.

Improving Fibromyalgia Diagnosis

The current paradigm is that women and men experience fibromyalgia in a three to one ratio and there are those who question this study on the basis of many years experience. Next steps include further research into the gap between prevalence and diagnosis and the development of strategies to close that gap should it be confirmed. Fibromyalgia patients were recently found to have, in half of cases, a potentially treatable nerve issue and improved diagnosis of fibromyalgia combined with new treatments could make a huge difference for those struggling with neck pain and other fibromyalgia symptoms daily.


Ann Vincent, Brian D Lahr, Frederick Wolfe, et al, Prevalence of fibromyalgia: A population-based study in Olmsted County, Minnesota, utilizing the Rochester Epidemiology project, Arthritis Care Res. Published online November 30, 2012.

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419 replies
  1. Stephen in Birmingham
    Stephen in Birmingham says:

    This was a really shocking study. I first heard about this a couple of months ago, and I even wrote an article on this myself. Overall, there is still plenty of mystery surrounding this medical condition. Prior to this, everything I had read suggested that this was a disorder that affected more women than men. I was quite surprised to read that there are many men who could be suffering from a number of symptoms and complications and have no idea why.

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