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Fibromyalgia Statistics — Quick-Reference Sheet

Last curated: 2026-08-28

Purpose. This sheet is the numbers layer of the fibromyalgia (FM) knowledge base: a dense, source-locked table of published statistics — prevalence and incidence by diagnostic criteria set, diagnostic delay and misdiagnosis in both directions, symptom-severity distributions, comorbidity percentages, drug NNTs and real-world treatment statistics, costs, work disability, longitudinal outcomes, and mortality/suicide. It complements (and deliberately does not repeat the prose of) wiki/epidemiology.md and wiki/diagnostic-criteria.md; where those pages argue, this sheet tabulates. FM-specific rule: every prevalence or sex-ratio figure in this sheet records the criteria set (ACR 1990 / 2010 / modified 2010–2011 / 2016 / AAPT) and the ascertainment route (self-report survey vs examination vs physician diagnosis vs claims/ICD codes), because these two choices — not biology — drive most of the disagreements between published numbers. Conflicting estimates are shown side by side with population, period, and method — never averaged or silently reconciled. All PMIDs were retrieved from PubMed during the 2026-08-28 curation session; portal pages were fetched the same day.

How to cite from this sheet. Always carry the PMID (or portal URL + access date) forward with the figure — never cite "the statistics sheet" as the source. Inline format: (Author Year, [PMID 12345678](https://pubmed.ncbi.nlm.nih.gov/12345678/){target="_blank" rel="noopener"}); portals: (Publisher — "Title", URL, accessed 2026-08-28). If a figure below is marked derived, it was computed from the cited source's numbers and should be re-derived, not quoted as published.

1. Prevalence and incidence

1.1 General-population prevalence — by criteria set and ascertainment

Figure Criteria / ascertainment Population Period Source
Pooled 1.78% (95% CI 1.65–1.92); women 3.98% (2.80–5.20); men 0.01% (−0.04–0.06) Mixed criteria across 65 papers / 81 evidences; mostly survey+exam 3,609,810 subjects worldwide, general population + special groups to ~2016 (Heidari 2017, PMID 28447207)
Range 0.2–6.6% general population; women 2.4–6.8%; urban 0.7–11.4%; rural 0.1–5.2%; special populations 0.6–15% 39 studies, mixed criteria (ACR 1990 dominant; 2010 "not yet widely used"); COPCORD methodology noted Worldwide studies 2005–2014 (Marques 2017, PMID 28743363)
2.1% (95% CI 1.6–2.7); women 2.4% vs men 1.8% — sex difference not significant; prevalence rises with age Modified 2010 ACR (survey self-report), no examination German general population, n=2,445, random sample 2012 (Wolfe 2013, PMID 23424058)
3.4% (95% CI 2.7–4.3) by modified FM 2016 criteria vs 5.7% (4.8–6.8) by AAPT criteria (+73%); κ=0.65 between sets; physician-diagnosed FM only 1.1% FM 2016 (survey mod.) vs AAPT 2019; self-report questionnaires German general population, n=2,531, random sample 2019 (Häuser 2021, PMID 32248629)
Same survey, three criteria sets: 1.7% (ACR 1990, exam), 1.2% (ACR 2010, clinician), 5.4% (modified 2010, self-report only) ACR 1990 vs 2010 vs modified 2010, applied to the same population with clinic examination subsample NE Scotland, 4,600 mailed adults; 104 examined published 2015 (Jones 2015, PMID 25323744)
1.75% (95% CI 1.42–2.07) ≈ 3.94 million US adults NHIS surrogate of modified 2010 ACR (PSD-based), national in-person survey US, NHIS 2012, weighted n=225.7 million 2012 (Walitt 2015, PMID 26379048)
Criteria prevalence ("CritFM") ~2% in the German population study reanalyzed with 2016 criteria 2016 ACR revision (survey), reanalysis of GPS n=2,435 Germany published 2018 (Wolfe 2018, PMID 30212526)
Pooled 6% (95% CI 5–7) in low- and middle-income countries (combined general/elderly/worker populations); I²>90% Mixed criteria, survey-based 28 LMICs, 119 publications (68 meta-analyzed) to ~2015 (Jackson 2016, PMID 27537761)
Primary-care point figures: physician-diagnosed 6.1% (5.3–6.9) vs criteria-positive 5.5% (4.8–6.3) — nearly equal totals but only ~1/3 overlap (see §2.2) 2016 criteria (survey) vs chart physician diagnosis 3,276 US primary-care patients (clinic, not population) published 2019 (Srinivasan 2019, PMID 31777779)

Reading note: the modern spread (≈1.2% to ≈6.4%) is criteria- and ascertainment-driven: clinician-input criteria sets (ACR 1990/2010) give ~1–2%, self-report survey adaptations (mod-2010/2016/AAPT/FM research survey criteria) give ~3–6.5%. A worldwide narrative review of the field is (Queiroz 2013, PMID 23801009) — retrieved this session, but its abstract carries no numeric global mean; its widely quoted "global mean 2.7%" is in the full text only and is left out of this sheet.

1.2 The criteria-dependent sex-ratio story (quantified)

Figure Criteria / setting Source
F:M 13.7:1 (ACR 1990, exam) → 4.8:1 (ACR 2010, clinician) → 2.3:1 (modified 2010, self-report) — same Scottish population Three criteria sets on one population (Jones 2015, PMID 25323744)
>90% women among 1,761 referred-and-diagnosed clinic FM patients vs 58.7% women among criteria-positive FM found by unbiased screening of an unselected RA cohort (n=4,342); 59.2% women in German population study; linear relation between female probability and PSD severity 2016 criteria; "Criteria-based FM" vs "Clinical FM" explicitly separated (Wolfe 2018, PMID 30212526)
Women 2.4% vs men 1.8% — not significant Modified 2010, survey, Germany (Wolfe 2013, PMID 23424058)
Clinical (physician) diagnosis strongly female-biased even at equal symptoms: odds of physician diagnosis for women OR 3.2 vs criteria-positivity OR 1.9 (p=0.023) US primary care (Srinivasan 2019, PMID 31777779)
"False-positive/prior" clinical diagnosis best predicted by female sex (OR 8.81), married (3.27), white (1.96); criteria-positive FM only modestly predicted by the same demographics (OR ~2.1) NHIS 2012, US (Walitt 2016, PMID 27281286)
Claims-based (ICD) incidence F:M only 1.64 (95% CI 1.59–1.69) — far below the clinic 7–9:1 lore ICD-9 729.1 claims, US (Weir 2006, PMID 16755239)
Relative risk of FM in females vs males 3.13 (95% CI 1.22–8.04) at mid-life, vs RR 1.16 (1.11–1.21) for generic chronic pain Meta-analysis of population studies (8 pooled), mixed criteria (Borra 2025, PMID 41153804)
Genetic architecture of FM "nearly identical between males and females" despite large prevalence differences GWAS meta-analysis, 54,629 cases (Kerrebijn 2026, PMID 42521817)

