Researchers from the University of Edinburgh (Scotland) reported that their study found that taking even a little too much acetaminophen over time is more dangerous, in fact, than taking a single much-too-large dose.

Dr. Kenneth Simpson of the University of Edinburgh, the study’s lead author, stated in a press release accompanying the study’s publication:

They haven’t taken the sort of single-moment, one-off massive overdoses taken by people who try to commit suicide, but over time the damage builds up, and the effect can be fatal . . . Staggered overdoses or patients presenting late after an overdose need to be closely monitored and considered for the (acetaminophen) antidote, N-acetylcysteine, irrespective of the concentration of (acetaminophen) in their blood.

(In the UK and other countries, acetaminophen is known as “paracetamol.”)

Additionally, patients who take some opioid pain medications along with acetaminophen should exercise even greater caution with their Tylenol doses, as many commonly-prescribed opioid medications contain acetaminophen as well, making the risk of an unwitting overdose even greater.

The FDA states that the maximum safe daily dose of acetaminophen is 4000 mg, and has taken steps to have manufacturers lower the per-unit dosage to 325 mg in an attempt to reduce the risk of accidental overdose.

Triggered by greater-than-average activity, post-exertional flare-ups may arise more frequently during the hectic lead-up to the holidays. Shopping, family meal preparations, home decoration projects, and a more active social schedule can all take a toll.

It’s a good idea to spend some time thinking about ways you can prepare for the eventuality of a flare-up and to minimize the chances you’ll have one ahead of time.

Some suggestions:

• Delegate whatever you can. Spouses and children can share the burden of décor and cleaning chores; children especially will enjoy putting up the decorations and this will help you avoid painful reaching and stretching.
• Consider outsourcing and simplifying meals wherever possible. One-pot recipes, casseroles, and the occasional delivered pizza can reduce the physical stress that comes with cooking.
• Make family meal gatherings a “pot-luck.” Everyone brings a dish, and that means you only provide the space and the necessary accessories (plates, flatware, glasses, drinks, ice, etc.). Cooking complicated menus can wreak havoc on painful muscles.
• Lower your expectations. The house doesn’t have to be spotless all over; the meal doesn’t have to be perfect; your neighbors will appreciate store-bought goodies just as much as the ones you slaved for hours to bake yourself.
• Seek out an active fibromyalgia support community, either online or in your hometown. Just knowing that others are having similar experiences can reduce emotional stress greatly, which can thus increase your ability to cope with the symptoms.

Finally, remember the real meaning of the holidays and consider cutting back on the whole endeavor this year. Celebrating the holidays doesn’t necessarily mean you have to go “all out.” Maybe this is a good year to take a breather and just enjoy your family and loved ones.

However, if you mention cognitive behavioral therapy to fibromyalgia advocates and you’re sure to get a passionate response.

Cognitive behavioral therapy or CBT is a term that covers a wide variety of psychological treatment approaches in which focus is placed on the role of the patient’s thoughts in controlling and impacting behavior and choices.

Some advocates and patients assert that focusing on CBT merely perpetuates unproven myths that the patient’s pain is “all in the head” – i.e., purely a mental issue. Others assert that CBT has been proven to lessen symptoms of fibromyalgia and should be a central part of treatment.

A recent multi-site clinical trial, the results of which are being reported in Arthritis & Rheumatism, seems to back up the latter group. This study found that CBT lessened depression in teenagers with fibromyalgia and helped them cope with the disease’s symptoms more effectively.

The study looked at 114 teenagers who had been diagnosed with juvenile fibromyalgia. The subjects were divided into groups which received either CBT or fibromyalgia education. Those in the CBT group experienced a reported 37% improvement in disability and depression compared to 12% of the education-only group.

While CBT and other forms of therapy might be useful in fibromyalgia treatment, and patients should consider any treatment that might be effective in managing the debilitating pain associated with fibromyalgia, care should be taken not to infer a reverse correlation. The mere fact that psychiatric treatment models may help a patient develop better coping skills does not mean that the disease is a psychiatric disorder.

On the other hand, if you are applying for Social Security disability, your goal is to win.  If the judge wants to consider your fibromyalgia as a mental condition there is no practical reason to object if if he finds in your favor.

But even if the fibromyalgia sufferer is willing to file the application and go through that potentially lengthy process, it’s far from a certainty that the application process will result in approval. For this reason, many applicants entertain serious doubts about the process, including the fear that they’ll somehow be asked to prove that their pain is real.

And in some ways, they are right to be concerned. A successful disability claim — for any illness — does depend significantly on adequate medical documentation and proof of both the diagnosis and the disease’s impact on the applicant’s ability to work. For that reason, getting professional functional capacity evaluations tests and opinions is a crucial step in the disability application process.

