I. Background

• Fibromyalgia is a disorder of unknown etiology characterized by widespread pain, abnormal pain processing, sleep disturbance, fatigue and often psychological distress. People with fibromyalgia may also have other symptoms; such as, (26)
• Morning stiffness
• Tingling or numbness in hands and feet
• Headaches, including migraines
• Irritable bowel syndrome
• Sleep disturbances
• Cognitive problems with thinking and memory (sometimes called "fibro fog")
• Problems with thinking and memory (sometimes called "fibro fog")
• Painful menstrual periods and other pain syndromes

II. Prevalence

• The prevalence of fibromyalgia is about 2%, affecting an estimated 5.0 million adults in 2005. Prevalence was much higher among women than men (3.4% versus 0.5%). (1)
• Most people with fibromyalgia are women (Female: Male ratio 7:1). However, men and children also can have the disorder.
• Most people are diagnosed during middle age and prevalence increases with age.
• Working age women with fibromyalgia hospitalized for occupational musculoskeletal disorders were almost 10 times less likely to return to work and 4 times less like to retain work at 1-year post hospitalization. (2)
• Working adults with fibromyalgia average almost 17 days of missed work per year compared to 6 days for persons without fibromyalgia. (3) Fibromyalgia has been associated with lower levels of health-related quality-of-life and more work productively loss. (27)

III. Incidence

• No incidence data found.

IV. Mortality

• ~23 deaths per year from 1979–1998. [Unpublished CDC data]
• Crude numbers of deaths coded as underlying cause-of-death as 729.1 rose from 8 in 1979 to a high of 45 in 1997.
• In 1998,”Myositis and Myalgia, Unspecified” accounted for only 0.45% (42/9367) of all deaths attributed to arthritis and other rheumatic conditions.
• Mortality among adults with fibromyalgia is similar to the general population, although death rates from suicide and injuries are higher among fibromyalgia patients. (4)

V. Hospitalizations

• In 1997, ~7,440 hospitalizations listed ICD9-CM code 729.1 as the principal diagnosis. (5)
• People with fibromyalgia have approximately 1 hospitalization every 3 years. (6)
• Women have higher hospitalization rates than men at all ages. Persons hospitalized with primary cardiovascular conditions more had a high prevalence of reporting fibromyalgia as a secondary condition. (25)

VI. Ambulatory Care

• 5.5 million ambulatory care visits on average per year. (7)
• Medical and psychiatric co-morbidity are stronger determinants of high physician use than functional co-morbidity among patients with fibromyalgia. (8)

VII. Costs

• Average yearly direct medical costs/person range from $3400 to $3600. (9)
• Total annual costs (direct and indirect)/person = $5,945. (6)
• Office and emergency room visits, procedures and tests, and hospitalizations are the largest components of direct medical costs among patients with fibromyalgia. (9)

VIII. Impact on health-related quality of life (HRQOL)

• Fibromyalgia patients scored lowest on 7 of 8 subscales (except role-emotional) of the SF-36 compared to patients with other chronic diseases. (10,11)
• Fibromyalgia patients scoring their perceived "present quality of life" averaged a score of 4.8 (1 = low to 10 = highest). (12)
• Standard, generic HRQOL instruments may not be sensitive enough to capture quality-of-life issues for many people with fibromyalgia.
• Adults with fibromyalgia are 3.4 times more likely to have major depression than peers without fibromyalgia. (13)

IX. Unique characteristics

• Causes and/or risk factors for fibromyalgia are unknown, but some things have been loosely associated with disease onset:
• Stressful or traumatic events, such as car accidents, post traumatic stress disorder (PTSD) (14)
• Repetitive injuries (14)
• Illness (e.g. viral infections) (14)
• Certain diseases (i.e., SLE, RA, chronic fatigue syndrome) (14)
• Genetic predisposition (14, 15)
• Obesity (16)
• People with fibromyalgia react strongly (abnormal pain perception processing) to things that other people would not find painful.
• Multidisciplinary treatment is recommended, including screening and treatment for depression. (17) Scientific evidence for effective therapies include:
• Pharmacotherapy (17, 18)
• Aerobic exercise and muscle strengthening exercise (19-23)
• Aerobic exercise may be most beneficial but more studies are needed examining resistance exercise
• Aerobic exercise has been shown to improve global well-being and reduce tender point counts in fibromyalgia (19,20,23)
• Education and relaxation therapy in a primary care setting has also shown improvements in physical impairment, days not feeling well, general and morning fatigue, stiffness, anxiety and depression. (24)
• Cognitive behavioral therapy (28)