1.3 Diagnosed (clinical) prevalence vs criteria prevalence — the under-diagnosis gap

Figure Population Method Source
Diagnosed-in-practice prevalence 1.1% (age/sex-adjusted) vs 6.4% by FM research survey criteria in the same county — a ~6-fold gap; men meeting criteria "unlikely to have been given a diagnosis" Olmsted County, MN Rochester Epidemiology Project record review (2005–2009, n=1,115 diagnosed) + mailed survey (n=830 responders, 27.6% response — selection caveat) (Vincent 2013, PMID 23203795)
73% of NHIS criteria-positive persons did NOT self-report an FM diagnosis (they reported other physician diagnoses) US, NHIS 2012 Survey surrogate criteria (Walitt 2015, PMID 26379048)
Only 35.4% of criteria-positive primary-care patients carried a physician FM diagnosis US primary care, n=3,276 2016 criteria vs chart (Srinivasan 2019, PMID 31777779)
Physician-diagnosed FM 1.1% of German general population — vs 3.4% criteria prevalence in the same sample Germany 2019 Survey (Häuser 2021, PMID 32248629)

1.4 Prevalence in special populations (clinic enrichment)

Figure Population / criteria Source
15.2% (13.6–16.9) of patients referred to rheumatology/internal medicine departments Pooled meta-analysis, mixed criteria (Heidari 2017, PMID 28447207)
12.9% (12.7–13.1) in IBS; 14.8% (11.1–18.4) in type 2 diabetes; 6.3% (4.6–7.9) in hemodialysis; special-group range 3.9% (hemodialysis) to 80% (Behçet) Pooled meta-analysis (Heidari 2017, PMID 28447207)
Concomitant FM in inflammatory arthritis — see §4.3 — (Duffield 2018, PMID 29788461; Mistry 2024, PMID 39424681)

1.5 Incidence

Figure Population Period Method Source
Age-adjusted incidence 11.28 (women) and 6.88 (men) per 1,000 person-years; F:M 1.64 (1.59–1.69); 2,595 incident cases US insured population, ~62,000 enrollees/yr 1997–2002 ICD-9-CM 729.1 claims — codes, not criteria; captures diagnosing behavior (Weir 2006, PMID 16755239)
25% (43/175) of women with self-reported musculoskeletal pain developed criteria-positive FM over 5.5 years — a high-risk subgroup, not general population Norwegian women (population-sampled pain reporters), ACR 1990 exam 1990–1995 Prospective interview + examination (Forseth 1999, PMID 10555910)
No population-based incidence study using ACR 2010+/2016 self-report criteria was retrieved this session — — gap [unverified — see §8]

1.6 Age distribution

Figure Source
Prevalence rises with age (German general population, mod-2010 survey criteria); highest categories in middle-to-older age (Wolfe 2013, PMID 23424058)
Clinic/survey samples: 61% of surveyed diagnosed patients aged 36–59; mean ~46 yrs in US claims cohorts; peak onset childbearing-to-middle years per claims incidence (Choy 2010, PMID 20420681; Berger 2007, PMID 17655684; Weir 2006, PMID 16755239)

1.7 Juvenile / pediatric FM

Figure Population / criteria Source
6.2% (21/338) of schoolchildren aged 9–15 met ACR 1990 criteria (widespread pain + ≥11/18 tender points); girls had lower tenderness thresholds than boys Beer-Sheva, Israel, one public school; examination-based (Buskila 1993, PMID 8474077)
Same cohort: 13% joint hypermobility; 81% of FM children hypermobile; 40% of hypermobile children met FM criteria Same 338 children (Gedalia 1993, PMID 8346976)
Juvenile FM: "most commonly affecting adolescent girls"; symptoms persist rather than resolve (review; no population prevalence in abstract) Narrative review of JFM (Kashikar-Zuck 2014, PMID 24275966)
52% (32/62) of adolescent girls in an inpatient psychiatric unit met Yunus–Masi juvenile FM criteria — extreme-enrichment setting, not population US inpatient psychiatry, exam-based (Lommel 2009, PMID 20306769)

2. Diagnosis statistics

2.1 Diagnostic delay

Figure Population Method Source
Mean 6.5 yrs since symptom onset at survey; ~1 yr from symptoms to first presentation; then mean 2.3 yrs and 3.7 different physicians to receive the FM diagnosis 800 diagnosed patients, 6 European countries + Mexico + South Korea (physician-recruited) Patient survey (Choy 2010, PMID 20420681)
Mean total time from initial characteristic complaints to diagnosis 6.42 yrs (SD 3.57); mean 3.75 yrs of it under the same primary physician; delay longer with comorbidity, younger patient age, older physician age; an initial FM-type complaint pattern was retrospectively identifiable in 67.9% of cases vs 27.6% of controls Israel, Maccabi HMO; 3,434 eligible diagnosed 2008–2011 (2,369 analyzable) vs 9,172 controls Claims/EHR reconstruction (Gendelman 2018, PMID 31174818)

2.2 Misdiagnosis in BOTH directions (the central diagnostic statistic)

Direction A — criteria-positive but undiagnosed (missed FM):

Figure Source
73% of NHIS criteria-positive US adults reported no FM diagnosis (Walitt 2015, PMID 26379048)
64.6% of criteria-positive primary-care patients had no physician FM diagnosis (only 35.4% diagnosed) (Srinivasan 2019, PMID 31777779)
Diagnosed 1.1% vs criteria 6.4% in Olmsted County (≈5/6 of criteria-positive undiagnosed, derived); men disproportionately missed (Vincent 2013, PMID 23203795)

