OBJECTIVES: Fibromyalgia (FM) is a chronic disorder characterized by persistent, widespread pain among other symptoms.  This study compares FM practice patterns and costs across the US and Europe in routine clinical practice. METHODS: Data from cross-sectional, observational studies of FM subjects 18-65 years of age in the US and Europe (France and Germany) were analyzed. Medical resource use (MRU) related costs were abstracted from retrospective chart review; patient out-of-pocket costs and lost productivity were collected via subject self-report.  Direct and indirect costs, related to absenteeism and disability, due to FM were calculated using standard costing algorithms and reported in 2009 US dollars.  Descriptive statistics on select variables and direct and indirect medical costs to society are reported. RESULTS: A total of 442 subjects (203 US, 70 France, 169 Germany) were analyzed.  The U.S., French, and German mean (SD) age was 47.9 (10.9), 51.2 (9.47), and 49.2 (9.80), respectively.  Approximately 95% of the U.S. subjects were female compared to 83% in France and 80% in Germany.  Approximately 40% of U.S. and French subjects and 44% of German subjects were employed either full- or part-time.  More than 27% of U.S. patients were disabled, compared to 11% and 3% in France and Germany, respectively.  Approximately 6% of U.S. subjects were retired compared to 24% in France and 10% in Germany.  The mean (SD) annual direct costs per subject for FM were $7974 (7341) in the U.S., $924 (862) in France and $2234 (2641) in Germany.  The mean (SD) annual indirect costs per subject in the U.S. were $10,697 (20,463) compared to $9,819 (18,242) in France and $7,898 (15,822) in Germany.   CONCLUSIONS: Total direct costs contribute more to the overall US cost in comparison to France and Germany, but total indirect costs due to absenteeism and disability proportionally contribute more in these countries compared to the U.S.