Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

Looking for Mr. Fibromyalgia

Men with fibromyalgia hiding in plain sight.

I have this funny habit of watching the evening network news with the television on mute. Oh, the first ten minutes are not so bad (although I’m still trying to figure out why the bail hearing last week for Oscar Pistorious merited the first story slot on the NBC Evening News), filled with truncated and castrated stories of national interest; but it is rough to listen to the last twenty, replete with early phase drug studies teasing us with a cure for cancer that just never is realized, or dogs caught on ice floes on one of the Great Lakes.

Indicative of the demographic that still gets its news from the likes of Brian Williams or Diane Sawyer, the sponsors of those broadcasts mostly include makers of drugs for incontinence, impotence, and pain. And it was while watching the commercials—with the television still on mute—that I realized how much the relief seen in the eyes of the woman giving a testimonial to the fibromyalgia-healing properties of Lyrica was similar to that of the women in the Cialis commercial. But where was the male figure in the Lyrica commercial? He was nowhere to be found.

Although a recent study tells us he is hiding in plain sight.

The results of this soon-to-be published study will appear in an upcoming issue of “Arthritis Care & Research.” It tells us that many who suffer from the chronic pain of fibromyalgia are not being diagnosed, men bearing the brunt of what ultimately is a missed opportunity to undergo the appropriate treatment. Health care providers apparently hear the complaints of a male patient, but just don’t make the diagnostic leap that he may have fibromyalgia.

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Compared to men, the prevalence of fibromyalgia in women is significantly higher.

Of course, this could be because fibromyalgia is less common in men. Or it could be that men seek out medical care less than women. Still, women can experience the missing of this diagnosis also. Researchers found that twenty times more men appeared to have fibromyalgia based on a survey response than had been diagnosed, while three times more women reported fibromyalgia symptoms than were diagnosed.

One of the researchers concluded that perhaps the problem is the way the medical profession has diagnosed fibromyalgia. Utilizing the prior (1990) fibromyalgia criteria, important symptoms such as fatigue, depression, and cognitive problems were omitted. The new criteria published in 2010 included symptoms such as fatigue, and did not require a tender point examination as part of the determination of fibromyalgia.

In this latest study, researchers first applied the 1990 criteria while reviewing medical records, then surveyed a random sample of adults using questions derived from the 2010 criteria. The use of the 2010 criteria revealed a higher prevalence of fibromyalgia in the community—three times higher in women compared to the diagnoses made using the medical record review, and twenty times higher in men. Perhaps men did not bother to go to the doctor to have a tender point assessment?

This is unfortunate news, as there are effective treatments for fibromyalgia; and it is likely that the best clinical response occurs when the drug is started earlier. In addition, early diagnosis of fibromyalgia generally will reduce health care costs, as patients do less doctor shopping; and all those doctors order fewer costly diagnostic tests.

At least this latest study alerts us once again to the fact that fibromyalgia is multidimensional. Patients have pain receptors firing all the time. This generates a lot of pain, to which the body on some level may become sensitized. But in fighting that pain, people become fatigued, have unrefreshing sleep and cognitive problems. It is important for health care providers to recognize that chronic pain kicks the symptom burden much higher, and that symptom management does not just involve pain management.

Pain medications only make pain better, whereas fibromyalgia drugs like Lyrica (pregabalin) and Cymbalta (duloxetine) also make sleep, anxiety, depression and fatigue better. If only the health care profession would take the time to discover. who needs the help.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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