Direction B — clinically diagnosed but criteria-negative (diagnosis without the phenotype):

Figure Source
73.5% of US adults self-reporting a clinician FM diagnosis did NOT meet NHIS surrogate criteria; this "false-positive/prior" group prevalence 1.3%, mild PSD (mean 6.2), yet utilization/work-disability equal to criteria-positive FM and 6–7× non-FM (Walitt 2016, PMID 27281286)
Only 32.2% of physician-diagnosed FM met 2016 criteria; diagnostic agreement κ=0.296 ("minimal"); 68.3% of physician-diagnosed received FM-specific pharmacotherapy regardless (Srinivasan 2019, PMID 31777779)
Of physician-diagnosed FM in the German population, 44.0% met FM 2016 criteria and 47.5% met AAPT (Häuser 2021, PMID 32248629)
Clinic FM ("ClinFM") vs criteria FM ("CritFM") formally distinguished; clinical diagnosis "severely affected by selection and confirmation bias" (Wolfe 2018, PMID 30212526)

2.3 Physician/specialty statistics

Figure Population Source
53% of physicians report difficulty diagnosing FM; 54% say their FM training was inadequate; 32% consider themselves not knowledgeable; awareness of ACR criteria 32% (psychiatrists) to 83% (rheumatologists); 48% not confident differentiating FM from mimics; 37% not confident managing long-term; PCPs and psychiatrists least confident, rheumatologists most 1,622 physicians (809 PCPs + rheumatologists, neurologists, psychiatrists, pain specialists), 8 countries (Perrot 2012, PMID 23051101)
Patients saw 3.7 different physicians before diagnosis 800 patients, 8 countries (Choy 2010, PMID 20420681)

2.4 ICD-code / clinical-label validity

Figure Source
Physician FM diagnosis vs 2016 criteria: κ=0.296; "no common definition of fibromyalgia in the community" (Srinivasan 2019, PMID 31777779)
ICD-9 729.1 claims cohorts capture the diagnosing behavior (F:M 1.64; incidence 6.9–11.3/1,000 p-y) — an order of magnitude above criteria-based population incidence expectations; no chart validation reported (Weir 2006, PMID 16755239)
NHIS: clinical-diagnosis prevalence (1.78%) and criteria prevalence (1.75%) almost identical in total — but the two groups overlap by only ~1/4, so equal totals conceal double misclassification (Walitt 2016, PMID 27281286; Walitt 2015, PMID 26379048)

3. Symptom and severity distributions

3.1 FIQ / FIQR anchors

Figure Population Source
FIQR total (0–100): FM mean 56.6 ± 19.9; healthy controls 12.1 ± 11.6; RA/SLE 28.6 ± 21.2; major depressive disorder 17.3 ± 11.8; FIQR–FIQ correlation r=0.88 (FIQ mean 60.6 ± 17.8 in same FM sample) 202 FM, 213 HC, 51 RA/SLE, 11 MDD (online) (Bennett 2009, PMID 19664287)
No published general-population FIQ/FIQR norms were retrieved this session — the instrument is FM-clinic-anchored — [unverified — gap]

3.2 Polysymptomatic distress (PSD) scale distribution and severity bands

Figure Source
PSD severity categories (0–31 scale): none 0–3, mild 4–7, moderate 8–11, severe 12–19, very severe 20–31; FM cannot be diagnosed below PSD 12; categories derived in a pain-clinic databank incl. 2,732 RA patients; linear relation between PSD and covariate severity; "no clear-cut symptom distinction between FM(+) and FM(−)" (Wolfe 2015, PMID 26077414)
General population (NHIS): FM-type symptoms extend over the full length of the PSD scale — evidence for a severity continuum, not a discrete disorder; PSD strongly correlated with somatic symptom severity (r=0.790 in German population) (Walitt 2015, PMID 26379048; Wolfe 2013, PMID 23424058)
PSD in criteria-positive cases: women mean 10.2 vs men 8.2 (referred databank); criteria-positive primary care mean 18.4 vs physician-diagnosed 12.4 (Wolfe 2018, PMID 30212526; Srinivasan 2019, PMID 31777779)
Mean symptom count 7.3 of 14 listed symptoms at diagnosis-journey survey; pain, fatigue, sleep problems, concentration difficulties most common (Choy 2010, PMID 20420681)

3.3 Somatic symptom burden

Figure Source
PHQ-15 ≥10 (medium-high somatic severity): 88.9% of FM vs 26.4% of RA vs 9.3% general population; 51.4% of FM report fatigue/sleep/cognitive problems that are "severe, continuous, and life-disturbing" (vs 14.8% RA); 38.5% of German-population FM met proposed DSM-5 somatic symptom disorder criteria 6,233 FM/RA/OA patients (NDB); German population

4. Comorbidity numbers

4.1 Psychiatric

Figure Method Source
Depression/major depressive disorder: lifetime weighted prevalence up to 63% (the most prevalent comorbidity); current-or-lifetime bipolar disorder, panic disorder, PTSD each ~1/3 of FM patients; GAD/OCD/phobias less common ACTTION systematic review, 31 cross-sectional clinical-epidemiology studies (no incidence data existed) (Kleykamp 2021, PMID 33383293)
Community (non-referral) FM: depression 75.1%, anxiety 56.5% documented in medical records 1,111 diagnosed FM, Olmsted County record review (Vincent 2015, PMID 25735301)
Claims: FM patients 2.14–7.05× more likely to carry depression, anxiety, headache, IBS, CFS, SLE, or RA codes US claims 1997–2002 (Weir 2006, PMID 16755239)
Suicidality — see §6.3 — —

