NEW YORK (Reuters Health) - When treating women with fibromyalgia, doctors should be on the lookout for depression and warning signs of suicide, according to a new study.
“People with fibromyalgia don’t just have fibromyalgia,” Dr. Lesley Arnold, a professor of psychiatry at the University of Cincinnati who studies fibromyalgia but was not involved with the current research, told Reuters Health.
Danish researchers looking at death rates in women diagnosed with this chronic pain condition found that the risk of death from suicide was ten times higher than in the general population. They also found a higher-than-average risk of death for liver disease and strokes, but no difference in overall death rates.
Patients with fibromyalgia - about 2 percent of the U.S. population - suffer from widespread pain and have tender points that are painful to the touch. There is no cure for fibromyalgia, and pain medications often aren’t very helpful, so patients can have pain that is bad enough to disrupt their everyday lives for years.
People with fibromyalgia also have higher rates of psychiatric illness than the general population, and about 90 percent of those with the condition are women.
In the current study, researchers led by Dr. Lene Dreyer, a rheumatologist at Copenhagen University Hospital, compared hospital records and entries in the Danish Mortality Register for about 1350 patients, about 1270 of them women. All of those patients had been referred to Frederiksberg Hospital, also in Copenhagen, and diagnosed with fibromyalgia.
An average of four years after patients had been referred to the hospital, the authors found no difference in the overall death rate, or the death rates from specific conditions, for the small group of men in the study.
Women also died at a rate that would be expected among similar healthy women - a total of 41 over the course of the study.
But 8 of those deaths were from suicide, a significantly higher proportion than in the general population. Among all Danish women, 5 to 6 out of 100,000 commit suicide every year.
Arnold said that doctors have known for a long time that having fibromyalgia means that patients are at a higher risk for other medical conditions - many of them psychiatric. Still, she said, the research sends a strong message.
“We need to evaluate all of our patients with chronic pain in general for the presence of coexisting psychiatric disorders, especially mood and anxiety disorders,” she said. “And of course (we need) to ask about suicide.”
Dr. Bente Danneskiold-Samse, a rheumatologist at Frederiksberg Hospital and one of the study’s authors, said that other psychiatric illnesses that often occur in tandem with fibromyalgia might not be the only explanation for the high suicide rates.
None of the patients in the study who committed suicide had a history of psychiatric illness before they were diagnosed with fibromyalgia.
The high suicide rate could still be linked to depression in these patients, or to anti-depressants that are known to carry risks of suicide, she told Reuters Health. But “many of these patients do not take anti-depressant medications because of the side effects, and because they do not feel depressed,” she said. “My opinion is that it has something to do with their pain.”
Pain may be a major reason for suicide in itself, the authors write. Higher suicide rates have also been found for people who are tired all the time, and many people with fibromyalgia complain of sleep problems and fatigue.
Women in the study also died of liver disease and strokes at a higher rate than the general population. It’s unclear what caused the higher rates of liver disease, the authors write, but people with fibromyalgia are more likely to be overweight and may not get much exercise because of their muscle pain, putting them at a greater risk for heart problems.
The results show that doctors should be aware of risk factors for a range of conditions when examining their patients with fibromyalgia, the authors write.
Arnold agreed. “You really have to get that whole history in order to help guide you as to what (treatment) approach to take,” she said.
SOURCE: link.reuters.com/rej57m Arthritis and Rheumatism, online June 25, 2010.
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