Fibromyalgia Underdiagnosed, Especially in Men, According to Mayo Clinic Study
Are men, women, young and old all being offered the same diagnosis for fibromyalgia symptoms?
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.
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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.
Reference
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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