4.2 Chronic overlapping pain conditions (COPC)

Figure Method Source
Chronic pain comorbidities in FM (chronic tension-type/migraine headache, IBS, myofascial pain, TMD): prevalence range 39–76% across studies ACTTION systematic review (Kleykamp 2021, PMID 33383293)
Migraine/chronic headaches 62.4% and chronic joint pain 88.7% in community FM records; >50% of patients had ≥7 chronic conditions Olmsted County, 1,111 FM (Vincent 2015, PMID 25735301)
FM–ME/CFS: diagnoses overlap in 47.3% (95% CI 45.97–48.63) of reported cases; 21 studies, I²=98%; most used ACR 1990 — overlap "likely higher" under 2016 criteria (which absorbed fatigue/unrefreshing sleep/dyscognition) Fixed-effect meta-analysis (Ramírez-Morales 2022, PMID 35690247)
Context — the paired IBS–migraine overlap: IBS patients OR 2.09 (1.79–2.43) for migraine; migraineurs OR 2.51 (1.76–3.58) for IBS; FM and depression show "strong similarity in expression rate" in both groups Meta-analysis, 22 articles (Todor 2023, PMID 37291550)
FM in IBS 12.9% (12.7–13.1) — see §1.4 Meta-analysis (Heidari 2017, PMID 28447207)

4.3 Concomitant FM in inflammatory rheumatic disease (meta-analytic)

Figure Method Source
RA: pooled 21% (study range 4.9–52.4%); axSpA (AS-only pool): 13% (range 4.1–25.2%); PsA: 18% (range 9.6–27.2%). Concomitant FM inflates disease-activity scores: DAS28 mean difference +1.24 (95% CI 1.10–1.37) in RA; BASDAI +2.22 (1.86–2.58) in AS — driven by the self-reported components Systematic review + meta-analysis, 40 articles (Duffield 2018, PMID 29788461)
SLE: pooled FM prevalence 15.8% (95% CI 13.4–18.5), I²=97.9%; 58,052 SLE patients across 56 studies; OR 3.7 (2.74–5.0) vs controls Systematic review + meta-analysis (Mistry 2024, PMID 39424681)
Unselected RA cohort screened with 2016 criteria: FM cases 58.7% female (used as the unbiased sex-ratio benchmark) Databank screening (Wolfe 2018, PMID 30212526)

4.4 Genetic-correlation quantification of the overlap

Figure Source
FM genetic correlations >0.7 with chronic low back pain, PTSD, and IBS; heritability enrichment exclusively in brain tissue; 26 risk loci; strongest single association a coding variant in HTT (Kerrebijn 2026, PMID 42521817)

5. Treatment and healthcare statistics

5.1 Drug efficacy — responder rates and NNTs (Cochrane / meta-analytic)

Drug (evidence base) ≥30% pain relief ≥50% pain relief Other key numbers Source
Duloxetine + milnacipran pooled (18 RCTs, n=7,903; low–very-low GRADE) RD 0.10; NNTB 10 (8–12) 31% vs 21% placebo; RD 0.09; NNTB 11 (9–14) — judged "no clinically relevant benefit" at this threshold PGIC much/very-much improved 52% vs 29%, NNTB 5 (4–8); fatigue SMD −0.13 (NNTB 18); HRQL SMD −0.20 (NNTB 11); AE dropout 19% vs 10%, NNTH 14; SAE no difference; authors: average benefits outweighed by harms, but a minority get substantial relief (Welsch 2018, PMID 29489029)
Pregabalin 300–600 mg (8 RCTs; 3,283 classic + 687 EERW; high-quality GRADE for primary outcomes) 39–43% vs 28% placebo (+11 points) 22–24% vs 14% (+9 points); NNTs 7–14 across benefit outcomes EERW maintained response 40% vs 20% (NNT 5; normalized-to-start 12); adverse events in 70–90% of all arms; NNH: dizziness 3.7, somnolence 7.4, weight gain 18, peripheral edema 19 (Derry 2016, PMID 27684492)
Amitriptyline (21 small studies, n=1,437, mixed neuropathic pain + FM; no top-tier evidence) — second-tier pooled: 38% vs 16%; RR 2.3; NNT 4.6 (3.6–6.6) — likely overestimates AE 64% vs 40%, NNH 4.1; "only a minority will achieve satisfactory pain relief"; effect probably overestimated by small crossover trials (Moore 2012, PMID 23235657)
All therapies, network-scale synthesis (224 trials, n=29,962) — — High-quality evidence only for: CBT (pain, short term, WMD −0.9/10), CNS depressants (medium term −1.2/10), antidepressants (−0.5/10; QOL −6.8/101) — all below minimum clinically important change (2/10 pain; 14/101 FIQ); long-term evidence lacking (Mascarenhas 2021, PMID 33104162)
Aerobic exercise (13 RCTs, n=839) — — vs control: pain MD −11.06/100; HRQL −7.89/100; physical function −10.16/100 (all reaching clinical-significance thresholds; low–moderate quality); withdrawal RR 1.25 (NS) — the strongest-recommended intervention class in guidelines (Bidonde 2017, PMID 28636204)
Placebo arms (29 SSRI/SNRI RCTs, n=8,453) — — Significant within-placebo improvements in pain, function, and depression (e.g., functional disability mean change 3.31, 95% CI 2.37–4.26); large heterogeneity — a design constraint for all FM trials (Koechlin 2021, PMID 35295427)

5.2 Real-world drug use, persistence, discontinuation

Figure Population Source
Duloxetine initiators: only 33% achieved adherence MPR ≥0.8 over 12 months (n=4,660); persistence higher with older age and prior antidepressant use US commercial claims, 2008 (Cui 2012, PMID 22792005)
~40% of community FM patients on ≥3 medications for FM symptoms; most-used classes: sleep aids 33.3%, SSRIs 28.7%, opioids 22.4%, SNRIs 21.0% Olmsted County, 1,111 FM, record review (Vincent 2015, PMID 25735301)
65% of FM claims patients used pain-related pharmacotherapy vs 34% matched controls US insurance database, n=33,176 (Berger 2007, PMID 17655684)
68.3% of physician-diagnosed (largely criteria-negative) primary-care FM received FM-specific pharmacotherapy US primary care (Srinivasan 2019, PMID 31777779)

