Mention fibromyalgia and most people automatically associate the condition with women. Even in the medical community, some are slow to link symptoms to a fibromyalgia diagnosis if the patient is male.
The truth is, not only do men suffer from this condition, they should also be aware of some special challenges that impact their gender.
According to the CDC (Center for Disease Control), 4 million US adults are affected by fibromyalgia, and about 1.3 million of those are men.
What is Fibromyalgia?
Fibromyalgia is a chronic neurologic health condition that causes widespread musculoskeletal pain, fatigue, and tenderness at specific points on the body. It is not an autoimmune or inflammatory disease, but it does share symptoms with some of those diseases.
The pain usually comes and goes and moves to different parts of the body. Fibromyalgia patients often complain of sleep issues and feeling tired throughout the day.
Symptoms of fibromyalgia are found in many other diseases and disorders, so it is difficult to diagnose. Researchers have suggested as many as three out of four sufferers goes undiagnosed.
What Causes Fibromyalgia in Men?
The cause of fibromyalgia is unknown. Some doctors believe the condition runs in families, but there is no significant data to suggest any specific cause.
According to rheumatologist Chad S. Boomershine, though the cause is unknown, recent research suggests the brain processes pain differently in people with fibromyalgia.
They have lower levels of the chemicals that inhibit pain signals (serotonin and norepinephrine) and higher levels of the chemicals that cause pain signals (substance P and glutamate).
The chemical imbalances in the brain are thought to be the reason people with fibromyalgia find changes in temperature, pressure, and light on their skin painful.
The impaired stress response is also being studied as a possible cause. The stress hormone cortisol seems to be processed differently in people with fibromyalgia.
What are the Risk Factors for Fibromyalgia in Men?
In addition to the differences in brain chemical and stress hormone processes, there are a few other risk factors that might make fibromyalgia more likely in certain people.
Age is another factor. Fibromyalgia symptoms could start at any time, but you are more likely to first experience them in middle age.
Having one or more of these commonly co-occurring conditions will also increase your risk: mood disorders (depression), rheumatoid arthritis, osteoarthritis, lupus, irritable bowel syndrome, temporomandibular joint disorder.
A genetic predisposition can put you at greater risk. If members of your family have fibromyalgia, you are more likely to have it.
Trauma, either emotional or physical, can increase your risk of developing fibromyalgia. This risk factor is increased if you already have a genetic predisposition.
Having a strenuous manual labor job will put you at risk if you are consistently performing difficult physical motions. Working in the heat, squatting for long periods of time, and pulling heavyweights are all triggers.
Research is providing more clarification all the time, but there is still much unknown about the risks and causes of fibromyalgia.
How is Fibromyalgia Diagnosed?
The primary means of detection is an analysis of symptoms and a physical exam. Many other conditions share similar symptoms with fibromyalgia, so it can be a bit tricky to diagnose.
There are no diagnostic tests for fibromyalgia, but doctors might order tests such as lab work and x-rays to rule out other possibilities. Only by eliminating other testable conditions can physicians declare a diagnosis of fibromyalgia.
Since widespread pain is the biggest indicator of fibromyalgia, patients are typically asked to describe the type and location of pain.
If you find it difficult to properly explain the different types of pain you might be feeling, you might want to check out this video: 8 Types of Fibromyalgia Pain
There are 19 tender points associated with the condition. Doctors apply pressure to each point, as well as other areas of the body to determine how many areas of pain coincide with the specific spots that are linked to fibromyalgia.
Determining the type and location of pain is critical to the elimination process. If tenderness is found at 11 or more locations in combination with several of the other major symptoms, that is considered a good indicator that fibromyalgia is the culprit.
Ticking enough symptom boxes and tender points is still not a definitive conclusion. It is also important to note whether pain was found at locations other than the 19 tender points.
This may indicate another condition or disease is responsible, and diagnostic tests will be run to rule out the other possibility.
According to the Mayo Clinic, fibromyalgia in men is greatly undiagnosed. Whether that is because men are less likely to report symptoms or medical professionals are less likely to associate a male patient with the disorder is undetermined.
It has been suggested that improvements in the fibromyalgia diagnostic process, as well as an increased awareness of its impact on men, could greatly reduce health care costs.
What are Fibromyalgia Tender Points?
In addition to the deep, widespread muscle pain associated with fibromyalgia, patients also experience more shallow, localized pain around joints and other specific areas of the body. Patients experience pain just under the skin when pressure is applied to these points.
The 19 tender points are found near the neck, chest, back, elbows, hips, buttocks, and knees. They are very small and extremely sensitive.
Because these tender points are often found in the same spot on all who suffer from the condition, identifying the exact areas of pain can be used to aid diagnosis.
What are the Symptoms of Fibromyalgia in Men?
General symptoms of fibromyalgia include:
- Tenderness to touch or pressure affecting muscles and sometimes joints or even the skin
- Severe fatigue
- Sleep problems
- Problems with memory or thinking clearly
- Depression and anxiety
- A migraine or tension headaches
- Digestive problems: irritable bowel syndrome (commonly called IBS) or gastroesophageal reflux disease (often referred to as GERD)
- Irritable or overactive bladder
- Pelvic pain
- TMJ (temporomandibular disorder)
Men have some additional symptoms and considerations.
