Gender differences on psychological factors in fibromyalgia: a systematic review on the male experience

Fibromyalgia (FM) is highly prevalent in the female gender. Scarce attention has been given to the exploration and description of this syndrome, from a psychological point of view, when occurring in males. The aim of the present study is to develop further knowledge, and to summarise the literature regarding subjective psychological experience, characteristics of symptoms presentation (both onset and development), and treatment options for FM in male patients, in order to highlight differences with FM in females.

All studies published between January 1993 and February 2020 using PubMed and PsycInfo were included, provided that they met the following criteria: 1) written in English; 2) original articles on studies with a longitudinal design; 3) prospective or retrospective, observational (analytical or descriptive), experimental or quasi-experimental, controlled or non-controlled studies. Reviews and non-original articles (i.e. editorials, letters to the editor, and book chapters) were not included. We utilised the following keywords: (male), (female), (fibromyalgia), combined with Boolean operators 'AND' and 'NOT'.

We found an initial number of 55 papers. Duplicated records were excluded (n=13), as well as papers not focusing on male patients or not fulfilling the inclusion criteria (n=25), thus narrowing the research to 17 papers.

FM male patients consider their masculine identity as inefficiently re-negotiated after the onset of symptoms. FM males tend to endure pain for longer periods of time than females before seeking treatment; bodily symptoms are prevalent with a compromised exploration of feelings about FM. Unfortunately, there is still a paucity of evidence on clinical characterisation and treatment options when FM occurs in males. Moreover, no studies have addressed the issue of the psychopharmacological/non-pharmacological management of males with FM and comorbid psychiatric syndromes.