Category: Fibromyalgia Conditions

Explore the conditions associated with Fibromyalgia, their symptoms, and how to manage them for improved well-being.

  • Struggled for the Social Security Disability of Fibromyalgia (FM) and Chronic Fatigue Syndrome (CFS)

    Struggled for the Social Security Disability of Fibromyalgia (FM) and Chronic Fatigue Syndrome (CFS)

    “Fibromyalgia, Chronic Fatigue Syndrome, and Objective Medical Evidence Requirements …” was the subject of a memorandum from Social Security Deputy Commissioner, Susan M. Daniels, Ph. D., (“the Deputy Commissioner”) to a Social Security administrative law judge (ALJ) in May 1998. This memo has been widely circulated.

    The memo was in response to memoranda from the ALJ to the Deputy Commissioner, to an appeal judge, and to the general counsel for Social Security. The ALJ asserted that fibromyalgia and chronic fatigue syndrome (CFS) are not “medically determinable impairments” under the Social Security Act and urged the Social Security Administration (SSA) to take a definitive position on this question.

    The Deputy Commissioner responded that SSA had taken a position: that fibromyalgia and CFS can be medically determinable impairments under the statute.

    She explained that a specific diagnosis is not necessary to prove a medically determinable impairment, especially where the medical community has not yet agreed on the diagnostic criteria. If there are anatomical, physiological, or psychological abnormalities that can be objectively observed and reported apart from the claimant’s perceptions, a medically determinable impairment is shown even in the absence of a definitive diagnosis.

    The “signs and the findings” required to prove the disability may include symptoms when appropriately reported by a physician or psychologist in a clinical setting.

    CFS is “clinically evaluated, persistent or relapsing chronic fatigue that is of new or definite onset which cannot be explained by another diagnosed physical or mental disorder, or by the result of ongoing exertion” and which “is not substantially alleviated by rest and results in a substantial reduction in previous levels of occupational, educational, social, or personal activities.” It is a systemic disorder whose symptoms and signs may vary in incidence, duration, and severity.

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    Records reflecting ongoing medical assessment and treatment are needed to document objective physical and/or mental findings. SSA will recognize a medically determinable impairment if the records for at least six consecutive months show one or more of the following:

    • low-grade fever;
    • palpably swollen and tender lymph nodes;
    • nonexudative pharyngitis; and/or
    • muscle wasting with no other direct cause identified.

    While there are no specific laboratory findings that definitively document the presence of CFS, findings indicating chronic immune system activation, such as slight elevations in immune complexes, depressed natural killer cell activity, or atypical lymphocytes, may also be included in the evidentiary record of individuals alleging CFS.

    Some CFS sufferers report problems with short-term memory, comprehension, concentration, speech, and/or calculation. Others may exhibit signs of mental or emotional disorders such as anxiety or depression. When documented by mental status examination and/or psychological testing, these findings mark the presence of a medically determinable impairment.

    So, when your patient reports disabling fatigue, your thorough examination – at least looking for the signs noted above, scheduling follow-up visits to monitor persistence, referral (as needed), and comprehensive chart notes on your observations, even if a definitive diagnosis is not possible, will provide the medical documentation needed should this condition become so impairing as to force your patient to apply for Social Security disability benefits.

    Your documentation is critical since symptoms alone cannot be the basis for finding a medically determinable impairment, which is necessary to prove disability under Social Security law.

    The SSA recognizes fibromyalgia as medically determined if the tender points identified by the American College of Rheumatology (ACR) are documented.

    The ACR defines fibromyalgia as “widespread pain in all four quadrants of the body for a minimum duration of 3 months … in at least 11 of the 18 specified tender points which cluster around the neck and shoulder, chest, hip, knee, and elbow regions.”

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    Other typical symptoms which may help prove fibromyalgia if clinically documented over time are irritable bowel syndrome, chronic headaches, temporomandibular joint dysfunction, sleep disorder, severe fatigue, and cognitive dysfunction.

    The Deputy Commissioner acknowledged that policies concerning the adjudication of claims involving impairments like fibromyalgia and CFS needed to be better explained and that policy guidelines were being drafted for that purpose.

    We have noticed that fibromyalgia has been the subject of increasing numbers of articles in medical journals in recent years, including several by Robert M. Bennett, M.D., F.R.C.P., Professor of Medicine and Chairman, Division of Arthritis, and Rheumatic Diseases, Oregon Health Sciences University.

    Recently, a victim of CFS represented by our office had to appeal her Social Security claim all the way to the Federal District Court. There, the Federal judge not only ordered that she be declared disabled and awarded benefits but also penalized the Commissioner of Social Security for unreasonably denying her claim. Our client’s medical record included the types of documentation described in the Deputy Commissioner’s memo.

    The absence of definitive diagnostic criteria and the absence of the usual objective and observable findings make these conditions difficult and frustrating for physicians to identify. However, Social Security will evaluate these on an individual basis. Severe cases of fibromyalgia and CFS cannot just be rejected solely for lack of traditional objective findings.

    We hope you find this summary useful as you record your observations, so your patients who qualify for Social Security disability may present the necessary medical documentation. The case study belongs to Social Security Disability Lawyer Articles.

