Why Fibromyalgia is Harder to Diagnose in Men
Whether it’s during a commercial break in the middle of your favorite show or an advertisement before an online video, odds are you’ve seen a prescription commercial talking about fibromyalgia, and there’s almost always a woman in the commercial talking about the widespread nerve pain she experiences.
Fibromyalgia is a syndrome in which people experience long-term, body-wide pain and tender points in joints, muscles, tendons and other soft tissues, and is believed to amplify this pain by affecting the way your brain processes pain. It is not gender-specific and can even affect children.
So what’s up with the one-sided commercials? Well, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, of the estimated 5 million people who suffer from fibromyalgia, 80 to 90 percent are women.
Melita Williams, M.D., a primary-care physician with Texas Health Physicians Group, says the difference can be attributed to a number of reasons, but she credits outdated diagnosis criteria for the skew.
“Criteria for diagnosis of fibromyalgia were formerly based on trigger points, which on exam caused an increased prevalence of diagnosis in women,” she says. “However, with removing this criterion, the difference in prevalence is reduced between men and women.”
In 2011, the American College of Rheumatology (ACR) modified their preliminary criteria for diagnosing fibromyalgia to reliably diagnose the disorder in a larger, more diverse group of patients. Along with the modification, the ACR also created easier-to-use alternate criteria with broader symptoms and more specific pain locations.
“If physicians are unaware of the diagnostic criteria changes, they will have a propensity to identify this condition in women,” Williams says. “Because many other diagnoses may present with similar symptoms and this has typically been a diagnosis of exclusion, it may not even be a part of the diagnosis for men, based on bias.”
Adding to the problem, a man’s symptoms can be very different from the symptoms experienced by a woman, and many times symptoms are exacerbated by stress.
Symptoms vary from person to person, but can include:
- Pain and tenderness
- Fatigue, including sleep problems
- Morning stiffness
- Irritable Bowel Syndrome symptoms
- Brain fog
The symptoms a man may experience can be widespread, like they are in women, but many times the symptoms are milder and last for less time. In order to be diagnosed with fibromyalgia, these symptoms must last for at least three months. Different, more mild symptoms mixed with a shorter window of time in which these symptoms affect men all make a diagnosis much harder.
“Pain is very subjective, so some may be dismissive of symptoms, especially if there is a waxing and waning in severity of symptoms based on activity changes and emotional or environmental contributing factors,” Williams says. “This may cause [men] to disregard the true duration of symptoms.”
Due to social norms, men are also more reluctant to see a physician when a problem arises.
“Many have to be [urged] by their wife or significant other to be seen or evaluated,” she says. “If a male patient has the perception that they have to ‘take it like a man’, they will be even less likely to present to the doctor, or freely discuss these complaints with a physician if not prompted, so getting the subjective data to enable evaluation for the diagnosis will be harder.”
Treatment & Outlook
Treatment of fibromyalgia focuses not only on relieving symptoms but also on helping patients learn how to cope with their symptoms. Treatment often includes:
- Physical therapy and low-impact exercise (such as aquatic exercise)
- Medications such as antidepressants, anti-seizure drugs and medications approved for specifically treating fibromyalgia
- Cognitive-behavioral therapy to help with coping skills
- Participation in support groups
- Lifestyle changes, such as avoiding caffeine and recognizing limits.
Williams says the greatest impact you can have on your health is creating a relationship with a primary care physician who can track your medical history and previous symptoms, making diagnoses much easier.
“Establishing a strong relationship with your PCP and the trust that is developed over time will create an atmosphere that can foster healing on a deeper level,” she says, “especially when a condition such as fibromyalgia may have emotional trauma as one of the contributing factors to the onset of the condition.”
Do you suspect that you or a loved one might be suffering from symptoms of fibromyalgia? Find a specialist near you with our Find-a-Physician tool.