5.3 Opioids in FM (documented problem: use despite universal guideline discouragement)

Figure Population Source
32% of 457 consecutive referrals used opioids; >2/3 of users on strong opioids; use associated with unemployment, disability payments, unstable psychiatric disorder, substance-abuse history, prior suicide attempts Canadian tertiary FM clinic (Fitzcharles 2011, PMID 21962316)
Opioids 22.4% in unselected community FM Olmsted County (Vincent 2015, PMID 25735301)
"No evidence from clinical trials that opioids are effective for FM"; observational users have poorer outcomes; guidelines recommend against; use nonetheless common Narrative evidence review (Goldenberg 2016, PMID 26975749)
Claims-database opioid use in FM reported at 11.3%–69% across studies (secondary summary as stated in this trial report; also quotes "30% of adults with fibromyalgia receive an opioid" — trace to primaries before quoting) Cited in a pediatric opioid study and a green-light RCT report (Gmuca 2019, PMID 29905842; Nelli 2023, PMID 37535780)

5.4 Healthcare utilization and costs

Figure Population Period Source
Mean annual total healthcare costs $9,573 (SD 20,135) vs $3,291 (13,643) age/sex-matched controls (~3×); median $4,247 vs $822 (~5×); n=33,176 FM claims patients; 75% women, mean age 46 US health-insurance database 2002–2005 (costs 2004–05) (Berger 2007, PMID 17655684)
Systematic review (36 studies): total annual direct costs per patient $1,750–$35,920 (USA) and $1,250–$8,504 (Europe), 2019 USD; medications the largest contributor in most studies; overall risk of bias high Worldwide cost-of-illness literature to ~2021 (D'Onghia 2022, PMID 35849890)
Utilization multiplier: criteria-positive AND "diagnosed-but-criteria-negative" NHIS groups both showed medical utilization and work disability 6–7× the non-FM population — costs track the label and the distress, not criteria status US NHIS 2012 (Walitt 2016, PMID 27281286)
Surgery rates in FM: no dedicated quantitative study retrieved this session — — [unverified — see §8]

6. Work, disability, and outcomes

6.1 Employment and disability benefits

Figure Population Period Source
>16% receiving US Social Security disability (SSD) — center range 6.3%–35.7% — vs 2.2% of US general population and 28.9% of RA clinic patients; 26.5% receiving ≥1 form of disability payment; yet 64% reported being able to work all/most days and >70% were employed or homemakers; <25% of SSD awards were specifically for FM before 1988, rising to 46.4% after 1,604 FM patients, 6 US rheumatology centers survey era 1988– (pub. 1997) (Wolfe 1997, PMID 9195528)
22% unable to work at all and a further 25% not able to work all the time because of FM 800 diagnosed patients, 8 countries 2008-era survey (Choy 2010, PMID 20420681)
Criteria-positive NHIS FM: high self-reported pain, comorbidity, psychological distress, medical costs, Social Security and work disability (pattern; abstract gives no single %) US NHIS 2012 2012 (Walitt 2015, PMID 26379048)
Opioid use associated with unemployment and disability payments in tertiary care Canada 2011 (Fitzcharles 2011, PMID 21962316)

6.2 Longitudinal course — what % improve

Figure Population Period Source
Over up to 11 yrs (11,006 semiannual observations): ~10% substantial improvement in pain; ~25% at least moderate improvement; FM severity worsened in 35.9% and pain in 38.6%; overall no clinically meaningful average improvement (global SMD 0.03); 44.0% of patients dropped below criteria threshold at least once (state-switching, not cure) 1,555 US FM patients (NDB), mod-2010 criteria at entry to 2011 (Walitt 2011, PMID 21765102)
Juvenile FM: symptoms "tend to persist and do not resolve over time as was previously believed" JFM review 2014 (Kashikar-Zuck 2014, PMID 24275966)

6.3 Mortality and suicide

Figure Population Method Source
All-cause SMR 0.90 (95% CI 0.61–1.26) — no excess mortality; HR vs osteoarthritis 1.05 (0.94–1.17); but standardized mortality OR raised for suicide 3.31 (2.15–5.11) and accidents 1.45 (1.02–2.06); malignancy not raised; 539 deaths 8,186 US FM patients over 35 yrs (clinic + NDB + refusers) Cohort + National Death Index (Wolfe 2011, PMID 20662040)
Meta-analysis (8 studies, 188,751 FM): all-cause HR 1.27 (1.04–1.51) — BUT not elevated in the subgroup diagnosed by ACR 1990 criteria; suicide SMR 3.37 (1.52–7.50); infections SMR 1.66 (1.15–2.38); cancer SMR 0.82 (0.69–0.97); accidents SMR 1.95 (0.97–3.92, borderline); significant heterogeneity Systematic review to 2022 Random-effects meta (Treister-Goltzman 2023, PMID 37429737)
Competing meta-analysis (7 cohorts, 152,933): all-cause OR 1.11 (0.81–1.53) — null, I²=82.6%; suicide OR 5.39 (2.16–13.43), I²=69.9% Systematic review to Mar 2023 Random-effects meta (Wang 2023, PMID 37929630)
Suicidality prevalence meta (13 studies, 394,087 FM): suicidal ideation 29.57% (OR 9.12, 95% CI 1.42–58.77); suicide attempts 5.69% (OR 3.12, 1.37–7.12); suicide events HR 1.38 (1.17–1.71); wide CIs, publication bias noted, significance sometimes lost after psychiatric adjustment Systematic review + meta Random-effects (Adawi 2021, PMID 34867495)

Reading note: every mortality source agrees the all-cause signal is absent-to-weak and the suicide signal is consistent (OR/SMR ~3–5.4); they disagree on whether all-cause mortality is elevated at all — the elevation appears only in code/label-based cohorts, not criteria-based ones (see §8.6).

