The investigators also noted that most clinical studies of fibromyalgia report a very high ratio of female to male cases, even going so far as to suggest that 90% of individuals with fibromyalgia are women.4 However, in the current study, when the investigators evaluated those individuals who met the criteria for fibromyalgia but had not been diagnosed with fibromyalgia, they found the female to male ratio was closer to 1:1 (63% female in the fibromyalgia criteria group). This finding suggests that although men and women may be equally likely to meet the criteria of fibromyalgia, women are more likely to receive a diagnosis of fibromyalgia.
Patients in the fibromyalgia diagnosis and criteria groups had similar responses for symptom impact, quality of life and life satisfaction, and were worse than those in the chronic pain group for all responses. Patients with a fibromyalgia diagnosis were also more likely to be unemployed due to health issues than individuals who met the fibromyalgia criteria but were undiagnosed and those with chronic pain. Additionally, patients with a diagnosis of fibromyalgia reported more negative experiences with healthcare than those who met the criteria but were undiagnosed and those with chronic pain.
Implications for Practice
Elena Schiopu, MD, rheumatologist at University of Michigan Health, Ann Arbor, explains that she often sees patients with fibromyalgia and, because she works at an academic center, she often provides a second, third or fourth opinion.
“Fibromyalgia has a huge impact on quality of life,” she says, adding that it is associated with many common rheumatic diseases and contributes to the pain complaints of patients with rheumatic diseases. She says rheumatologists who don’t recognize the contributions of fibromyalgia to pain may treat patients with ineffective and dangerous medications.
Dr. Schiopu says that, absent a biomarker, the widespread pain index and symptom severity scale used in the study are the best ways to diagnose fibromyalgia. She provides these two questionnaires for patients to complete in the waiting room before an appointment.
According to Dr. Schiopu, patients with fibromyalgia have nervous systems that are hyperexcitable, especially under stress. Although both physical trauma and psychosocial factors contribute to fibromyalgia, psychosocial factors appear to be especially important for the generalized and durable pain associated with fibromyalgia.5 She explains that because pain is amplified in fibromyalgia, patients have difficulty interpreting the pain sensations in their bodies.
“They feel like something is wrong with their body,” says Dr. Schiopu, and because of this feeling, they may use the emergency department multiple times per month, have a great deal of dissatisfaction with the healthcare system and may frequently self-identify as being disabled.
