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Gender Differences in Patients with Fibromyalgia at the Initial Visit

 

Department of Rehabilitation, Hatsukaichi Memorial Hospital, 5-12 Youkoudai, Hatsukaichi-city, Hiroshima 738-0060 Japan

Katsuhiro Toda


Abstracts

Objective: Gender differences in patients with fibromyalgia (FM) were investigated.

Subjects:  The number of tender points, number of control sites, the visual analog scale (VAS), global-VAS, face scale, short-form McGill pain questionnaire (SF-MPQ), self-rating depression scale (SDS), and Fibromyalgia Impact Questionnaire (FIQ) of both genders at the initial visit were compared.  The Mann-Whitney U-test was performed in all analyses.  P < 0.05 was considered significant.

Results: Ninety-one females and 21 males were studied.  There were no significant differences between female and male patients in the number of tender points (13.9 vs 14.2), number of control points (2.6 vs 3.4), VAS (70.9 vs 77.2), global-VAS (52.7 vs 62.2), face scale (12.9 vs 13.8), SF-MPQ; S-PRI (17.1 vs 20.8), A-PRI (5.6 vs 6.7), T-PRI (22.8 vs 27.5), and present pain intensity (3.3 vs 3.8), SDS (53.4 vs 55.0), and FIQ (69.2 vs 79.9); however, the symptoms of male patients tended to be more serious than those of female patients.

Conclusions: Some studies show no significant gender differences or mixed results.  Other studies show that males with FM reported more severe symptoms than females and vice versa.  No gender differences were found in this study, but symptoms of male patients tended to be more serious than those of female patients.

 

Key words; Fibromyalgia; Gender differences; Symptoms


Introduction

  Patients with fibromyalgia (FM) experience a variety of symptoms such as widespread pain, fatigue, and sleep disturbance [1].  Women account for approximately 80% of patients with FM.  Gender differences in patients with FM were investigated.

 

Methods

   This retrospective case-control study included patients with FM at Hiroshima Prefectual Rehabilitation Center from April 2004 to March 2007 or Hatsukaichi Memorial Hospital from April 2007 to February 2011.  All patients fulfilled the 1990 American College of Rheumatology (ACR) criteria for the classification of FM.  The number of tender points, number of control sites, visual analog scale (VAS), global-VAS, face scale, short-form McGill pain questionnaire (SF-MPQ), self-rating depression scale (SDS), and Fibromyalgia Impact Questionnaire (FIQ) of both genders at the initial visit were compared.

   Seven control sites, gleaned from the summary of control sites provided by the ACR [2] and from the control sites provided by the American Pain Society [3], were defined as control sites for this study.  They included: the bilateral thumbnails, the bilateral distal dorsal third of the forearms, the bilateral midpoint of the dorsal third metatarsals, and the mid-forehead. 

   The G-VAS uses a straight line with 0 at one end, meaning the best condition and 100 at the other, meaning the worst condition [4].

   The SF-MPQ is a shortened version of the McGill Pain Questionnaire developed by Melzack. Here, a Japanese version of SF-MPQ developed by Yokota et al. [5] was used. The sensory pain rating index (S-PRI) consists of sensory pain scores of 11 items.  Each item is ranked on an intensity scale in four stages from 0 to 3.  No pain is 0 and the worst pain score is 33.  The affective pain rating index (A-PRI) consists of affective pain scores of four items.  Each item is ranked on an intensity scale in four stages from 0 to 3.  No pain is 0 and the worst pain score is 12.  The total pain rating index (T-PRI) is the sum of S-PRI and A-PRI.  The present pain intensity is a self-administered survey to quantify the present pain status.  It is ranked on an intensity scale in six stages, the best status is 0 and the worst is 5 [4].

   The tentative Japanese version of FIQ [6] was until January 2008 and the Japanese version of the FIQ [7] from February 2008.  The Mann-Whitney U-test was performed in all analyses.  P < 0.05 was considered significant.  This study was approved by the ethics committee of Hatsukaichi Memorial Hospital.

 


Table

Table 1. Gender differences in patients with fibromyalgia at the initial visit

 

TePs = tender points, CSs = control sites, VAS = visual analog scale, SDS = self-rating depression scale, SF-MPQ = short-form McGill pain questionnaire, S-PRI = sensory pain rating index, A-PRI = affective pain rating index, T-PRI = total pain rating index, PPI = present pain intensity, FIQ = fibromyalgia impact questionnaire

Figure in parentheses shows the number of patients.

Table 1. Gender differences in patients with fibromyalgia

at the initial visit

 

 

 

 

Female

Male

P

N

91

21

 

Age at initial visit

48.5(12-83)

48.2(27-67)

Nunber of TePs

13.9 (91)

14.2 (21)

0.4856

Number of CSs

 2.6 (67)

 3.4 (10)

0.2652

VAS

70.9 (76)

77.2 (13)

0.4384

Global-VAS

52.7 (76)

62.2 (13)

0.1597

Face scale

12.9 (73)

13.8 (12)

0.6254

SF-MPQ

 

 

 

  S-PRI

17.1 (76)

20.8 (16)

0.0736

  A-PRI

 5.6 (76)

 6.7 (16)

0.0736

  T-PRI

22.8 (76)

27.5 (16)

0.0736

  PPI

 3.3 (75)

 3.8 (17)

0.0885

SDS

53.4 (78)

55.0 (16)

0.4413

FIQ

69.2 (68)

79.9 (11)

0.0933

 


Text 2

Results

 Ninety-one females (age 12-83 years, average 48.5 years) and 21 males (age 27-67 years, average 48.2 years) were studied.  There were no significant differences between female and male patients in the number of tender points, number of control points, VAS, global-VAS, face scale, SF-MPQ (S-PRI, A-PRI, T-PRI, and present pain intensity), SDS, and FIQ; however, symptoms of male patients tended to be more serious than those of female patients (Table 1).

