HIS and HER Fibromyalgia

I received an article to my Inbox this morning from newlifeoutlook│Fibromyalgia about men with FM:

Is Fibromyalgia in Men Different?

Fibromyalgia-in-Men-210x270Many people believe that fibromyalgia is a woman’s disease. In fact, men do get fibromyalgia, though not at the rate of occurrence seen in women. It is unknown why women suffer from it more often than men.

People with certain biological markers are predisposed to fibromyalgia. Fibro patients of both genders have been found to have a higher level of substance P, a neurotransmitter that signals pain. To make things worse, their level of serotonin is lower than average; this neurotransmitter is responsible for inhibiting pain. Genetics and hormones also have a role in bringing the disease out or making it worse. Women are more likely to experience more pain because estrogen reduces the pain threshold.  The heightened sensitivity to pain may be why the odds are greater for women to be diagnosed with fibromyalgia.

How Fibromyalgia Affects Men

Men often have less severe fibromyalgia symptoms than women do. They may not have as much pain and it will be in fewer places; they often don’t have the complaint of “hurting all over” like female fibromyalgia patients do. They also don’t experience as much fatigue. They do, however, experience many of the other conditions and symptoms that accompany fibro, including irritable bowel syndrome, chronic fatigue, difficulty sleeping and restless leg syndrome. Memory problems are apparent and it can become very difficult to concentrate at times.

Undiagnosed Fibromyalgia Cases in Men

There may be more cases of fibromyalgia in men then we know about, as men are less likely to go to the doctor than women. It is usually gender-based stereotyping that influences this trend – men are raised to think they should not admit to any weakness, that they shouldn’t complain of pain or discomfort lest they be viewed as less of a man. It is estimated that up to 20% of men with fibromyalgia are undiagnosed.

If you think you may have fibromyalgia, it is important to see a doctor as soon as possible. By putting it off, you put yourself more at risk of developing complications. This means your work could be affected as well as any hobbies and other important things in your life. You could also be putting your mental health as risk. Depression is a common ailment that crops up among men who delay getting an answer to their health problems. Work with your doctor to get the proper diagnosis and treatment. The sooner this is done, the better you will feel so that you can enjoy life again.

Managing Fibromyalgia

Fibromyalgia cannot be cured, but it can be managed. Medications can help control the symptoms and lifestyle changes can help in a big way. Being overweight can increase the pain and fatigue that accompanies fibromyalgia, so adding exercise to your daily regimen and eating better will help lessen these symptoms.

Resource: Web MD (How Fibromyalgia Affects Men)

Head clampBut I also remember writing about a study a while back…so I did a little search of my own blog and found Men Get Fibro, Too! from back in 2012 and (although all my picture links are missing) the post mentions an Israeli study from 2000 that found men with FM actually had more severe symptoms, decreased physical function, and lower quality of life than women the same age with FM.

I don’t know too many men with FM personally, so what do you think?


Man Undiagnosed

More research is needed, particularly on why men who reported FM symptoms were less likely than women to receive a FM diagnosis, says lead author of a recent study, Ann Vincent, M.D., medical director of 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,” Dr. Vincent says. “These findings need to be explored further.”

Researchers focused on Olmsted County, Minn., home to the comprehensive medical records pool known as the Rochester Epidemiology Project, and used two methods to try to discover the number of people over age 21 with FM.

To the best of my knowledge, this is the first report of the rate at which FM is being diagnosed (or undiagnosed) in a community. This is also the first report of prevalence as assessed by the FM research survey criteria.

Firstly, they used the epidemiology project to identify just over 3,000 patients who looked like they might have FM: only a third had a documented FM diagnosis. That amounted to 1.1 per cent of the county’s population 21 and older.

In the second method, researchers randomly surveyed Olmsted County adults using the American College of Rheumatology‘s fibromyalgia research survey criteria. The criteria include the hallmarks of FM: widespread pain and tenderness, fatigue, feeling unrested after waking, problems with memory or thinking clearly and depression or anxiety, among other symptoms. Of the 830 who responded to the survey, 44, or 5.3 per cent, met those criteria, but only a dozen had been diagnosed with FM.

