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There is no conclusive link between fibromyalgia/widespread chronic pain and risk of all-cause mortality among patients, according to recent findings, though patients with fibromyalgia may be at a heightened risk of suicide.¹

These findings resulted from a new meta-analysis conducted to look into the risks of all-cause, specific mortality for individuals that have fibromyalgia. Recent research prior to this analysis led to mixed results on the topic, with some studies showing high mortality risk among patients and others showing no increases in mortality rates.^2,3

The new meta-analysis on this topic was led by Lin Huang from the College of Basic Medical Science at Zhejiang Chinese Medical University in Hangzhou, China. Huang and colleagues noted that the subject has become somewhat controversial among researchers.

“What has been reported indicates that the relationship between fibromyalgia and mortality remains uncertain and needs further investigation,” Huang and colleagues wrote. “This meta-analysis was undertaken to ascertain the potential link between fibromyalgia, encompassing chronic widespread pain, and heightened mortality risk.”

Background and Findings

The investigators utilized a comprehensive search which they conducted across the Cochrane Library, PubMed, and Embase databases from their inception up to March 2023, making sure not to use any specified restrictions. The team’s search implemented subject terms (Emtree in Embase and MeSH in PubMed) as well as keywords that related to mortality rates, widespread pain which was shown to be chronic, fibromyalgia, and related variations.

Cohort studies which the investigators deemed to be eligible for their search had to meet the following criteria:

• Outcomes related to all-cause mortality as well as specific mortality
• Exposure which involved a confirmed fibromyalgia diagnosis or chronic widespread pain diagnosis
• The availability of quantitative point estimates such as hazard ratio, relative risks, or odds ratios, in addition to their corresponding 95% confidence intervals
• Type of research being cohort studies and conducted in the English language
• Exclusion of letters to editors, conference abstracts, duplicates, incomplete data, or research found to be without the relevant outcome of interest

The research team looked into the full texts of the appropriate studies to find those deemed suitable for inclusion in their analysis. The team used a quality assessment of their chosen cohort studies which involved the Newcastle–Ottawa Scale.

The method involved a star-based system which had a range from 0 - 9. Their rating criteria included elements such as selection of study participants, statistical analysis, exposure measurements, comparability of studies, adequacy of their outcome evaluations, and follow-up quality.

The investigators noted that higher star ratings suggested research which was of greater quality than others. They noted that research with 0 - 3 stars was viewed as low in quality, 4 - 6 as medium level of quality, and 7 - 9 as high-quality. They also constructed PRISMA tables to enhance the study’s overall transparency.

In the process of reviewing 7 cohort studies—involving a total of 152,933 subjects and spanning from 2001 - 2020—the team’s research did find substantial information which would point to a link between patients’ fibromyalgia or widespread pain and their risk of all-cause mortality (with an odds ratio [OR] of 1.11 and a 95% CI 0.81–1.53; I2 = 82.6%, P = .505).

Despite these findings, the investigators’ subgroup analysis did lead to several unique pieces of information. Specifically, the data showed a substantially greater risk of suicidality among those with the condition when compared to those without (OR 5.39, 95% CI 2.16–13.43; I2 = 69.9%, P < .05).

The research team highlighted the value of new research looking into this potential association between those with fibromyalgia or widespread pain and elevated risk of suicide. They note that their own limited participant pool proved to be a constraint, highlighting the need for further comprehensive research into the interrelationship between the variables.

“Future studies in developing countries should include case–control and cross-sectional studies to augment empirical diversity, validity, and clinical relevance,” they wrote. “The abstracts of international rheumatic conferences from the past few years were not considered in the literature screening process, which might have led to potential inaccuracies.”

References

1. ^{Wang, H, Li, X, Wang, X, et al. Fibromyalgia and risk of all-cause, specific mortality: A meta-analysis of observational studies. Int J Rheum Dis. 2023; 00: 1-8. doi:10.1111/1756-185X.14905.}
2. ^{Macfarlane GJ, McBeth J, Silman AJ. Widespread body pain and mortality: prospective population based study. BMJ. 2001; 323(7314): 662-665.}
3. ^{Wolfe F, Ablin J, Baker JF, et al. All-cause and cause-specific mortality in persons with fibromyalgia and widespread pain: an observational study in 35,248 persons with rheumatoid arthritis, non-inflammatory rheumatic disorders and clinical fibromyalgia. Semin Arthritis Rheum. 2020; 50(6): 1457-1464.}