Fibromyalgia Studied Within the Context of a Large National Health Survey

A recent analysis of data from the 2012 National Health Interview Survey (NHIS) yields a new picture of fibromyalgia and the people it affects. Fibromyalgia is a disorder that causes widespread pain, fatigue, and other symptoms; its causes are unknown. The study, published in a recent issue of PLoS One was led by two researchers at the National Center for Complementary and Integrative Health, and included colleagues from Drexel University College of Medicine, Rush University Medical Center, and the National Data Bank for Rheumatic Diseases in Wichita.

People who participated in the study were drawn from the general population instead of clinical settings (in which health-seeking behaviors and selection issues can influence study results).The researchers adapted a set of criteria from the American College of Rheumatology’s polysymptomatic distress scale that can be used to predict individuals who likely, but not definitively, have fibromyalgia. A total of 8,446 respondents were included in the analysis. About 1.75 percent of respondents met the study’s criteria for fibromyalgia (a figure that, when weighted, represents about 3.94 million U.S. adults). These respondents had certain characteristics:

• They had high levels of pain, non-pain symptoms, and psychological distress.
• Their fibromyalgia-like symptoms were severe and continuous.
• About one-quarter (27 percent) were diagnosed with fibromyalgia by a physician.
• The remaining three-quarters (73 percent) who were not diagnosed with fibromyalgia were told they had rheumatoid arthritis, gout, lupus, or low-back pain.
• They were more likely to have co-occurring major medical conditions, such as heart attack, hypertension, diabetes, depression or other mental illnesses, rheumatoid arthritis, or lupus.
• They had relatively high levels of medical costs, Social Security disability, and work disability.
• Certain demographic factors and health behaviors were more highly associated with the presence of fibromyalgia than its absence, including: being female; a resident of the Midwest; educational level lower than college; being divorced or separated; obesity; smoking; and/or a U.S. citizen rather than noncitizen. Fibromyalgia occurred about equally across all racial and ethnic groups, but was less common in Asians.

The authors noted that clinicians differ in how they view and diagnose symptoms that could be attributed to fibromyalgia or another condition, which impacts treatment and insurance coverage; cultural and social views can differ as well. They encouraged viewing fibromyalgia not as a discrete diagnosis but rather as symptoms on a continuum that are influenced by physical and psychological stressors, and offering descriptive symptom categories such as mild, moderate, and severe. Clinicians should acknowledge patients’ symptom-related distress, they add, yet avoid overly attributing them to specific medical conditions (which could lead to unnecessary medical testing and over-treatment).