 

Discussion

   Women account for approximately 80% of patients with FM.  There are a variety of studies about gender differences of patients with FM.  Some studies show no significant gender differences [8-10] or mixed results [11].  Whereas other studies show that males with FM reported more severe symptoms than females [12-13] and vice versa [14-15].

   Social factors such as education history, employment rate, and working status are different in both genders.  There are two opinions, one is that multivariate analysis excluding these factors should be performed to know the true gender differences, and the other opinion is that multivariate analysis is not necessary because a difference in social factors is one of the main factors of gender differences.  Among previous studies, one study alone [12] matched age and education level, and the other studies just compared female with male patients without adjustment.  No gender differences were found in this study, but symptoms of male patients tended to be more serious than those of female patients.

Two hospitals where the author has worked are inconveniently located in terms of public transportation and the consultation time is on weekday mornings; therefore, it is difficult for working patients to be examined.  It is believed that working patients have a tendency to be examined after the symptoms have become aggravated.  The employment rate of men is higher than that of women, which may result in the tendency for symptoms of male patients to be more serious than those of female patients.

Based on the results of this study and published articles, it is unclear whether the symptoms of one gender are more serious than those of the other gender.

 

Conclusions

 No gender differences were found in this study, but symptoms of male patients tended to be more serious than those of female patients.

 

Acknowledgement

  The author thanks Daniel Mrozek for reviewing this manuscript.

 

References

1         Toda K, Harada T. Prevalence, classification, and etiology of pain in Parkinson's disease: association between Parkinson's disease and fibromyalgia or chronic widespread pain. Tohoku J Exp Med 2010;222:1-5.

2         Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990;33:160-72.

3  Burckhardt CS, Goldenberg DL, Crofford LJ, et al. Guideline for the management of fibromyalgia syndrome pain in adults and children. Glenview: American Pain Society, 2005.

4         Toda K. Comparison of symptoms among fibromyalgia syndrome, chronic widespread pain, and an incomplete form of chronic widespread pain. J Musculoskelet Pain 2011;19:52-55.

5          Yokota N, Inoue H, Higashi W, Shimizu N. Evaluation of effects of selective serotonin reuptake inhibitor in the treatment of chronic pain with use of the short-form McGill Pain Questionnaire. Orthop Surg 2005;56:32-361 in Japanese.

6         Toda K. Tentative Japanese version of fibromyalgia impact questionnaire. Journal of the Hiroshima Medical Association 2006;59:49-52 in Japanese.

7          Osada K, Oka H, Isomura T, et al. Development of the Japanese version of the fibromyalgia impact questionnaire (JFIQ): translation and linguistic validation. Rinshou Riumachi 2008;20:19-28 abstract in English.

8          Yunus MB, Celiker R, Aldag JC. Fibromyalgia in men: comparison of psychological features with women. J Rheumatol 2004;31:2464-7.

9          Hauser W, Kuhn-Becker H, von Wilmoswky H, Settan M, Brahler E, Petzke F. Demographic and clinical features of patients with fibromyalgia syndrome of different settings: a gender comparison. Gend Med 2011;8:116-25.

10        Lange M, Karpinski N, Krohn-Grimberghe B, Petermann F. Patients with fibromyalgia: gender differences. Schmerz 2010;24:262-6 abstract in English.

11        Hooten WM, Townsend CO, Decker PA. Gender differences among patients with fibromyalgia undergoing multidisciplinary pain rehabilitation. Pain Med 2007;8:624-32.

12        Buskila D, Neumann L, Alhoashle A, Abu-Shakra M. Fibromyalgia syndrome in men. Semin Arthritis Rheum 2000;30:47-51.

13        Ruiz Perez I, Ubago Linares MC, Bermejo Perez MJ, Plazaola Castano J, Olry de Labry-Lima A, Hernandez Torres E. [Differences in sociodemographic, clinical, psychosocial and health care characteristics between men and women diagnosed with fibromyalgia]. Rev Clin Esp 2007;207:433-9.

14        White KP, Speechley M, Harth M, Ostbye T. The London Fibromyalgia Epidemiology Study: comparing the demographic and clinical characteristics in 100 random community cases of fibromyalgia versus controls. J Rheumatol 1999;26:1577-85.

15        Yunus MB, Inanici F, Aldag JC, Mangold RF. Fibromyalgia in men: comparison of clinical features with women. J Rheumatol 2000;27:485-90.

 

 


Author

Author

Katsuhiro Toda M.D.

 

Katsuhiro Toda: Efficacy of Lafutidine for Fibromyalgia Yokyo, Booklog Inc., 2013. http://p.booklog.jp/book/74824/read

 

Katsuhiro Toda: Efficacy of Epadel® (comprising not less than 98% eicosapentaenoic acid ethyl ester) for fibromyalgia Tokyo, Booklog Inc., 2013. http://p.booklog.jp/book/74825/read

 

Katsuhiro Toda: Efficacy of Neurotropin in chronic fatigue syndrome-The U.S. Mational Institutes of Health have performed double-blind, cross-over, placebo-controlled studies of Neurotropin in fibromyalgia patients (protocol number: 06-NR-0229)- Tokyo, Booklog Inc., 2013. http://p.booklog.jp/book/68901/read


copyright page

Gender Differences in Patients with Fibromyalgia at the Initial Visit

 

11/27/2013 First edition publication

 

http://p.booklog.jp/book/79765/read

Author:   Katushiro Toda

Issuer:    Kengo Yoshida

Publisher:Booklog,Inc. Cerulean Tower 26-1, Sakuragaoka-chou, Shibuya-ku, Tokyo 150-8512 Japan http://booklog.co.jp



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