Focusing on the actual limitations that fibromyalgia imposes on the  applicant means that the application process revolves around the true purpose of Social Security Disability: finding out whether the patient/applicant is capable of working, and to what extent. Coupled with sufficient medical evidence of the several facts we do know about fibromyalgia — that it appears to be a neural disorder, for instance, and that it is characterized by cortical or sub-cortical augmentation of pain processes — a thorough FCE can help support the disability applicant with objective, demonstrable proof of physical limitations.

Some doctors incorrectly see fibromyalgia as a “garbage can” diagnosis, meaning that any pain symptoms that cannot otherwise be explained end up with the fibro label.  The problem with this approach is that Social Security judges are increasingly familiar with the American College of Rheumatology’s diagnostic classifications for the disease and judges will discount or ignore a physician diagnosis that does not refer to the American College diagnostic criteria.

Some doctors – thankfully fewer and fewer – do not accept that fibromyalgia exists at all.  Often the medical records from these doctors will contain suggestions that the patient has psychiatric problems, or worse, that the patient is a malingerer or drug seeker.The Hardison law post quotes from a National Fibromyalgia Association publication that offers the following questions that a fibro patient should ask his doctor:

• Are you comfortable with diagnosing and treating fibromyalgia?
• How many fibromyalgia patients have you treated?
• Are you familiar with my other conditions?
• What medications do you usually prescribe for fibromyalgia? Do you have a problem with the medications I am currently taking?
• What do you feel is adequate pain control?
• Can you treat depression or must I see a specialist?
• Are you familiar with alternatives therapies? What therapies do you recommend?
• How can you and I communicate best?

In this era of soaring medical costs and lower reimbursements, patients must serve as their own advocates.  Changes in health care law will discourage treatment of conditions that cannot be objectively observed on x-rays or MRI scans.   Fibromyalgia patients will therefore need to assert the legitimacy of their condition and their rights to treatment.

Successful claimants need treating doctors who fully support the claim.  The “classic” fibromyalgia treatment record is usually voluminous as the suffering patient goes from one doctor to another seeking relief.  The symptoms that the patient suffers also change over time.  A good record will contain discussions from either a primary care doctor or a pain doctor that explains how the claimant is seeking relief and that her symptoms are changing and resistant to treatment.

Less compelling cases, by contrast, usually contain a medical record that is conspicuous for what it does not say.  The treating doctor may talk about the claimant’s complaints and how those complaints do not seem consistent with any particular diagnosis.  Hints of drug seeking behavior may appear in the record.   The treating doctor will report the symptoms but make it clear that these symptoms are self reported, with nothing said about whether the doctor believes his patient.

Judges reading these records will “read between the lines” and will recognize that the doctor has come to the conclusion that his patient has multiple complaints but that no medical treatment of any type is going to help.  Judges often translate this resignation on the part of both the doctor and the patient as the dreaded “attitude of entitlement.”

I recently posted a case study on my Georgia Social Security disability web site describing a hearing in a fibro case I tried that the judge will likely deny.  My client is a pleasant person and she undoubtedly experiences fatigue and discomfort but the record in her case will not support a claim for disability.  Compare this case study to the case studies on this web site that describe winning cases.

An individual’s walk is examined using various parameters, including: step length, time on each foot, time on both feet, walk spend, and sole pressure on the ground (Eureka Alert). The lead researcher believed that people living with fibromyalgia had decreased motor skills and also showed low performance in strength tests, body constitution, and psychological evaluations. From this belief came his theory that people with this disability have altered motion parameters that are then linked to decreased physical and psychological abilities, thereby limiting their quality of life. He decided to test whether fibromyalgia could be diagnosed on these altered motion parameters reliably.

The study focused on sixty-four women and twelve men diagnosed with fibromyalgia, as well as forty-five women and twelve men who were healthy and had no signs or symptoms of the disability. The participants underwent various tests regarding their medical and physical conditions. They found that those individuals who lived with fibromyalgia presented with definite altered motion capabilities compared to those who did not have the condition. Moreover, the fibromyalgia sufferers also had other symptoms that impacted their overall quality of life.

Although observing a person’s gait may not be likely used alone to diagnose fibromyalgia, it may be used in addition to diagnostic criteria to produce a more reliable result. The current testing criteria can often be misinterpreted and evaluating the way a person walks may provide that extra evidence needed to make a correct diagnosis. The earlier a person can be diagnosed with the condition, the easier it will be for them to get the necessary treatment and improve other areas of their life. Additionally, if the condition is so debilitating that they must stop working, having an accurate fibromyalgia diagnosis will allow them to seek disability benefits through the Social Security Administration.

