Fibromyalgia in Men
For decades, men with the widespread pain of fibromyalgia were ignored. The condition received little attention in the 1970s and 80s, but men with fibromyalgia weren’t even a blip on the radar. Then in 1990, the diagnostic criteria for the “syndrome” led to improved awareness of fibromyalgia among women, but not men.
Flawed Criteria
The 1990 criteria required patients to say “ouch” when doctors applied pressure to specific areas throughout the body. It was called the tender point exam. But men have more muscle mass than women, as well as higher pain thresholds. It’s a physiological difference between the sexes. Unfortunately, the criteria ignored this fact. As a result, only men with extreme pain (more than the average female patient) were diagnosed with fibromyalgia.
This flaw in the diagnostic criteria gave physicians the impression that fibromyalgia was a woman’s illness. It reinforced the misnomer that men don’t get fibro. As 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 and the same symptoms as female patients.1 They simply have more muscle mass and greater baseline pain thresholds than women. This is the only difference. The physician examiners simply needed to press a little harder on male patients, that’s all.
The 1990 criteria improved fibromyalgia’s credibility. It became a painful condition with an objective diagnostic method … at least in the eyes of some physicians. It also paved the way for more research on the illness, but almost all studies enrolled only women. Why? Researchers falsely assumed that men made less than 10 percent of the patient population, so they focused on women.
Better Diagnostics
The new diagnostic criteria for fibromyalgia published in 2016 tossed out the tender point exam (i.e., pressing on painful areas). In place of a physical exam, patients simply fill out a questionnaire and identify areas that hurt on a body diagram.
Using the new criteria, studies show 4% of women and 2.4% of men get fibromyalgia.2 So roughly 38 percent (not 10 percent) of fibromyalgia patients are men. This is a step in the right direction. Unfortunately, the long-standing assumption that fibromyalgia is a woman’s disease contributes to many issues faced by men today.
Research Excludes Men
Despite the more inclusive nature of the 2016 criteria, most research studies still exclude men. Why? More males need to be diagnosed with the new criteria so they become 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. As a result, efforts are made to control variables that can impact the results. Examples include age, body weight, medication use, and yes, even sex. So, until enough men are recruited into studies to make a difference (2-3 is not enough), most small-scale studies will exclude men.
Today, men are the focus of a handful of fibromyalgia studies published in the medical journals. Albeit these studies focus on symptom surveys and social issues rather than physiological mechanisms. Hopefully the trend to include men grows and important findings identified in female subjects will be replicated in males.
One study funded by AFSA in 2024 includes 30 percent men. The project investigates the mechanisms of cranial electrical stimulation (CES) to treat fibromyalgia. Another AFSA-funded study involves a large-scale trial of medical grade cannabis. It also includes analyzing the influence of gut microbes on the effectiveness of the drug. The project just started, and both men and women with fibromyalgia are being recruited.
Other Challenges
Progress is happening, but men with fibro still have a long road ahead. The decades of being ignored have taken a toll on men, with many challenges remaining.
Effectiveness of Treatments: Most drug and nondrug treatments for fibromyalgia were 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 respond differently to the same drug is seldom 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, the TV commercials depicted mostly female fibromyalgia patients. The public was given the false impression that men do not get this disease. Of course, the commercials implied that patients just needed to ask their doctor for a drug to relieve their pain. Just another fallacy.
Men with fibromyalgia are still branded with a woman’s disease. This makes it harder for 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. While communication issues face both sexes, it’s a greater roadblock for men than it is for women.
Men Have More Difficulty Getting Diagnosed: Surveys show that men see twice as many doctors as women before being diagnosed with fibromyalgia. Although the new criteria are more inclusive of men, many doctors don’t know how to diagnose this illness. As a result, physicians fail to consider fibromyalgia as a possible diagnosis for their male patients. Hopefully, time will remedy this situation.
Research Findings in Men
A study evaluating the symptoms of men with fibromyalgia illustrates the similarities to women.3 In the introduction, the authors state: “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 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
Men battle the same symptoms as women, their health is poor, and their satisfaction with medications is low.
References for Fibromyalgia in Men
Resource for Men: If you are a man with fibromyalgia, check out a website and forum: menwithfibro.com. If you do not have anyone to talk to, the men who run this site can help you.
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- Jiang L, et al. Mayo Clinic Proc 4(6): 767-774, 2020. Free Report
- Wolfe F, et al. PLOS ONE 13(9): e0203775, 2018. Free Report
- Ruschak I, et al. Symptomatology of Fibromyalgia Syndrome in Men: A Mixed-Method Pilot Study. Int J Environ Res Public Health 19,1724, 2022. This is an excellent report for men to read or bring to a healthcare provider. It’s available for free: click here