7. Data infrastructure appendix — what stands behind FM numbers

Resource What it is / contains Scale (verified this session) Access / key source
NDB — National Data Bank for Rheumatic Diseases (Wichita, KS) Longitudinal US patient-reported databank of rheumatic disease incl. FM; semiannual detailed questionnaires; source of the longitudinal-outcome, mortality, PSD-category, and criteria-bias analyses 1,555 FM followed ≤11 yrs (11,006 observations); 8,186 FM in mortality study; 6,233 FM/RA/OA in symptom studies; FM databank samples up to 1,761 referred + 4,342 comparison Papers: (Walitt 2011, PMID 21765102; Wolfe 2011, PMID 20662040; Wolfe 2015, PMID 26077414; Wolfe 2018, PMID 30212526). Website fetch attempted and blocked (HTTP 403; https://www.arthritis-research.org/, attempted 2026-08-28)
US NHIS — National Health Interview Survey Nationally representative US in-person health survey; 2012 wave carried items allowing surrogate mod-2010/PSD criteria; the only US national criteria-vs-diagnosis dataset 2012 wave: n=8,446 sampled adults weighted to 225.7 million (Walitt 2015, PMID 26379048; Walitt 2016, PMID 27281286)
German general-population survey series (Brähler/Häuser/Wolfe collaborations) Repeated random-sample national surveys applying evolving criteria sets (mod-2010 in 2012; FM 2016 + AAPT in 2019); the reference series for criteria-set prevalence comparisons and the population sex-ratio 2012: n=2,445 (also reported as GPS n=2,435 in reanalysis); 2019: n=2,531 (Wolfe 2013, PMID 23424058; Häuser 2021, PMID 32248629; Wolfe 2018, PMID 30212526)
Rochester Epidemiology Project (Olmsted County, MN) Countywide medical-record linkage enabling diagnosed-prevalence vs survey-prevalence comparison and community comorbidity/medication profiles 1,115 diagnosed FM 2005–2009; 1,111 record-reviewed for comorbidity (Vincent 2013, PMID 23203795; Vincent 2015, PMID 25735301)
ACTTION — Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities and Networks Public-private partnership (FDA-funded among others) to improve analgesic trial methods; published the ACTTION Guide to Clinical Trials of Pain Treatments; with APS produced the AAPT diagnostic taxonomy (incl. AAPT FM criteria, 2019); ACTTION systematic reviews quantify FM comorbidity for trial design Guide: 2 supplements, 15 articles (site) (ACTTION — "ACTTION: Home", https://acttion.org/, accessed 2026-08-28; Kleykamp 2021, PMID 33383293; AAPT criteria applied in Häuser 2021, PMID 32248629)
OMERACT — Outcome Measures in Rheumatology International consensus organization (working groups + biennial meetings, next 2027; patient research partners) producing core outcome sets and instrument validation for rheumatology trials incl. FM and, currently, a nociplastic-pain instrument initiative for inflammatory arthritis 2025 pain SIG: 24 stakeholders; 86% endorsed systematic review for a nociplastic-pain instrument (OMERACT — "Outcome Measures in Rheumatology", https://omeract.org/, accessed 2026-08-28; Khot 2026, PMID 41856014)
FIQ / FIQR The standard FM-specific severity/impact instrument (0–100); revised 2009; anchor values in §3.1 202 FM + 275 comparison subjects in validation (Bennett 2009, PMID 19664287)
Genetics consortia incl. UK Biobank 2026 multi-ancestry FM GWAS meta-analysis across 11 cohorts (deCODE, FinnGen/FIMM, Estonian Biobank, Danish Blood Donor Study, Intermountain, Genes & Health, UK cohorts, etc.): the largest genetically characterized FM case set 54,629 FM cases / 2,509,126 controls (Kerrebijn 2026, PMID 42521817). UK Biobank portal fetch attempted and blocked (HTTP 403; https://www.ukbiobank.ac.uk/about-our-data, attempted 2026-08-28)
US claims databases (commercial insurance, ICD-coded) Source of incidence, cost, drug-persistence, and opioid-use figures; capture diagnosing/prescribing behavior, not criteria status 62,000 enrollees/yr (Weir); 33,176 FM (Berger); 4,660 duloxetine initiators (Cui) (Weir 2006, PMID 16755239; Berger 2007, PMID 17655684; Cui 2012, PMID 22792005)

