Increased Risk for Death From Suicide and Accidents Seen in Fibromyalgia Patients
From Clinical Pain Medicine ISSUE: MARCH 2011 | VOLUME: 9:03
Increased Risk for Death From Suicide and
Accidents Seen in Fibromyalgia Patients
by Alice Goodman
Atlanta-Although patients with fibromyalgia are not at an
overall increased risk for mortality, they are at greater risk for
suicide and accidents, according to a large observational study
presented at the annual meeting of the American College of
Rheumatology.This is only the second study to evaluate death in
patients with fibromyalgia, said study investigator Kaleb Michaud, MD,
MS, PhD, assistant professor of medicine at the University of Nebraska,
Omaha, and co-director of the National Data Bank (NDB) for Rheumatic
Diseases, who presented the findings. “Prior to 2010, mortality in
fibromyalgia patients was unknown,” he added.
According to Dr. Michaud, these results are consistent with those
reported in the first study to evaluate fibromyalgia mortality
(Arthritis Rheum 2010;62:3101-3108). This initial study found no
increase in overall mortality in Danish women with fibromyalgia, but
did find a significant spike in deaths from suicide, liver
cirrhosis/biliary tract disease and cardiovascular disease.
The most recent study, conducted in the United States, included 8,186
patients with fibromyalgia who were observed over 35 years in three
settings: 1,115 patients from clinical practice, 3,482 patients
enrolled in the NDB longitudinal outcome study and 3,589 others who had
declined to participate in that study.
The investigators calculated standardized mortality ratios (SMRs) based
on age- and sex-stratified U.S. population data after adjusting for
those who did not respond to the NBD study. Overall, they recorded 539
deaths and calculated an SMR of 0.90. The SMRs were 0.92 among clinical
patients, 0.67 among NDB-enrolled patients and 1.1 in non-enrolled
patients.
More than 93% of the patients were female and almost all were
non-Hispanic white ethnicity. The mean Health Assessment Questionnaire
(HAQ) score was 1.1 (range, 0-3), the mean pain score was 6.4 (range,
0-10) and the average global disease severity was 5.5 (range, 0-10).
The researchers diagnosed fibromyalgia, according to ACR criteria, in
67.4% of the patients and reported the presence of pain in 81%.
Compared with the general U.S. population, patients with fibromyalgia
had more accidents that resulted in death (7.1% vs. 5%, respectively),
had more deaths from influenza/pneumonia (5% vs. 2.3%, respectively)
and septicemia (4.1% vs. 1.4%, respectively), and committed more acts
of self-harm, such as suicide (4.4% vs. 1.4%, respectively). Predictors
of death also included body mass index (BMI) greater than 29, smoking,
HAQ score and more severe pain.
“These two studies relay an important message that physicians [caring
for patients with fibromyalgia] need to be sensitized to the risks of
suicide, particularly for patients who receive medications that may be
used in suicide attempts,” cautioned Mary-Ann Fitzcharles, MD,
associate professor of medicine in the Division of Rheumatology and
director of the Alan Edwards Pain Management Unit at McGill University,
in Montreal.
Generally, patients with chronic pain conditions have an increased rate
of suicide ideation and completed suicide, said Dr. Fitzcharles, who
was not involved in the study. Factors that may contribute to suicide
risk, specifically in patients with fibromyalgia, include depression
and psychogenic distress, such as anger, frustration or fear of having
an undiagnosed condition.
Dr. Michaud speculated that women with fibromyalgia may be at a higher
risk for suicide because they use more painkillers and antidepressants
and have high levels of somatic symptoms and depression.
Dr. Fitzcharles added that “the health of patients with fibromyalgia is
often suboptimal compared with that of the population in general for
both physical and psychological symptoms.” Patients with fibromyalgia
generally report reduced physical activity, which also contributes to
poor health, obesity and poor mood.
“These studies raise an important red flag warning for health care
professionals caring for fibromyalgia patients,” Dr. Fitzcharles
concluded.
