A study in U.S. veterans found that fibromyalgia was diagnosed more often in younger vets who were often women, with more headaches and a higher rate of psychiatric conditions. The study also showed that men with fibromyalgia had increased alcohol dependence and more medical disorders.
The study, “Gender Differences in the Prevalence of Fibromyalgia and in Concomitant Medical and Psychiatric Disorders: A National Veterans Health Administration Study,” appeared in the Journal of Women’s Health.
A recent revision of diagnostic standards showed that gender differences in the prevalence of fibromyalgia are far smaller than previously believed. Still, researchers showed that these guidelines are not universally used in the clinical setting and lack a physiological basis, which means there is still no gold standard to diagnose the disorder.
Psychiatric conditions — such as depression, anxiety, bipolar disorder, obsessive-compulsive disorder, personality disorders, and post-traumatic stress disorder — are frequently associated with fibromyalgia.
These complications add to its still-unknown cause, which makes diagnosis rely solely on self-reported data.
The combination of diagnostic ambiguity and psychiatric co-morbidities leads to a frequent and controversial view of fibromyalgia as a “somatoform” psychiatric disorder, which refers to mental illnesses characterized by pain and fatigue, but with no apparent physical cause.
Research in patients outside the U.S. has indicated that fibromyalgia leads to greater impairment and utilization of healthcare resources than the general population. This is aggravated in patients with co-existing conditions. Higher rates of lost jobs due to impairment have also been reported.
The few large studies on the prevalence of fibromyalgia in the U.S. also showed higher healthcare usage and more pain medication, particularly with increased disease severity and functional impairment.
Fibromyalgia patients were also more likely to undergo surgeries and require hospitalization.
Researchers had previously found a high rate of fibromyalgia in a national sample of patients served by pain clinics in the Veterans Health Administration.
They now expanded these findings to characterize gender differences, sociodemographic characteristics, medical and psychiatric comorbidities (co-existing conditions or diseases), and use of healthcare services in fibromyalgia compared to other pain syndromes.
The study included patients who received a pain diagnoses from October 2011 through September 2012. Results showed that 77,087 of a total 2,216,621 veterans with pain diagnoses (3.48%) had fibromyalgia.
Data showed that patients with fibromyalgia were more likely to be female and younger than those with other conditions.
“The major finding of the first set of analyses was the substantial gender disparity associated with a fibromyalgia diagnosis, with a female:male ratio of 4:1,” the researchers wrote.
When restricting the analysis to the fibromyalgia group, women were nearly nine years younger and had more headaches and connective tissue diseases, which involve inflammation and pain. They also have more psychiatric conditions, including major depression, anxiety, bipolar disorder, and personality disorders.
The findings related to psychiatric conditions are in line with previous studies in female veterans with chronic pain or with musculoskeletal pain, the authors observed.
Men generally showed an increased likelihood for alcohol dependence and more comorbid medical conditions, such as heart attacks, peripheral and vascular disease, cerebrovascular accidents, and diabetic complications, including pain.
The results did not reveal extensive use of opioids in these veterans, regardless of gender.
“A particular strength of this study is the large sample, including high numbers of men, and one that reflects real-world clinician practice in a national healthcare system,” the investigators wrote.
Future studies should use more recent samples and consider information on tender points, the areas of tenderness around joints classically used to diagnose fibromyalgia, the authors said.
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