8. Known conflicts and caveats — the biggest statistical disagreements

  1. Prevalence spans ~1.2% to ~6.4% in the same populations depending on criteria set and ascertainment. Scotland: 1.7% (ACR 1990) vs 1.2% (ACR 2010) vs 5.4% (mod-2010 self-report) in one survey (Jones 2015, PMID 25323744). Germany 2019: 3.4% (FM 2016) vs 5.7% (AAPT) in one sample (Häuser 2021, PMID 32248629). Olmsted: diagnosed 1.1% vs survey 6.4% (Vincent 2013, PMID 23203795). Never quote "FM prevalence" without naming criteria + ascertainment.
  2. The sex ratio is a criteria/selection artifact spanning ~13.7:1 to ~1.6:1. Exam-based ACR 1990 and clinic referral give 9:1 to 13.7:1; self-report criteria in unselected populations give ~2:1 (2.3:1 Scotland mod-2010, Jones 2015, PMID 25323744; 58.7–59.2% female in unbiased samples, Wolfe 2018, PMID 30212526; F:M 1.64 in claims incidence, Weir 2006, PMID 16755239; NS sex difference in Germany 2012, Wolfe 2013, PMID 23424058); genetics shows near-identical architecture by sex (Kerrebijn 2026, PMID 42521817). The ACR-1990 tender-point requirement (women's lower pain thresholds) plus physician diagnostic bias (female OR 3.2 vs criteria OR 1.9; Srinivasan 2019, PMID 31777779) are the quantified drivers.
  3. Diagnosis and phenotype are two different populations that happen to be the same size. Clinical-diagnosis prevalence ≈ criteria prevalence (1.78% vs 1.75% NHIS; 6.1% vs 5.5% primary care), but overlap is only ~26–35% (Walitt 2016, PMID 27281286; Srinivasan 2019, PMID 31777779). Any statistic keyed to "fibromyalgia patients" must state whether the denominator is labeled patients, criteria-positive people, or both.
  4. Incidence numbers differ by an order of magnitude by design. ICD-claims incidence 6.9–11.3 per 1,000 person-years (Weir 2006, PMID 16755239) reflects coding behavior; criteria-based population incidence data are essentially missing (the one prospective figure — 25%/5.5 yrs — is from a preselected pain-reporting female cohort; Forseth 1999, PMID 10555910). No modern population-based incidence study under 2016 criteria was found this session.
  5. Drug effect sizes look different depending on the outcome dial. The same SNRI data yield "no clinically relevant benefit" at ≥50% pain relief (NNTB 11) but a "clinically relevant benefit" at PGIC (NNTB 5) (Welsch 2018, PMID 29489029); pregabalin is "high-quality evidence" for a ~10-percentage-point responder gain (Derry 2016, PMID 27684492); the trial-corpus-wide synthesis finds no therapy exceeding minimum clinically important change on averages (Mascarenhas 2021, PMID 33104162). Present responder gains, NNT, and MCID-vs-average distinctions together, never one alone. Large placebo-arm improvements (Koechlin 2021, PMID 35295427) further compress apparent drug effects.
  6. Mortality metas disagree on all-cause risk (HR 1.27 significant vs OR 1.11 null) but agree on suicide (≈3–5×). The elevation appears in label/registry-based cohorts and disappears in criteria-based subgroups (Treister-Goltzman 2023, PMID 37429737; Wang 2023, PMID 37929630; Wolfe 2011, PMID 20662040) — consistent with diagnostic-label confounding rather than disease-intrinsic mortality. Suicide statistics carry wide CIs and partial attenuation after psychiatric adjustment (Adawi 2021, PMID 34867495).
  7. Cost estimates spread >20-fold ($1,750–$35,920/patient-yr US) across settings, payers, cost categories, and eras, with high risk of bias throughout (D'Onghia 2022, PMID 35849890); the cleanest single matched anchor is ~3× mean / ~5× median vs controls (Berger 2007, PMID 17655684). Utilization is equally elevated in criteria-negative labeled patients (Walitt 2016, PMID 27281286), so "FM costs" partly measure the label.
  8. Concomitant-FM percentages in inflammatory arthritis are pooled over extreme heterogeneity (RA range 4.9–52.4% pooling to 21%; SLE I²=97.9% pooling to 15.8%) — criteria set and screening instrument drive the spread; use ranges alongside pooled values (Duffield 2018, PMID 29788461; Mistry 2024, PMID 39424681).
  9. Figures searched for but NOT verifiable this session (do not quote from memory): Queiroz's "global mean prevalence 2.7%" (abstract carries no number; PMID 23801009); population FIQ/FIQR norms; a primary claims study for the oft-quoted "~30% of FM patients receive opioids" (only secondary statements retrieved: Gmuca 2019, PMID 29905842; Nelli 2023, PMID 37535780; plus tertiary-clinic 32%, Fitzcharles 2011, PMID 21962316); FM-specific surgery rates; juvenile-FM prevalence under modern criteria; disability-benefit statistics outside the US.

Source key (all PMIDs verified against PubMed 2026-08-28)