Based on the study’s findings, the researchers estimate that 6.4 per cent of people 21 and older in Olmsted County have FM—far more than have been officially diagnosed with it.

fibrommaleThe study found that the discrepancy between the number of people reporting FM symptoms and the number actually diagnosed with the condition was greatest among men. Twenty times more men appeared to have FM based on their survey response than had been diagnosed, while three times more women reported FM symptoms than were diagnosed.

“It is important to diagnose fibromyalgia because we have effective treatments for the disorder,” says co-author Daniel Clauw, M.D., director of the University of Michigan Health System Chronic Pain & Fatigue Research Center. Do we?



Men Get Fibro, Too!

Fibromyalgia can take years to diagnose—three to five years on average—but, if you’re a man, it can take even longer! It is common knowledge (at least, with us) that FM is diagnosed in 2% to 4% of the population but is about nine times more common in women than men.

The lower numbers mean that doctors are less likely to consider the diagnosis in the first place, and, what’s more, fibromyalgia may look slightly different in men than women. The condition may be milder in men, who may also have fewer symptoms. Some research has suggested that men tend to have less frequent flare-ups of their symptoms, which also are likely to last for shorter periods of time.

However, one Israeli study in 2000 found that men with fibromyalgia actually had more severe symptoms, decreased physical function, and lower quality of life than women the same age with fibromyalgia.

Part of the reason men are less likely to be diagnosed may be due to deeply ingrained social norms that teach men to hide their feelings, making them less likely to seek help for something that could be viewed as a weakness, like body pain. Doctors need to question their male patients about pain to get their patients to talk, because men are sometimes reluctant to talk about it.

Unfortunately, as we know, FM also still has a serious credibility problem. Even if men are willing to talk, not all doctors believe what they are hearing. In a 2007 survey, more than 25% of the 2,000 fibromyalgia patients questioned reported that their doctors did not view fibromyalgia as a ‘very legitimate’ disorder.

Fortunately, at least for patients in the US, the Food and Drug Administration’s approval of three drugs—Cymbalta, Lyrica, and Savella (Lyrica has not been approved by the PBS in Australia – I have no idea about other countries) —for FM has helped to bring the condition out of the closet, says Patrick Wood, MD, a member of the medical advisory board of the National Fibromyalgia Association. “With the release of recent medications, there’s been a greater orientation to the reality of this disorder and emphasis to make it something that’s treated as a legitimate condition.”

But in addition to disbelief and social norms, there are also some physical variations that make fibromyalgia different in men. The current guidelines for diagnosing fibromyalgia include feeling pain at 11 or more of 18 common tender points. But because the average woman is more sensitive to pain than the average man, women score higher on this diagnostic test and, therefore, meet the criteria for fibromyalgia more frequently than men, explains Daniel Clauw, MD, the director of the Chronic Pain and Fatigue Research Center at the University of Michigan, in Ann Arbor.

Dr Clauw supports the burgeoning movement to eliminate the tender points test from fibromyalgia diagnoses because of this bias toward women. “Using [tender points] criteria, fibromyalgia is about 95% female,” he says. “That will probably go down to about 65% because chronic, widespread pain is only about 1.5 times greater in women than in men.”

Another deviation may be chemical imbalances in the brain. Dr Wood suggests hormones may play a role. “With the dopamine system, in particular, there are gender differences as to how the brain responds to situations,” he says, pointing particularly to stress. “Estrogen is very excitatory to the central nervous system, [while] progesterone is very calming.” Greater attention to hormonal imbalances may lead to gender-specific treatment in the future, he adds.

However Dr Clauw is not convinced that estrogen is the culprit. “Pregnancy and menopause [cause great changes in estrogen] and neither of those are associated with changes in pain in women,” he says. “We simply don’t know why women have more pain than men.” Until the condition is more deeply understood, managing the pain is any patient’s best plan of attack.

Despite the gender imbalance, advice for thriving with fibromyalgia is gender neutral. Both men and women can benefit from the same advice.

Both men and women deserve to have their pain treated.