Fibromyalgia: Chronic Pain That Packs a Punch to You and Your Employee By Bonnie S. Muheim Managing chronic pain can be a full-time job, making life for people who have to work to support themselves and their families twice as tough. Workers with diseases and disorders that cause chronic pain must learn to manage their discomfort while maintaining job performance that won’t let down their coworkers and employers. Daily regimens of exercise, rest, medications and other therapies must be fulfilled in order for them to be able to show up for work and contribute as well as other employees. Fibromyalgia (FM) is one clinical syndrome that challenges many employees. A disorder with no known cause or cure, FM affects 2-4 percent of the population. Women are disproportionately affected by FM, with onset occurring most often during early to mid-adulthood. FM is characterized by chronic widespread muscular pain, fatigue and tenderness, and is often accompanied by stiffness, migraine and tension headaches, irritable bowel or bladder, sleep disturbance, cognitive lapses (sometimes called “fibro fog”) and psychological distress. Fibromyalgia is a difficult disorder to diagnose due to its myriad of symptoms. No diagnostic test exists for FM and, because it is often accompanied by other painrelated conditions, such as arthritis, back pain or painful neuropathies, patients often suffer for months and sometimes years before a diagnosis is made. The most effective treatment for FM is a multi-disciplined, customized plan that includes stress reduction, exercise and medication. FM patients are usually prescribed anti-depressants, analgesics, non-steroid anti-inflammatory drugs (NSAIDs), and/or sleep medications. Only one drug, pregabalin (Lyrica), has been approved by the FDA for specifically treating FM. “Fibromyalgia is not just one thing,” said Joy Selak, author of You Don’t Look Sick: Living Well with Invisible Chronic Disease. “It’s a whole basket of disorders, which makes it hard to know which doctor to see and how to treat it.” Selak, a former high-powered stock broker, says it took her seven years and several doctors to arrive at her FM diagnosis. She tried a number of medications, with countless combinations and dosages, and alternative medicine to stabilize her symptoms. She learned her limitations and pain thresholds, and eventually changed her lifestyle by cutting back on her stressful job, allowing her husband to care for her more and making peace with her diagnosis. “I pay attention to how I live now and the changes to my lifestyle allow me to function at a high level.” The Cost of Fibromyalgia As with other chronic diseases and disorders, FM can be expensive. According to the Centers for Disease Control and Prevention (CDC), people with FM have approximately one hospitalization every three years and 2.2 million ambulatory care visits each year.1 A 2007 study of the health care costs of patients with FM revealed that the mean number of doctor’s office visits for FM patients was four times higher than a comparison group. FM patients also had twice as many outpatient visits and four times as many emergency room visits. Average total health care costs for one year were approximately four times higher among FM patients.2 Understanding Fibromyalgia’s Impact Because FM is an “invisible” illness that is very difficult to diagnose, many people are unaware of it or do not believe it is a real condition. Though recognized by the American Academy of Rheumatology in 1990, FM still carries a stigma which, unfortunately, keeps many FM patients from disclosing their diagnosis to their employers. An understanding about FM can help business owners minimize costs associated with FM, including losing a valued employee. By educating themselves about FM, employers have a better appreciation for the effort, pain and frustration their employees may be going through on the job every day. Just because they are not outwardly showing signs of discomfort or fatigue, does not mean they are feeling well. Or, if there is a mistake in task execution, the reason is not necessarily poor judgment or lack of proficiency. Like others with disabilities, individuals with FM often need modifications in their schedules or workplaces in order to remain on the job. If an employee chooses to divulge his or her diagnosis, there are simple, cost-effective accommodations that may be made to ease their workday and maintain productivity. For example, allowing frequent breaks, providing a place to rest comfortably, and increasing mobility in the immediate work area are just a few easy adjustments. Sometimes allowing an employee to work reduced or flexible work hours may make the difference between keeping or losing a valued employee. “An employee should never be penalized for a medical situation,” said Orvalene Prewitt, co-founder and president of the National Chronic Fatigue Syndrome and Fibromyalgia Association and owner of a small business. “So many people fear losing their jobs when diagnosed with fibromyalgia. As an employer, I believe it is my responsibility to educate myself about an employee’s situation and respond to his or her personal conditions. If I value their contribution, I want to do whatever I can to make the arrangement work.” 1 2 Centers for Disease Control and Prevention, www.cdc.gov. International Journal of Clinical Practice, Characteristics and healthcare costs of patients with fibromyalgia syndrome, September 2007. Research into fibromyalgia continues with investigators trying to identify its etiology, or cause, and develop specific treatments. Until then, FM patients will continue with their varied regimens to ease pain, improve their quality of life and contribute to the workplace. ## SIDEBAR A Fibromyalgia Diagnosis What You Can Do As A Patient Educate yourself on fibromyalgia, its symptoms and treatments. Find the right doctor who will help you explore and understand your condition. Be a good reporter. Help your doctor diagnose and effectively treat your condition. Develop accommodations at work to alleviate your symptoms. Identify back-up systems at work to ensure that your job is being performed adequately. What You Can Do As An Employer Educate yourself on fibromyalgia, its symptoms and treatments. Seek compromises and accommodations for employees who suffer from fibromyalgia. Consider a flexible or abbreviated work schedule. Advocate for your employee with your insurance company to ensure that they are adequately covered for diagnostics, medications and complementary treatments. Bonnie Muheim is a health care communications consultant specializing in patient advocacy.