Fibromyalgia in Men
For decades, men with the widespread pain of fibromyalgia were ignored. In the 1970s and 80s, the condition didn’t get much attention, but men with fibromyalgia were not even a blip on the radar. Then in 1990, new criteria for diagnosing this “syndrome” of pain and other symptoms led to improved awareness of fibromyalgia among women, but not men.
The 1990 criteria required that patients say “ouch” when the examining physician applied a certain amount of pressure to specific areas throughout the body. But men have more muscle mass than women (raising their pain threshold), and these criteria did not take this into account because 92 percent of the test subjects were women. As a result, only a small portion of men with extreme pain (more than the average female patient) were diagnosed with fibromyalgia.
This obvious flaw in the diagnostic criteria led physicians to think that fibromyalgia was a woman’s illness. It reinforced the misnomer that men don’t get this condition, and for those men who met the 1990 criteria, their pain was thought to be less severe than female patients. Not true!
Men with fibromyalgia have just as much pain, fatigue, sleep disorder, trouble concentrating (fibrofog), and all the common symptoms of this disease. They simply have more muscle mass, so the physician examiners should have applied more pressure when pressing on areas over their muscles … that is the only difference.
The 1990 criteria gave credibility to fibromyalgia for being a painful condition that could objectively be identified. It also paved the way for more research on the illness, but almost all studies enrolled only women. Why? Researchers had the false impression that men made up only 10 percent of the patient population, so they focused on women.
In 2016, new diagnostic criteria for fibromyalgia tossed out the requirement to press on tender areas to elicit a painful response. In place of a physical exam, patients simply fill out a questionnaire and identify the areas on a body diagram where they hurt.
Using the new criteria, studies show that 4% of women and 2.4% of men get fibromyalgia. So roughly 38 percent (not 10 percent) of fibromyalgia patients are men. This is a step in the right direction, but the long-standing assumption that fibromyalgia was a woman’s disease contributes to many issues that face men today. Some of the pitfalls that men with fibromyalgia must still contend with are described below.
Research Still Excludes Men: Although the new criteria are more inclusive of men, they are still being excluded from research studies. Why? More men need to get diagnosed with the new criteria so that they can be included in the potential pool of study participants. The current pool of fibromyalgia subjects is still predominantly female.
Funding for fibromyalgia research is extremely limited, which means that almost all studies include only a small number of participants (both patients and healthy controls). As a result, every effort is made to control for variables that could impact the results, such as age, body weight, medication use, and yes, even sex. So, until enough men can be recruited into studies to make a difference (2-3 is not enough), small-scale studies will be predominantly female.
In recent years, men have been included in some studies. In addition, there are now researchers looking solely at men with fibromyalgia. Hopefully this trend will grow and the significant findings that have been found in mostly female subjects will be replicated in males.
Effectiveness of Treatments: Most drug and nondrug treatments for fibromyalgia have been tested predominantly in female patients. Do they work as well in men? No one knows.
When physicians prescribe medications to their patients, they typically make dose adjustments based on the patient’s weight and age. The possibility that men and women may respond differently to the same drug is not usually factored into the equation. This is the case for most conditions; fibromyalgia is no exception.
Perceptions Linger: When the three FDA-approved drugs hit the market, there were commercials on TV depicting mostly women as fibromyalgia patients. The general public was wrongly given the impression that men do not get this disease. Of course, the commercials made it sound as though all one had to do was ask their doctor for a drug and it would greatly relieve their pain … if only that were true!
Men with fibromyalgia are now branded with having a woman’s disease, making it harder on them to talk about their illness with family, friends, and coworkers. Yet, communicating with others is an essential part of coping with one’s chronic illness and it is more of a roadblock for men than it is for women.
Men Have More Difficulty Getting Diagnosed: Surveys show that men see almost twice as many doctors as women before being told they have fibromyalgia. Although the new criteria are more inclusive of men, many doctors may not be aware of it. As a result, they may be using outdated criteria that exclude men. Hopefully time will fix this problem.
Resource for Men: If you are a man with fibromyalgia, check out a website and forum that have been around for more than 20 years: menwithfibro.com. If you do not have anyone to talk to, the men who run this site—along with the regulars who post on it—can help you cope with your symptoms.
Research Findings in Men
As new research studies appear in the medical journals on men (except those that focus on psychobabble), we will report on them here.
For now, we provide a summary of a study in Spain looking at the symptoms of a random group of men with fibromyalgia.* In the introduction, the authors point out: “the symptoms experienced by men were much less likely to be identified and diagnosed than those of women. The discrepancy between men and women in relation to the prevalence and diagnosis of fibromyalgia seems to be related to the social stigma associated with it being considered a ‘female illness.’”
Quotes from the men in the study regarding common symptoms are below.
PAIN:
“Everything hurts and it makes me want to hit myself against the wall.”
“I raise my arm to change a light bulb, it hurts all day.”
FATIGUE:
“Tiredness is like your batteries have gone dead.”
ANXIETY:
“I suffer from anxiety because I’ve had pain and been taking tests for years. At first you think it will go away but after some failed and serious diagnoses, you end up suffering a great deal of anxiety.”
“You go to a specialist and he tells you’re anxious, that you are somatizing.”
DEPRESSION:
“Having to put up with so much pain makes you feel depressed.”
SLEEP:
“The pain stops me from going to sleep.”
MEMORY:
“You have something to say and when you’re going to say it, you forget what you were going to say.”
HYPERSENSITIVITY:
“If someone makes a low-pitched noise, it’s as if they were piercing my eardrums.”
EFFECTS OF OPIOIDS;
“I’ve taken a lot of strong medicines; they make you feel sleepy and you can’t lead a normal life or do the things you need to do for yourself.”
On a scale from 0 to 10, the men rated the following:
Current pain level – 8.2
Perceived health level – 4.6
Satisfaction with medications – 3.5
Symptom-based studies show men with fibromyalgia battle the same problems as women. They are in constant pain, their health is poor, and their satisfaction with prescribed medications is low.
* Ruschak I, et al. Symptomatology of Fibromyalgia Syndrome in Men: A Mixed-Method Pilot Study (2022), Int J Environ Res Public Health 19,1724. If you want to read the report or bring it to your healthcare provider, click here and then click on the “Download” button to get the PDF of the article.