E2 ModerateModerate confidencePEM unclearLongitudinalPeer-reviewedReviewed
Prevalence, health care utilization, and costs of fibromyalgia, irritable bowel, and chronic fatigue syndromes in the military health system, 2006-2010.
Jeffery, Diana D, Bulathsinhala, Lakmini, Kroc, Michelle et al. · Military medicine · 2014 · DOI
Quick Summary
This study looked at how many military service members had fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome between 2006 and 2010. Fibromyalgia diagnoses increased significantly during this period, while chronic fatigue syndrome diagnoses stayed about the same. The cost of treating fibromyalgia cases rose dramatically, especially after new fibromyalgia medications became available.
Why It Matters
This study provides important epidemiological context for CFS by showing that CFS prevalence remained stable even as other medically recognized conditions increased during the same period, suggesting different disease trajectories. Understanding how clinical recognition, diagnostic approval, and pharmaceutical marketing influence reported prevalence helps ME/CFS patients and researchers interpret disease burden statistics and recognize potential biases in how conditions are tracked and reported.
Observed Findings
- Fibromyalgia prevalence increased 70% from 0.307% to 0.522% over five years, with the largest increase occurring between 2007 and 2008.
- Chronic fatigue syndrome and irritable bowel syndrome prevalence rates remained stable throughout the study period.
- Total pharmacy costs for FMS cases increased from $55 million to $96.3 million, while CFS costs increased only $3.7 million over five years.
- FMS cases showed higher health care utilization compared to IBS and CFS cases.
- The increase in FMS prevalence coincided temporally with FDA approvals of medications for fibromyalgia and pharmaceutical industry marketing campaigns.
Inferred Conclusions
- The temporal association between FDA drug approvals, pharmaceutical marketing, and increased FMS prevalence suggests that drug availability and promotion may have influenced diagnostic practices and prevalence reporting.
- The stability of CFS prevalence in the same population contrasts sharply with FMS trends, suggesting different factors affecting recognition and diagnosis of these conditions.
- Pharmaceutical approval and marketing activities may influence not only treatment patterns but also disease prevalence estimates in surveillance data.
Remaining Questions
- Did true disease incidence increase or did diagnostic awareness and ease of diagnosis change? Why did CFS prevalence remain stable while FMS increased—was this due to diagnostic barriers, clinician skepticism, lack of approved treatments, or different underlying epidemiology?
What This Study Does Not Prove
This study cannot establish causation—it only documents that FMS prevalence increased at the same time as FDA drug approvals and marketing campaigns. The observation does not prove that drugs caused increased diagnoses; increased recognition, improved diagnostic criteria, or genuine increases in disease incidence could also explain the trend. The stable CFS prevalence does not reflect the true disease burden, as diagnostic barriers and underrecognition may mask actual prevalence.
Tags
Method Flag:Weak Case DefinitionMixed Cohort
Symptom:Fatigue
Metadata
- DOI
- 10.7205/MILMED-D-13-00419
- PMID
- 25181721
- Review status
- Editor reviewed
- Evidence level
- Single-study or moderate support from human research
- Last updated
- 12 April 2026
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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