In one study men reported lower pain intensity, lower tender point count, lower depression rates, longer duration of symptoms, and higher overall disability from symptoms. Continuing pain in men was linked to hyperalgesia (increased pain) in the neck.
Numerous men with fibromyalgia experience pain in and around their testicles. This can be an uncomfortable topic to broach with your doctor, but it is a necessary one.
Testicle pain is linked to many diseases and disorders, some of which are quite serious and better able to treat with early diagnosis. Testicle pain is an important symptom to consider when making a fibromyalgia diagnosis.
Men with fibromyalgia may also find they have lower than average testosterone levels and low libido. If your testosterone levels are low, your doctor may prescribe some.
Correcting testosterone levels can reduce pain, increase energy, increase libido, improve mood, decrease depression, and improve muscle strength.
Diseases with Similar Symptoms
Because fibromyalgia shares symptoms with so many other conditions, it is often misdiagnosed. Physicians must be very thorough, and patients must be very descriptive when detailing their symptoms.
These are the most common conditions mistaken for fibromyalgia:
Arthritis
According to Michael H. Lowenstein, Ph.D., although arthritis and fibromyalgia both cause widespread pain and fatigue, they do have differences. Fibromyalgia causes pain, but it does not cause inflammation or damage muscles and joints like arthritis.
This misdiagnosis usually takes place in the early stages of arthritis, before it has had a chance to do any damage. The patient will only feel the initial pain and stiffness and experience the fatigue associated with both maladies. Arthritis can’t be ruled out until it has had time to progress and an x-ray can document the damage.
Multiple Sclerosis
Multiple sclerosis is a neurological disorder that destroys the coating, called myelin, that protects our nerves. Once the protective coating is gone, multiple sclerosis moves deeper and attacks the nerves themselves. This results in the widespread pain also felt with fibromyalgia.
Key differences are that multiple sclerosis also causes difficulty walking, slurred speech, and blurry vision. It too is difficult to diagnose and ultimately comes down to rule out all the other options.
Lupus
Like fibromyalgia, lupus causes fatigue, pain, and difficulty sleeping. It’s an autoimmune disease that can wreak havoc on just about any area of the body, from the skin to the organs.
Differences in symptoms include a facial rash that is exacerbated by the sun, trouble breathing, kidney failure, stroke, and heart attack.
To test for lupus, doctors take a blood sample and check it for antinuclear antibodies. Their presence indicates a positive diagnosis of lupus. Doctors will confirm by ordering several other specialized lab tests.
Chronic Fatigue Syndrome
Like fibromyalgia, there is no lab test for chronic fatigue syndrome. Virtually all the general symptoms are the same as fibromyalgia.
Rules for establishing chronic fatigue as a diagnosis require patients to have suffered from chronic fatigue and key symptoms for at least six months.
Depression
Since depression is a key symptom of fibromyalgia, sufferers may be diagnosed without realizing it is an extension of fibromyalgia. If you are being treated for depression, but continue to suffer other symptoms like pain and fatigue, you should discuss it with your doctor.
Hypothyroidism
Hypothyroidism is caused by an abnormally low amount of activity in the thyroid gland. That means it’s not producing the appropriate level of hormones. This impacts metabolism and causes unexplained weight gain, low energy, sensitivity to cold, slow heart rate, and depression.
Doctors can check hormone levels with a blood test to rule out this condition.
Polymyalgia Rheumatica
Polymyalgia Rheumatica produces almost every fibromyalgia symptom as well. There is no lab test or physical symptom that could show up on any medical imaging equipment. The one distinguishing factor is that polymyalgia rheumatica is more common in the older population.
The average age of onset of fibromyalgia is somewhere in the 50s, but polymyalgia rheumatica usually shows up in people who are in their 70s and 80s.
How Are Fibromyalgia Symptoms Treated?
There are many approaches to combating the fatigue, sleep issues, anxiety, depression, and pain caused by the condition. Usually, it’s most effective to employ a combination of treatments.
This can include over-the-counter or prescription medications, alternative therapies, and lifestyle changes. The best combination will differ from patient to patient, so there is a degree of trial and error when choosing an approach.
These are some of the common treatments:
Medications
Many people find relief from fibromyalgia pain by taking over-the-counter pain medications. These include acetaminophen (Tylenol), NSAIDs (nonsteroidal anti-inflammatory drugs) such as aspirin (Bayer) or ibuprofen (Motrin, Advil) or naproxen (Aleve).
Milnacipran (Savella), pregabalin (Lyrica), and Pregabalin (Cymbalta) are prescription nerve pain medications used to treat fibromyalgia. They relieve the chronic nerve and muscle pain as well as reduce anxiety and depression.
Prescription muscle relaxers may help as well. Cyclobenzaprine (Flexeril) and Orphenadrine Citrate (Norflex) have been found to improve quality of sleep, reduce pain, and lessen stiffness in muscles and joints.