  • Heidari F, et al. Prevalence of fibromyalgia in general population and patients, a systematic review and meta-analysis. Rheumatol Int. 2017;37:1527-1539. PMID 28447207
  • Marques AP, et al. Prevalence of fibromyalgia: literature review update. Rev Bras Reumatol Engl Ed. 2017;57:356-363. PMID 28743363
  • Queiroz LP. Worldwide epidemiology of fibromyalgia. Curr Pain Headache Rep. 2013;17:356. PMID 23801009 (no figures quotable from abstract)
  • Wolfe F, et al. Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress. Arthritis Care Res (Hoboken). 2013;65:777-85. PMID 23424058
  • Häuser W, et al. Modified 2016 ACR fibromyalgia criteria, the AAPT criteria, and the prevalence of fibromyalgia. Arthritis Care Res (Hoboken). 2021;73:617-625. PMID 32248629
  • Jones GT, et al. The prevalence of fibromyalgia in the general population: comparison of the ACR 1990, 2010, and modified 2010 criteria. Arthritis Rheumatol. 2015;67:568-75. PMID 25323744
  • Walitt B, et al. The prevalence and characteristics of fibromyalgia in the 2012 National Health Interview Survey. PLoS One. 2015;10:e0138024. PMID 26379048
  • Walitt B, et al. Three-quarters of persons in the US population reporting a clinical diagnosis of fibromyalgia do not satisfy fibromyalgia criteria. PLoS One. 2016;11:e0157235. PMID 27281286
  • Vincent A, et al. Prevalence of fibromyalgia: a population-based study in Olmsted County, Minnesota. Arthritis Care Res (Hoboken). 2013;65:786-92. PMID 23203795
  • Vincent A, et al. Cross-sectional assessment of multiple chronic conditions and medication use in adults with fibromyalgia in Olmsted County. BMJ Open. 2015;5:e006681. PMID 25735301
  • Wolfe F, et al. Fibromyalgia diagnosis and biased assessment: sex, prevalence and bias. PLoS One. 2018;13:e0203755. PMID 30212526
  • Srinivasan S, et al. The problematic nature of fibromyalgia diagnosis in the community. ACR Open Rheumatol. 2019;1:43-51. PMID 31777779
  • Jackson T, et al. Global burden of chronic pain without clear etiology in low- and middle-income countries: systematic review and meta-analysis. Anesth Analg. 2016;123:739-48. PMID 27537761
  • Borra C, et al. Sex differences in the prevalence of chronic pain in mid-life: systematic review and meta-analysis. Biomedicines. 2025;13:2523. PMID 41153804
  • Weir PT, et al. The incidence of fibromyalgia and its associated comorbidities (ICD-9 claims cohort). J Clin Rheumatol. 2006;12:124-8. PMID 16755239
  • Forseth KO, et al. Prognostic factors for the development of fibromyalgia in women with self-reported musculoskeletal pain. J Rheumatol. 1999;26:2458-67. PMID 10555910
  • Buskila D, et al. Assessment of nonarticular tenderness and prevalence of fibromyalgia in children. J Rheumatol. 1993;20:368-70. PMID 8474077
  • Gedalia A, et al. Joint hypermobility and fibromyalgia in schoolchildren. Ann Rheum Dis. 1993;52:494-6. PMID 8346976
  • Kashikar-Zuck S, Ting TV. Juvenile fibromyalgia: current status of research and future developments. Nat Rev Rheumatol. 2014;10:89-96. PMID 24275966
  • Lommel K, et al. Juvenile primary fibromyalgia syndrome in an inpatient adolescent psychiatric population. Int J Adolesc Med Health. 2009;21:571-9. PMID 20306769
  • Kerrebijn I, et al. The genetic architecture of fibromyalgia across 2.5 million individuals. Nat Med. 2026;32:3060-3070. PMID 42521817
  • Choy E, et al. A patient survey of the impact of fibromyalgia and the journey to diagnosis. BMC Health Serv Res. 2010;10:102. PMID 20420681
  • Gendelman O, et al. Time to diagnosis of fibromyalgia and factors associated with delayed diagnosis in primary care. Best Pract Res Clin Rheumatol. 2018;32:489-499. PMID 31174818
  • Perrot S, et al. Survey of physician experiences and perceptions about the diagnosis and treatment of fibromyalgia. BMC Health Serv Res. 2012;12:356. PMID 23051101
  • Bennett RM, et al. The Revised Fibromyalgia Impact Questionnaire (FIQR): validation and psychometric properties. Arthritis Res Ther. 2009;11:R120. PMID 19664287
  • Wolfe F, et al. The use of polysymptomatic distress categories in the evaluation of fibromyalgia and fibromyalgia severity. J Rheumatol. 2015;42:1494-501. PMID 26077414
  • Wolfe F, et al. Symptoms, the nature of fibromyalgia, and DSM-5 defined mental illness in patients with rheumatoid arthritis and fibromyalgia. PLoS One. 2014;9:e88740. PMID 24551146
  • Kleykamp BA, et al. The prevalence of psychiatric and chronic pain comorbidities in fibromyalgia: an ACTTION systematic review. Semin Arthritis Rheum. 2021;51:166-174. PMID 33383293
  • Duffield SJ, et al. Concomitant fibromyalgia complicating chronic inflammatory arthritis: systematic review and meta-analysis. Rheumatology (Oxford). 2018;57:1453-1460. PMID 29788461
  • Mistry S, et al. The frequency of fibromyalgia in patients with systemic lupus erythematosus: systematic review and meta-analysis. Clin Rheumatol. 2025;44:9-21. PMID 39424681
  • Ramírez-Morales R, et al. Clinical overlap between fibromyalgia and myalgic encephalomyelitis: systematic review and meta-analysis. Autoimmun Rev. 2022;21:103129. PMID 35690247
  • Todor TS, Fukudo S. Systematic review and meta-analysis of calculating degree of comorbidity of irritable bowel syndrome with migraine. Biopsychosoc Med. 2023;17:22. PMID 37291550
  • Welsch P, et al. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia. Cochrane Database Syst Rev. 2018;2:CD010292. PMID 29489029
  • Derry S, et al. Pregabalin for pain in fibromyalgia in adults. Cochrane Database Syst Rev. 2016;9:CD011790. PMID 27684492
  • Moore RA, et al. Amitriptyline for neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2012;12:CD008242. PMID 23235657
  • Mascarenhas RO, et al. Association of therapies with reduced pain and improved quality of life in patients with fibromyalgia: systematic review and meta-analysis. JAMA Intern Med. 2021;181:104-112. PMID 33104162
  • Bidonde J, et al. Aerobic exercise training for adults with fibromyalgia. Cochrane Database Syst Rev. 2017;6:CD012700. PMID 28636204
  • Koechlin H, et al. Placebo responses and their clinical implications in fibromyalgia: meta-analysis using SSRI and SNRI trials. Front Pain Res (Lausanne). 2021;2:750523. PMID 35295427
  • Fitzcharles MA, et al. Opioid use, misuse, and abuse in patients labeled as fibromyalgia. Am J Med. 2011;124:955-60. PMID 21962316
  • Goldenberg DL, et al. Opioid use in fibromyalgia: a cautionary tale. Mayo Clin Proc. 2016;91:640-8. PMID 26975749
  • Gmuca S, et al. Opioid prescribing and polypharmacy in children with chronic musculoskeletal pain. Pain Med. 2019;20:495-503. PMID 29905842 (secondary for the adult "30%" claim)
  • Nelli A, et al. Green light-based analgesia — novel nonpharmacological approach to fibromyalgia pain. Pain Physician. 2023;26:403-410. PMID 37535780 (secondary for the 11.3–69% claims range)
  • Cui Z, et al. Predictors of duloxetine adherence and persistence in patients with fibromyalgia. J Pain Res. 2012;5:193-201. PMID 22792005
  • Berger A, et al. Characteristics and healthcare costs of patients with fibromyalgia syndrome. Int J Clin Pract. 2007;61:1498-508. PMID 17655684
  • D'Onghia M, et al. The economic burden of fibromyalgia: a systematic literature review. Semin Arthritis Rheum. 2022;56:152060. PMID 35849890
  • Wolfe F, et al. Work and disability status of persons with fibromyalgia. J Rheumatol. 1997;24:1171-8. PMID 9195528
  • Walitt B, et al. The longitudinal outcome of fibromyalgia: a study of 1555 patients. J Rheumatol. 2011;38:2238-46. PMID 21765102
  • Wolfe F, et al. Mortality in fibromyalgia: a study of 8,186 patients over thirty-five years. Arthritis Care Res (Hoboken). 2011;63:94-101. PMID 20662040
  • Treister-Goltzman Y, Peleg R. Fibromyalgia and mortality: a systematic review and meta-analysis. RMD Open. 2023;9:e003005. PMID 37429737
  • Wang H, et al. Fibromyalgia and risk of all-cause, specific mortality: a meta-analysis of observational studies. Int J Rheum Dis. 2023;26:2402-2409. PMID 37929630
  • Adawi M, et al. Suicidal behavior in fibromyalgia patients: systematic review and meta-analysis of over 390,000 fibromyalgia patients. Front Psychiatry. 2021;12:629417. PMID 34867495
  • Khot S, et al. The complexity of pain in inflammatory arthropathies beyond pain intensity and impact: an OMERACT initiative. Semin Arthritis Rheum. 2026;78:152962. PMID 41856014

Portal pages fetched 2026-08-28: ACTTION (https://acttion.org/), OMERACT (https://omeract.org/). Fetches attempted and blocked (HTTP 403): NDB / arthritis-research.org, UK Biobank (ukbiobank.ac.uk/about-our-data).