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.