Case history
Case history #1
A 38-year-old woman sees her physician with 4 years of widespread body pain. The pain began after a motor vehicle accident and was initially limited to her neck. Gradually, the pain has spread and she now complains of hurting all over, all the time. She does not have any joint swelling or systemic symptoms. She does not sleep well and has fatigue. She has irritable bowel syndrome but is otherwise healthy. Physical examination reveals a well-appearing woman with normal musculoskeletal examination, except for diffuse tenderness to palpation. Routine laboratory testing is normal.
Case history #2
A 45-year-old man is referred to the rheumatology clinic with a 3-year history of widespread pain, fatigue, and sleep disturbance. The pain started gradually in his neck before later involving both shoulders and upper arms, neck, lower back, and legs. He additionally reports daily headaches, severe fatigue, and unrefreshing sleep, to the point that he has had to quit his job as a custodian to the local school. He denies skin changes, weight loss, joint swelling or redness, personal or known family history of autoimmune or rheumatological disease. Physical examination revealed minimal muscle tenderness of palpation and no evidence of inflammation or joint damage. His blood tests are normal.
Other presentations
Chronic, widespread pain, which is ultimately diagnosed as fibromyalgia (FM), may present following a significant injury, trauma, illness, admission to hospital, or emotionally stressful period. However, an inciting event is not always seen.
Fibromyalgia in men
FM in men is often overlooked and misunderstood, as patients and physicians may dismiss it as a women's syndrome or confuse it with other health problems. Emerging evidence from cross-sectional studies indicates that there are notable differences in how the condition presents between the two sexes, such as: men often present with lower pain intensity; men may present with fewer tender point counts (resulting in the American College of Rheumatology revising their diagnostic criteria, relying on the widespread pain index and symptom severity score); lower levels of depression in men; or lower levels of pain catastrophising in men.[2][3][4][5][6]
Men may present with a longer history of pain and higher rates of disability.[2] These differences may be due to men presenting in later stages of disease, but there is evidence that the experience of pain and response to therapy is affected by differences in sex hormones, including oestrogen, progesterone, and testosterone.
As most clinical trials of FM have predominantly enrolled women, the efficacy and safety of non-pharmacological and pharmacological interventions for FM have not been adequately evaluated for men.[6] More research is needed to understand the sex-specific aspects of FM and to optimise its diagnosis and treatment in both men and women.
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