Fibromyalgia: An Environmental Scan
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Fibromyalgia is the most common chronic pain syndrome encountered in general medicine and rheumatology. Historically, the conceptualization of the syndrome and our understanding of the process of fibromyalgia have impacted how we define, identify and estimate the occurrence of fibromyalgia in the population (Perrot, S., Dickenson, AH., and Robert Bennett n.d.). Epidemiological studies in fibromyalgia are becoming more common; however, there are significant concerns surrounding diverse study populations, methodological approaches and the operationalization of outcome measures. Thus the epidemiology for fibromyalgia remains unclear in the literature. In some geographical regions across the globe, it is difficult to understand the scope of chronic pain conditions, including fibromyalgia because of differences among cultural norms surrounding chronic pain (Mease, P. 2005)(Bernard Bannwarth et al. 2009)(Mäkelä 1999).
Estimates are that fibromyalgia affects between 2% and 5% of the US, Canadian and UK populations, which in the US accounts for approximately 6% of patients attending general practice. Similarly, estimates of fibromyalgia are approximately 3% across Western European countries (France, Germany, Italy, Portugal and Spain). Overall, global estimates range from .05 to 5.0% of the general population, with very low estimates for China, Finland and Denmark (Branco et al. 2009). Fibromyalgia is most often diagnosed using the American College of Rheumatology (ACR) criteria (See Appendix F: Schematic ACR Trigger Points Fibromyalgia and Appendix G: ACR Classification of Fibromyalgia). Furthermore, women are between 3 and 9 times more often diagnosed with fibromyalgia than men with a ratio of 9:1 more females than males. The age range of diagnosis is between 20 and 50 years of age. A substantial number of those diagnosed are 2 to 7 times more likely to have a co-morbid condition such as depression, chronic fatigue syndrome, irritable bowel syndrome and/or anxiety (Marcus 2009) (Weir, Peter T., Harlan, Gregory A., Nkoy, F. et al 2006). Despite fibromyalgia commonly occurring in young to middle age women, it is also observed in older adults, children including both young and adolescents along with cases among males albeit much less frequently (Chakrabarty and Zoorob 2007).