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 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 worrisome trends in a cohort of patients with fibromyalgia that can change the focus of the health care community to fibromyalgia.
The main findings of this study of 1,269 Dansih patients were the highest risk of death from suicide, liver disease and cerebrovascular disease. Disturbingly, the risk of suicide among patients with fibromyalgia was ten times higher than that of the general population. However, none of the patients with fibromyalgia 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 under-reporting 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 along 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 be related to the higher rate of accidental death in patients with fibromyalgia: it may very well be the case that an apparently “accidental” death is actually a suicide (for example, a fall or a single vehicle) accident). A diagnosis of chronic pain is associated with an increase in mortality due to a variety of external causes.
An increase in the mortality rate due to liver disease in fibromyalgia can 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 patients with fibromyalgia 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 may contribute to atherosclerosis.
Physicians should look for risk factors for suicide, liver disease and cerebrovascular disease each time a fibromyalgia patient presents for an evaluation. It is a little more work, but more than chronic pain it is likely to have to be addressed by the patient and the provider.