The Challenges Of Fibromyalgia In Men: Symptoms, Diagnosis, And Treatment

The widespread pain condition known as fibromyalgia can be debilitating long before it’s diagnosed. Since women experience fibromyalgia compared to men at a rate of nearly nine to one, men have the additional challenge of getting their doctors to even consider that a cluster of symptoms could be fibromyalgia. Fibromyalgia in men does occur, perhaps at higher rates than previously understood. Here’s what you need to know about fibromyalgia in men.

Do men get fibromyalgia?

The challenges of fibromyalgia in men starts at the very beginning with historically low rates of incidence. Research indicates that roughly ten million people in the U.S. have fibromyalgia, with as many as one and a half million of those being men living with fibromyalgia (both diagnosed and undiagnosed).

Because the typical cluster of fibromyalgia symptoms can indicate other medical conditions, most doctors won’t reach first for a fibromyalgia diagnosis in men. Indeed, it may not even be a discussion for most doctors. This presents significant difficulties when it comes to treatment – both physically and mentally. If your doctor won’t even consider it, how could fibromyalgia be a possibility?

The truth is, men do get fibromyalgia, and they deserve supportive treatment options.

Risk factors

The main risk factor for fibromyalgia is gender, but there are other factors that can increase your risk. Rheumatic disease, including lupus, increases your chances of fibromyalgia, as does having a first-degree relative, male or female, with fibromyalgia.

People with mood disorders such as depression and anxiety are also at an increased risk of fibromyalgia.

In general, patients with chronic and systemic inflammation accompanied by a genetic link and a history of mood disorders are most at risk of developing fibromyalgia.

16 fibromyalgia in men symptoms

The number one fibromyalgia in men symptom is stigma. Men who experience other symptoms of fibromyalgia may be described as weak, lazy, or whiney. They may be accused of not taking care of their family or shirking their responsibilities. All of these assessments are patently unfair and may prevent men from seeking treatment. A stiff upper lip and stoic demeanor may sound good on paper, but many men suffer needlessly because of the expectation to be tough and strong.

Fibromyalgia is no joke, with symptoms that can make just getting out of bed nearly impossible. Here are 15 symptoms and co-occurring disorders men with fibromyalgia might experience.

  1. Cognitive difficulties with concentration and memory (also known as “fibro fog”)
  2. Tenderness across the body
  3. Migraines or headaches
  4. Pins and needle sensations
  5. Irritable bowel syndrome
  6. Nausea
  7. Lower gastrointestinal issues, including constipation, diarrhea, and excessive gas
  8. Sleep disorders, including insomnia or extreme fatigue
  9. Anxiety, depression, or other mental health challenges
  10. Increased sensitivity to hot and cold
  11. Difficulty with balance
  12. Stiffness in joints
  13. Emotional sensitivity
  14. Muscle spasms
  15. Anger and irritability (often masking depression or other mood disorders)

What does fibromyalgia feel like?

All of these symptoms may not be present, but a diagnosis of fibromyalgia relies on the presence of a cluster of them over time.

Men also report hyperalgesia (amplified pain) specifically in the neck more frequently than women. For men who have delayed seeking treatment for years, this may be the one symptom that reliably sends them to their doctor.

Symptoms may appear and be very intense, only to disappear completely for weeks or months at a time. Some men with fibromyalgia find their symptoms intensify with lack of sleep or changes to the weather. Others experience a fairly constant set of symptoms.

Sensitivity to bright lights and loud sounds may also be present, sometimes increased by allodynia. Allodynia is pain sensation triggered by even the slightest touch, including a breeze, a hug, or a handshake.

Extended periods of stress, poor sleep, poor diet, and limited physical activity may also trigger symptoms.

Diagnosing fibromyalgia in men

When men are the primary provider for their families, this can add to the challenge of getting a fibromyalgia diagnosis. Fibromyalgia costs more annually than diabetes and high blood pressure in terms of direct medical costs and missed work and lost wages. The first step in a diagnosis is finding a doctor who is willing to explore fibromyalgia as a possible condition.

Research and anecdotal evidence offer conflicting opinions on how men experience symptoms, further complicating diagnosis. Some researchers believe that men experience milder symptoms (and fewer of them), while others report that men experience more severe symptoms that include less ability to function and a lower quality of life.

Clearly, your doctor matters when it comes to obtaining a diagnosis. They will take a complete medical and family history to eliminate the possibility of other conditions.

Conditions with some symptomatic similarities include:

  • Multiple chemical sensitivity
  • Tension-type headaches
  • Interstitial cystitis
  • Chronic fatigue syndrome
  • Irritable bowel syndrome
  • Restless legs syndrome
  • Post-traumatic stress disorder (PTSD)
  • Migraines
  • Temporomandibular joint dysfunction (TMD)
  • Lyme disease
  • Multiple sclerosis or myasthenia gravis

A formal diagnosis

Tracking fibromyalgia symptoms is an important part of getting a diagnosis. Keeping a pain journal (or tracking with a pain app on your phone) can help you identify patterns in symptoms that can be useful in the beginning stages of your fibromyalgia treatment.

