Men and Fibromyalgia

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Fibromyalgia occurs disproportionately among women and men, at a rate of approximately 9 to 1 in favor of women. The reasons for this discrepancy are unclear. Some authors suggest that these differences are likely the result of an interaction between numerous biological, psychological, and sociocultural factors (Yunus 2001). Others suggest that physicians may be less likely to diagnose fibromyalgia in males altogether (Katz et al., 2010).

Due in part to its relatively low occurrence in men, data pertaining to the specific characteristics of fibromyalgia in men is sparse. Larger, more well-designed studies are needed in order to better address the potential gender differences in fibromyalgia, which can hopefully lead to more successful treatments (Buskila et al., 2000; Aparicio et al., 2012). A review of available studies evaluating various aspects of fibromyalgia in men is provide below, along with comparisons to women where available.

Demographics and Clinical Features

The research related to the demographic and clinical features of fibromyalgia in men is limited and at times, disparate. Hauser et al. (2011) recently published findings of their study, which compared demographic characteristics (such as age and family status) and clinical variables (including duration of chronic pain and fibromyalgia diagnosis, tender points, pain sites, and depressive symptoms) between male and female fibromyalgia patients. In total, 885 female patients and 138 male patients were included in the study. Unlike the findings of prior research, this study found no relevant differences between male and female fibromyalgia patients in terms of their demographic and clinical features. The only differences noted were that women had a longer duration of chronic widespread pain and time since diagnosis than men. Women also had higher tender point counts on average.

Yunus et al., (2004) have also published findings that revealed little if any difference between the sexes in terms of certain clinical features of fibromyalgia. They evaluated 160 women and 40 men, all with a diagnosis of fibromyalgia. A number of standardized and validated psychiatric assessments were used to measure various psychological variables for each patient, including anxiety, stress, and depression. After analyzing the results of all assessments, no significant differences were found with regard to psychological symptoms such as anxiety and depression. Approximately 62.5% of men and 66.3% of women met criteria for a diagnosis of anxiety; 67.5% of men and 64.4% of women experienced significant abnormal stress; and 47.5% of men and 39.4% of women were depressed.

An earlier study published in 2000 also reported findings related to the differences in the clinical features of male and female fibromyalgia patients. The study evaluated 469 female and 67 male patients, along with 36 healthy men without chronic pain. The researchers found that men with fibromyalgia experienced significantly fewer tender points, a lower tender point score, less overall pain, less fatigue, and fewer irritable bowel symptoms when compared with women (Yunus et al., 2000). Buskila and colleagues also reached similar findings, reporting that women with Fibromyalgia generally have worse health outcomes than men, including more severe symptoms, decreased physical functioning, and lower quality of life (Buskila et al., 2000). Another more recent study examined the gender differences in quality of life and symptoms between 20 men and 78 women with fibromyalgia. This study found that women were more likely to experience fatigue and morning tiredness, whereas men were more likely to experience a greater overall impact on quality of life (Aparicio et al., 2012).

Response to Treatment

Hooten and colleagues (2007) conducted a study which was designed to determine whether men and women demonstrated differences in physical and emotional function during participation in a three-week multidisciplinary pain rehabilitation program that used cognitive behavioral therapy and gradual withdrawal from pain medication use. Thirty-three men and 33 women with a diagnosis of fibromyalgia completed standardized and validated assessments to evaluate pain, health status, coping strategies, and depression both before and after completion of the rehabilitation program. The study found that prior to the start of treatment, the male patients had lower health perception and greater physical limitations, whereas women experienced greater interference of pain in their daily life activities. Although both men and women had experienced similar responses to the treatment, following completion of therapy men continued to have lower health perception than women, more physical limitations, and decreased social functioning. No differences were determined between the sexes with regard to reductions in pain medication use.

A recent study by Carbonell-Baeza et al. (2011) evaluated the use of Tai Chi to treat tenderness, functioning, symptoms, and quality of life in six men with fibromyalgia. Following the four month intervention, the researchers found a significant improvement in lower body flexibility, which was sustained for the three month period following completion of the intervention. The study found no improvements in tenderness, pain symptoms, or quality of life. It is important to note, however, that only six men were included in this study therefore the results should be interpreted with caution due to the small sample size.

A very small case study research design was used to gather data related to physical fitness, psychosocial factors, and symptoms over the course of a 14 month exercise program administered to two male fibromyalgia patients. In summary, the researchers found that the men benefitted from exercise therapy for their fibromyalgia. The researcher stressed the need to take gender-specific differences into account when conducting exercise programs for fibromyalgia patients (Karper 2007).

Sexual Dysfunction

Rico-Villademoros et al. recently published a study reporting the results of an evaluation into the sexual functioning in both male and female patients with fibromyalgia. This study evaluated 293 patients with fibromyalgia (including 17 males) and 86 healthy control patients without a diagnosis of fibromyalgia (of whom 14 were males). The researchers examined each individual’s responses to a standardized questionnaire designed to evaluate sexual functioning (the Changes in Sexual Functioning Questionnaire [CSFQ]). After analyzing the data, the researchers found that patients with fibromyalgia reported a significantly higher rate of sexual dysfunction when compared to controls. When only the men were considered, 76.5% of men with fibromyalgia demonstrated worse sexual functioning when compared to controls (6.7%).

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References

1.        Aparicio VA, Ortega FB, Carbonell-Baeza A, Femia P, Tercedor P, Ruiz JR, Delgado-Fernández M. Are there gender differences in quality of life and symptomatology between fibromyalgia patients? Am J Mens Health. 2012;6(4):314-319.

2.        Buskila D, Neumann L, Alhoashle A, Abu-Shakra M. Fibromyalgia syndrome in men. Semin Arthritis Rheum. 2000;30(1):47-51.

3.        Hooten WM, Townsend CO, Decker PA. Gender differences among patients with fibromyalgia undergoing multidisciplinary pain rehabilitation. Pain Med. 2007;8(8):624-632.

4.        Karper WB. Exercise effects on two men with fibromyalgia syndrome. Am J Mens Health. 2007;1(4):278-283.

5.        Katz JD, Mamyrova G, Guzhva O, Furmark L. Gender bias in diagnosing fibromyalgia. Gend Med. 2010;7(1):19-27.

6.        Rico-Villademoros F, Calandre EP, Rodríguez-López CM, García-Carrillo J, Ballesteros J, Hidalgo-Tallón J, García-Leiva JM. Sexual functioning in women and men with fibromyalgia. J Sex Med. 2012;9(2):542-549.

7.        Yunus MB, Celiker R, Aldag JC. Fibromyalgia in men: comparison of psychological features with women. J Rheumatol. 2004;31(12):2464-2467.

8.        Yunus MB, Inanici F, Aldag JC, Mangold RF. Fibromyalgia in men: comparison of clinical features with women. J Rheumatol. 2000;27(2):485-490.

Yunus MB. The role of gender in fibromyalgia syndrome. Curr Rheumatol Rep. 2001;3(2):128-134.

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