For Patients With Fibromyalgia, Chronic Pain and Mood Disorders Predominate

neck pain
Recently updated diagnostic criteria for fibromyalgia that reduce the underdiagnosis in men had not been implemented during these studies.

Among patients with fibromyalgia, a systematic review associated higher rates of chronic pain and mood disorders and lower rates of anxiety-related conditions. These findings were published in Seminars in Arthritis and Rheumatism.

Publication databases were searched through July 11, 2019, for studies relating fibromyalgia with chronic pain and psychiatric comorbidities. A total of 31 studies were selected for this review.

The cross-sectional design studies included were published between 1992 and 2018. The sample sizes ranged between 22 and 509 with high bias toward women (80%). Psychiatric studies were conducted in 7 countries, mostly Italy and the United States. The quality of studies, assessed by the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies, was 4 out of 7 with an overall ratio of quality to risk for bias equal to 0.57.

The studies examined anxiety (n=16), mood (n=14), or personality (n=2) disorders. In general, lifetime mood disorders were more prevalent (depression [63.0%], major depressive disorder [52.3%], and bipolar [26.2%]) compared with anxiety disorders (panic disorder [33.0%], agoraphobia [12.0%], posttraumatic stress disorder [16.1%], and generalized anxiety disorder [9.10%]).

Among chronic pain, lifetime temporomandibular disorders were the most commonly reported (57.0%), followed by migraine (56.0%), chronic tension-type headache (48.0%), irritable bowel syndrome (44.0%), and lower back pain (39.0%).

Rates for lifetime instance compared with currently comorbid conditions were higher, except for social phobia (14.0%. vs 17.7%), posttraumatic stress disorder (16.1% vs 39.1%), and irritable bowel syndrome (44.0% vs 45.0%), respectively.

This study was limited by the underlying studies, which tended to have low sample sizes (N<100), and a majority female bias. Recent diagnostic criteria for fibromyalgia have been updated to reduce the underdiagnosis among men; however, these criteria had not been implemented during these studies.

The review authors concluded patients with fibromyalgia had elevated rates of psychiatric conditions of depression and major depressive disorder as well as temporomandibular disorders, migraine headaches, and irritable bowel syndrome, highlighting the importance of evaluating patients with fibromyalgia for comorbid conditions.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Kleykamp BA, Ferguson MC, McNicol E, et al. The prevalence of psychiatric and chronic pain comorbidities in fibromyalgia: an ACTTION systematic review. Semin Arthritis Rheum. 2020;51(1):166-174. doi:10.1016/j.semarthrit.2020.10.006