It has been accepted by many in the medical community for many years that fibromyalgia is a chronic pain syndrome – not even an illness. And certainly not kill 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 troubling trends in a cohort of fibromyalgia patients that may shift the focus of the health care community to fibromyalgia.
The main findings of this study of 1,299 Dansih patients were the highest risk of death from suicide, liver disease and cerebrovascular disease. Disturbingly, the risk of suicide among fibromyalgia patients was ten times greater than that of the general population.
However, none of the fibromyalgia patients who committed 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 higher rates of depression, anxiety, pain, fatigue and other psychiatric disorders.
There is a tendency towards underreporting when it comes to suicide, no matter the country. The incidence of suicide is affected by social integration and imitation. In Denmark, there is a relative lack of the stigma that often surrounds suicide; And this coupled with the fact that autopsies are required when a suicide is suspected, would seem to ensure fairly accurate estimates of the suicide rate.
This increased risk of suicide may have some relation to the higher rate of accidental death in patients with fibromyalgia: very well may be the case that a seemingly “accidental” death is actually a suicide (eg 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 increase in the mortality 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, pain similar to fibromyalgia is often reported by patients with hepatitis C.
The increase in the rate of cerebrovascular disease in patients with fibromyalgia may be due to the fact that many patients with fibromyalgia are overweight if they are not obese. In fact, 19% of fibromyalgia patients were obese, and 54% were current smokers, more than half of these smokers. Healthy subjects demonstrated a better cardiovascular response to physical and emotional stress. Of course, physical inactivity due to pain can contribute to atherosclerosis.
Physicians should look for risk factors for suicide, liver disease and cerebrovascular disease every time a fibromyalgia patient presents for an evaluation. It is a bit more work, but more that chronic pain is likely to have to be addressed by the patient and the provider.