Regular monitoring of physical and mental health is necessary to minimize risks of accidents, infections, and especially suicide, based on pooled data analysis.

Fibromyalgia, a condition that causes persistent widespread pain and fatigue, may be associated with an increased risk of death due to vulnerability to accidents, infections, and especially suicide. This information comes from a pooled data analysis of available evidence, published in the open access journal RMD Open.

The researchers urge for regular monitoring of patients’ physical and mental health to minimize these risks.

It’s unclear what causes fibromyalgia, but researchers note its increasing prevalence. There is a growing recognition that the condition often coexists with other health problems, including rheumatic, gut, neurological, and mental health disorders.

Given the extent of pain experienced by these patients and the likelihood of other debilitating conditions, they are probably at heightened risk of premature death.

In order to support this hypothesis, the researchers examined the results of 8 pertinent studies that were published between 1999 and 2020, out of an initial group of 33. They combined the findings from 6 of these studies, which included a total of 188,751 adults, all of whom had other concurrent conditions.

The analysis revealed that fibromyalgia was linked to a 27% increased risk of death from all causes over time, although this did not apply to those diagnosed using the 1990 criteria.

But the diagnostic criteria for fibromyalgia have evolved since 1990 in tandem with an increasing understanding of the array of clinical symptoms associated with the condition. They were consequently revised in 2010, 2011, and 2016, as pointed out by the researchers.

Specifically, the analysis indicated that the risk of cancer-related death was 12% lower than that of the general population of the same age, and only marginally higher (5%) for accidents.

But the infection rate was 44% higher, including pneumonia and septicaemia, and more than 3 times as high for suicide.

The researchers note that it is not clear whether the increased risk is due to fibromyalgia itself or the accompanying conditions, as their research was not designed to evaluate this. They emphasize that this is an important issue that requires further research.

They caution that their findings should be interpreted in the light of differing study designs and the small number of participants included in their analysis.

“Due to significant differences among the studies, which were also limited in number, no definitive conclusions can be made from the available data,” they wrote. “However, it is possible that for the subgroup of patients diagnosed using the 1990 criteria, there is no increased risk of mortality, and for those diagnosed using later versions, the risk is higher,” they added.

“Plausible explanations exist for their findings,” they suggest. The increased mortality associated with accidents may be linked to fatigue, unrefreshing sleep, and concentration difficulties that accompany fibromyalgia. These are also a component of its diagnostic criteria since 2010.

More evidence supports immune system involvement and inflammation in fibromyalgia pathophysiology, explaining the increased mortality from infections. Physical comorbidity may be an additional factor.

And the reduced risk of a cancer death may be due to these patients’ extensive use of health services, they suggest.

The analysis has identified risks that could pose a significant public health concern, given the condition’s high prevalence, which clinicians do not always take seriously.

“Studies have shown that medical staff are often hesitant to acknowledge fibromyalgia as a legitimate medical condition. They also encounter emotional and psychological challenges when interacting with these patients and managing their disorder,” the researchers state.

“Fibromyalgia is often referred to as an ‘imaginary condition,’ sparking ongoing debates about the legitimacy and clinical usefulness of this diagnosis. However, our review offers additional evidence supporting the need to take fibromyalgia patients seriously. We particularly emphasize the importance of screening for suicidal ideation, preventing accidents, and addressing the prevention and treatment of infections,” the researchers conclude