Tricyclic antidepressants like Amitriptyline (Elavil), Nortriptyline (Pamelor), and Doxepin (Sinequan) have improved mental and physical symptoms. Patients have reported improvement in the quality of sleep, pain, and morning stiffness. Anti-depressants also help to reduce anxiety and lessen emotional fatigue.
Physical Therapy
Physical therapists can teach patients how to relieve some of the stiffness and pain experienced with the disorder. By building strength and improving range of motion, people with fibromyalgia can better control movement and avoid pain.
Therapists can also teach proper posture for efficient muscle function, stretching to improve muscle flexibility, and relaxation to reduce muscle tension. Basically, patients learn to move correctly and improve the condition of the muscles that enable them to do so.
Exercise
Some men afflicted with fibromyalgia become unfit because they are fearful that more movement will cause more pain, but exercise is one of the best ways to relieve pain and combat depression.
Exercise keeps muscles strong, keeps the body flexible, produces mood-enhancing endorphins, and reduces excess weight that puts stress on sore muscles and painful joints. In short, it makes physical activity easier which, in turn, reduces pain.
Regular aerobic exercise is also known to improve sleep, which aids in reducing the fatigue that plagues most fibromyalgia sufferers.
Some great exercise options to try are walking, stretching, swimming, yoga, and Pilates. Anything low-impact will help to get you fit without putting too much strain on your joints or the tender points affected by fibromyalgia.
Hydrotherapy & Massage
Warm hydrotherapy baths will relax joints and muscles and improve circulation. This decreases pain in muscles as well as at the tender trigger points. Combining hydrotherapy with massage is even more effective.
Applying pressure to the muscles with massage increases blood flow, further relaxes the muscles, and increases pain relief. Massage is also beneficial to those who suffer from the mental and emotional fatigue associated with fibromyalgia.
Stress Reduction
According to Dr. Edward J. Kowlowitz, emotional stress affects the perception of pain. This might be why people suffering from fibromyalgia are more susceptible to stress than those who don’t. Stress makes the body weaker, which makes you more vulnerable to pain, fatigue, and depression.
Stress management begins with reprioritizing. Fibromyalgia patients need to make their health and well being a priority. They need to engage in activities that allow them to relax and take time away from worrying about daily stressors.
Relaxation therapy is one technique. It involves mentally focusing in a way that calms the body as well as the mind. Some people find that spending a few minutes doing a relaxation therapy activity every day can help to keep their stress levels in check.
This is one area that men with fibromyalgia should pay close attention to. According to the APA (American Psychological Society), men put less emphasis on the need to manage stress than women do, but men are more likely to be diagnosed with chronic physical illnesses linked to high levels of stress.
Acupuncture
Acupuncture is an ancient Chinese healing therapy that involves inserting thin needles at strategic places on the body. The idea is to improve the flow of energy that has become blocked and caused an issue. Some fibromyalgia sufferers have reported a reduction in general pain after acupuncture treatment.
How Do the Psychological Symptoms of Fibromyalgia Impact Men?
The psychological aspects of fibromyalgia can be especially jarring for men. Though men report fewer issues with depression, they can be more affected mentally by the loss of physical strength and inability to perform to their normal standards.
Many societies still equate physical strength with “manliness” so it’s easy to see how a man with fibromyalgia might find it harder to mentally deal with any loss of physical power.
This also factors into the high numbers of undiagnosed men with fibromyalgia. They simply don’t want to acknowledge they are physically deteriorating. They certainly aren’t anxious to embrace the idea of being diagnosed with what has been considered a “woman’s” disorder.
Awareness and open communication will go a long way to alleviate some of these misconceptions. More men speaking out and sharing experiences could researchers and doctors find better treatments and better methods of diagnosis.
How to Cope with Fibromyalgia as a Man
One of the most challenging things about dealing with fibromyalgia as a man is the lack of support available. Since it is still sometimes thought of as a condition only affecting women, many men may feel isolated and without anyone to talk to.
Men might find community support groups are primarily attended by women, and though the symptoms might be the same, their impact seems to affect the genders differently.
Finding a good source of support for a man diagnosed with fibromyalgia could start with an internet search. Even if there aren’t any local community groups to attend for men, there are usually plenty of options online. This might be an ideal choice for the more introverted types who prefer written, anonymous communication.
If online communication doesn’t appeal, don’t hesitate to ask your doctor for support sources. The chronic pain and fatigue caused by fibromyalgia can be debilitating.
You often feel just as weak of mind as weak of body, and speaking with others who feel the same can help you to feel more in control and less helpless.
Many cultures still perpetuate the notion that it is a sign of weakness for a man to expose vulnerabilities and ask for help. It’s important to reach out anyway.
Fibromyalgia is chronic, lifelong condition that can be treated but not cured. Men often place a high value on strength and unfortunately, that’s one of the things that fibromyalgia attacks.
Seeking help from medical professionals or community groups can help to regain some of that strength both mentally and physically.