Along with reviewing your symptoms, your doctor will complete a thorough physical exam looking for tender points in the body. Fibromyalgia pain is generally felt symmetrically but may not be present in all areas across the body. While this is no longer the clear indicator of fibromyalgia it once was, tender points can provide important information during a diagnosis.

Your doctor will also use the 2010 American College of Rheumatology diagnosis guidelines to assist them in getting a clear picture of your symptoms. These new guidelines look to the following markers for a formal fibromyalgia diagnosis.

  1. Widespread pain index (WPI) greater than or equal to seven and symptom severity (SS) scale score greater than or equal to five or WPI equaling three to six and SS scale score greater than or equal to nine
  2. Symptoms have to persist for at least 90 days, or three months
  3. There is no alternate disorder that can explain the pain
  4. The WPI notes the number of areas in which the patient has felt pain over the past week, with a score that will be between zero and 19

As a part of your physical, your doctor will also run lab tests, largely to uncover what your condition is not (fibromyalgia cannot be diagnosed with a blood test). Some tests your doctor may order include:

  • Complete blood count
  • Urinalysis
  • Erythrocyte sedimentation rate
  • Thyroid function tests
  • Vitamin D levels

Taken together, all of this gathered information can help present a clearer picture of all symptoms you’re experiencing, potentially leading to a fibromyalgia diagnosis.

men with fibromyalgia

How to treat fibromyalgia in men: 11 treatments

Healthcare professionals treat fibromyalgia in men in two ways: symptomatically and holistically. Typically, the goal is to ease current symptoms while working towards long-term remission of them. While there is no known cure for fibromyalgia, it is possible to lengthen periods of remission, ease painful attacks, and improve a person’s overall quality of life.

Lifestyle changes

Making certain lifestyle changes are the best way to prevent flare-ups. Getting plenty of good-quality rest is crucial. Many men resist this due to the above-mentioned stigma about being lazy, but combat that notion with a healthy dose of exercise three or four hours before bed.

Regular exercise promotes good sleep, and it directly combats the perception of laziness. Exercise also promotes excellent mental health, reducing the risk and severity of depression, anxiety, and symptoms of PTSD.

Eating a healthy diet is also key to managing any chronic pain condition. Adding plenty of fresh fruit and vegetables and lean, healthy protein can help keep your body healthy. Eating an anti-inflammatory diet that includes things like turmeric, tart cherries, and ginger may also help when pain flares up.

There is also increasing evidence that gut health is an important factor in the management of many chronic conditions. Including probiotic foods like kefir, sauerkraut, and kombucha in your diet can also ease any digestive symptoms and strengthen what is known as the brain-gut axis.

Alternative treatments

The following five treatments can also ease pain and the stress that it causes.

  1. Float tanks: Weightless treatment in float tanks can ease pain and stress in just one session.
  2. Acupuncture: Research on acupuncture has suggested that it can ease painful symptoms and restore mobility and ease of movement.
  3. Gentle massage: Light massage on a regular basis can help maintain good circulation, ease pain, and relieve stress.
  4. Biofeedback: Patients learn how to recognize, monitor, and control their body’s physical response to pain. This can help to literally change the way the body responds over time.
  5. Mindfulness meditation: Mindfulness meditation does not ease pain so much as it eases a person’s response to it.

Interventional fibromyalgia treatments

In addition to the above holistic treatments, there are medications that can help address painful flare-ups. There are currently only three approved fibromyalgia medications:

  1. Lyrica
  2. Cymbalta
  3. Savella

Off-label medications sometimes prescribed for fibromyalgia include:

  • Certain antidepressants, such as milnacipran or amitriptyline
  • Muscle relaxants, like cyclobenzaprine
  • Anti-seizure medications, such as gabapentin or pregabalin
  • Anti-steroidal inflammatory medications (NSAIDs) for acute pain episodes

While some might reach for opioid medications as a first-line treatment for fibromyalgia, there is no evidence that opioids are effective for long-term management of chronic pain. For acute pain and cancer, opioids may provide relief, but for chronic conditions the risk of addiction and complicating side effects outweigh any possible minor relief.

Epidural steroid injections for tender points or TENS unit therapy may also provide pain relief during flare-ups.

Get help

In addition to treatment, men who are recently diagnosed with fibromyalgia may find tremendous relief by participating in a fibromyalgia support group.

These groups are filled with men who are going through the same challenge and they can help you deal with the pressures placed on men diagnosed with a chronic illness. Fibromyalgia support groups (or individualized therapy) can also help you navigate any mood disorders that may be present in addition to fibromyalgia.

We know how challenging it can be for men with fibromyalgia to ask for help. If you are in Arizona, give the compassionate doctors at Arizona Pain a call. We can help you get your life back.