By : Mark Borigini M.D
It has been accepted by many in the medical community for many years that fibromyalgia is a chronic pain syndrome—not even a disease. And certainly not killing anyone. However, there have been sporadic reports in the literature of increased mortality due to cardiovascular disease and suicide. A study published last year in “Arthritis and Rheumatism” found disturbing trends in a cohort of fibromyalgia patients that may change the health care community’s approach to fibromyalgia.
The main findings of this study of 1,269 Dansih female patients were the increased risks of death due to suicide, liver disease, and cerebrovascular disease. Disturbingly, the suicide risk among fibromyalgia patients was ten times that of the general population. However, none of the fibromyalgia patients who did commit suicide had a medical history of depression or other psychiatric illness at the time of diagnosis. This is of interest in that previous studies have found increased rates of depression, anxiety, pain, fatigue and other psychiatric disorders.
There is a trend toward underreporting when it comes to suicide, no matter the country. The incidence of suicide is impacted by social integration and imitation. In Denmark, there is a relative lack of the stigma often surrounding suicide; and this coupled with the fact that autopsies are required when a suicide is suspected, would seem to assure fairly accurate estimates of the suicide rate.
This higher suicide risk may have some relation to the higher rate of accidental death in patients with fibromyalgia: It very well may be the case that a seemingly “accidental” death is in reality a suicide (for example, a fall, or a single vehicle accident). A diagnosis of chronic pain is associated with increased mortality due to a variety of external causes.
An increased death rate due to liver disease in fibromyalgia may be related to alcohol consumption. According to the World Health Organization, Denmark has a high rate of alcohol consumption. In addition, fibromyalgia-like pain is often reported by patients with hepatitis C.
The increased rate of cerebrovascular disease in patients with fibromyalgia may be due to the fact that many fibromyalgia patients are overweight, if not obese. In fact, 19% of fibromyalgia patients were found to be obese, and 54% were current smokers-more than half of these heavy smokers. Healthy subjects demonstrated a better cardiovascular response to physical and emotional stress. Of course, physical inactivity due to pain may contribute to atherosclerosis.
Physicians need to seek risk factors for suicide, liver disease and cerebrovascular disease whenever a fibromyalgia patient presents for an evaluation. It is a little more work, but more than chronic pain will likely need to be addressed by patient and provider.