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    References:

    Fibromyalgia Contact Us Directly

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    Official Fibromyalgia Blogs

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  • Study shows that Fibromyalgia (FM) and Irritable Bowel Syndrome (IBS) mostly attack together

    Study shows that Fibromyalgia (FM) and Irritable Bowel Syndrome (IBS) mostly attack together

    Len Chung, MD Associate Professor of Medicine, Co-Director of the UCLA/CURE Neuroenteric Disease Program, Director of the UCLA Motility Unit Irritable bowel syndrome (IBS) is a very common gastrointestinal condition, which is present in 8- 20% of the general population.

    Several population-based studies have demonstrated IBS symptoms to be more common in women, with prevalence ratios ranging from 2 to 3:1. It has been estimated to affect 14-24% of women and 5-19% of men. The classic gastrointestinal symptoms of IBS are chronic or recurrent abdominal pain and/or discomfort and associated alterations in bowel habits.

    However, many individuals with IBS also suffer from non-gastrointestinal symptoms. Rheumatologic symptoms, such as skin rashes, muscle contraction headache, and myalgias, have been reported in two-thirds of IBS patients. Previous studies have found that IBS typically overlaps with fibromyalgia syndrome (FM) in the same patient, suggesting a common cause.

    FM occurs in up to 60% of patients with irritable bowel syndrome (IBS). Up to 70% of patients with a diagnosis of FM have symptoms of IBS. FM belongs to a general class of chronic musculoskeletal pain syndromes. It is a common pain disorder in which the presence of multiple muscular tender points is associated with characteristic symptoms of generalized muscle aching, stiffness, fatigue, and an abnormal sleep pattern.

    Following osteoarthritis and rheumatoid arthritis, FM is the most common disorder seen in community rheumatologic practice. In rheumatology clinics, the proportion of new patients with FM syndrome ranges from 10% to 20%, while in non-specialized settings, the reported prevalence is less, 2.1% to 5.7%. FM affects 2% for both sexes, 3.4% for women and 0.5% for men.

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    The diagnosis of FM is presently defined by criteria, which consists of widespread pain and the presence of painful tender points established by the American College of Rheumatology in 1990. Although IBS is a chronic gastrointestinal pain condition and FM is a chronic muscular pain disorder, IBS and FM have common clinical characteristics:

    • both are functional pain disorders which cannot be explained by structural or biochemical abnormalities,
    • both occur predominantly in women,
    • the majority of patients associate stressful life events with the onset or exacerbation of symptoms,
    • the majority of patients complain of disturbed sleep and fatigue,
    • psychotherapy and behavioral therapies are efficacious in treating symptoms,  
    • certain medications can treat symptoms of both conditions.

    It has been suggested that IBS and FM have a common cause and that specific physiologic alterations may be responsible for the symptoms seen in these two conditions. While IBS is a condition characterized by visceral (intestinal) hypersensitivity, FM is a condition of somatic (skin and muscle) hypersensitivity.

    There have been several studies, which have shown that IBS patients have normal or decreased somatic sensitivity. We have recently completed somatic perception studies in female patients with IBS alone, both IBS + FM, and healthy individuals.

    The response to pressure that was placed on particular muscle tender points was measured. Like FM patients, patients with IBS + FM demonstrate somatic hyperalgesia (increased somatic pain sensation). However, patients with IBS alone have somatic hypoalgesia (decreased somatic pain sensation).

    This study demonstrates that while IBS patients have increased sensitivity to visceral pain, they are less sensitive to somatic pain. Only a couple of studies have evaluated visceral sensation in FM patients using a balloon catheter placed in the rectum and lower large intestine (colon).

    The balloon catheter is connected to a computerized pump which inflates the balloon and thus reaches specific pressure levels in the bowel. The patient’s sensations in response to the balloon inflation can be measured. These studies have reported that patients with FM with or without IBS have visceral perception in between that of healthy controls and IBS patients.

    These data suggest that IBS has altered perceptual responses to visceral and somatic pain/discomfort and the coexistence of FM alters these perceptual responses. Recent studies using brain-imaging techniques have found alterations in how the brain processes visceral information in IBS.

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    To determine if similar altered responses to visceral and somatic pain information occur in patients with IBS and FM, we have compared the brain responses to visceral and somatic stimuli in patients with IBS alone, IBS + FM, and healthy individuals. Brain responses are assessed by positron emission tomography (PET), which can measure blood flow to brain areas in response to a particular stimulus.

    Results have shown that patients with both IBS and FM have greater brain responses in areas that are involved in pain, memory retrieval of past painful experiences, and increased attention or awareness to a stimulus than the other subject groups. Recent functional brain imaging studies have suggested that alterations in the processing of sensations by the brain play an important role in IBS and FM.

    In summary, clinical characteristics and significant overlap of symptoms suggest that the functional syndromes IBS and FM may have a common etiology. Visceral and somatic perception studies and brain imaging have demonstrated that each of these conditions has specific responses to painful stimuli and that patients with both IBS and FM may have responses to somatic and visceral stimuli that are uniquely different from that of IBS alone and FM alone.

    Further studies are being performed in these common conditions to further our understanding of chronic visceral and somatic pain conditions and lead to more effective treatment.

    https://fibromyalgia-6.creator-spring.com/
    https://www.teepublic.com/stores/fibromyalgia-store

    Click Here to Visit the Store and find Much More….

    For More Information Related to Fibromyalgia Visit below sites:

    References:

    Fibromyalgia Contact Us Directly

    Click here to Contact us Directly on Inbox

    Official Fibromyalgia Blogs

    Click here to Get the latest Chronic illness Updates

    Fibromyalgia Stores

    Click here to Visit Fibromyalgia Store