In a previous fibromyalgia disability case I tried in court, my client had a very insufficient work record. In addition, what was stated in her medical records about her condition did not match with what she claimed about her condition; she seemed to very much exaggerate her fibromyalgia pain during the hearing, but when the Judge reviewed the records, he could not find any evidence that she suffered from severe pain. This may not have been a deal breaker for her case, but combined with her lackluster work background, it was enough for her to lose the case. I sometimes feel that if a client has a strong work background and appears to want to work, then that client may have a better chance of winning even despite discrepancies in the medical record.

For example, I had a client once who had a managerial level position within her company and made over $100,000 at the time when her fibromyalgia took her out of work. Well, she won her case without even having to make too much of a compelling argument, since the Judge trying the case likely thought that a person who earns a good salary is less likely to want to stop working and earn a $2,000 Social Security pay check. Seems logical, right? In essence, I believe that this client’s work background helped her win her case even though her medical records weren’t all that comprehensive.

In yet another fibromyalgia case, a client of mine had an excellent testimony which again focused on her past work and desire to keep working even though she couldn’t. In this particular case, the woman testified about her pain, her problem with adjusting to a great decrease in her monthly income after being forced out of work by her condition, and about her feelings of unimportance now that she no longer had a job. This great testimony helped her win the case.

So, in conclusion, if you are suffering from fibromyalgia and want to make the most of your case, focus on what work you have done, communicate that you wish you could still be working if you were healthy enough, and make the Judge understand that getting on Social Security is a necessary evil and not something you actually want. Then, your chances of winning at the hearing are that much better.

One last note: It always helps, of course, to have good medical records to back up your claim or what we call a functional capacity form that is filled out by your physician. If your physician is willing to assist, you will be that much more ahead of the game when it comes to winning your fibromyalgia disability claim.

First of all, you will need to obtain strong support from your treating physician. You will have to submit solid medical records along with your claim for benefits, and these medical records must clearly show that you have a firm fibromyalgia diagnosis and that it interferes with your ability to perform work in major ways. Things like discussions of pain levels and extent of fatigue are the types of things that will need to be present in such records in order for you to even have a chance at winning early.

Another way of possibly winning early is if your condition meets a Listing – which is essentially the SSA’s definition of severe/disabling fibromyalgia. Anything that falls short of meeting that definition/description will fail to meet the listing. Here, again, your medical treatment records must be extensive and consistent. Also, a form completed by your physician which tracks the listing can help. Such a form, which is structured as an easy to read checkbox type of document, will ideally make the adjudicator reviewing your case recognize that your condition meets a listing. This will increase your chances at an early approval.

There is one final way to possibly win a fibromyalgia claim early, and that is to Meet a Grid Rule. Like meeting a listing, this may sound mysterious, but it’s really quite simple (especially if you are over the age of 50). Here’s an example: Let’s say that you don’t meet a listing. Well, you can still win if you have a physical impairment like fibromyalgia, you have limited work and educational history, and you are 50 years old or older. If you meet these criteria, consider taking a look at the “grid rules.” You may fall under a certain grid rule and therefore automatically qualify. The grid rules, however, can sometimes be difficult to understand, so that is why it is a great idea to talk to a disability attorney about winning disability benefits based on the grids.

State Agency adjudicators are known to issue positive decisions in grid cases. That’s why it is imperative that you stress that your case is a grid case and point out the specific grid. Like I said, an attorney can help.

Finally, it is also important to note that State Agency adjudicators are usually underpaid and overworked. They are often given very limited authority, and they are quick to deny cases, even if they are deserving. Consider asking the adjudicator to give your file to a medical consultant or even a supervisor in the State Agency office. That may be your last chance at winning your fibromyalgia disability case early.

The study, conducted by researchers from Johns Hopkins School of Medicine, focused on determining whether participants could get thirty minutes of exercise completed most days of the week and generally remain more active throughout the day.  The eighty-four participants were separated into two groups: one which incorporated “lifestyle physical activity” into their days, including taking stairs, walking more, and parking further away from stores, and one which was a control group, which did not make the same lifestyle changes.  Those in the “lifestyle” group reported better physical movement and decreased pain at the end of the study.  They also increased the amount of exercise that they could complete in a given day or week.  The researchers understood that people have good and bad days with fibromyalgia and encouraged them to simply move as much as they could on a bad day and to not try to overcompensate on a good day.

To make these recommendations more practical for you, U.S. News and one of the researchers listed various “lifestyle” activities that you can try to begin exercising.  They suggest doing activities such as small arm circles or slowly lifting your legs while seated.  Additionally, you should invest in a pedometer to monitor how far you have walked every day.  Perhaps you could challenge yourself to get in a couple extra steps each day.  The researchers also suggest doing yard work, gardening, and doing housework.  Each of these activities needs to be tailored toward your specific needs and should be broken up into short bursts over a couple of days.  Finally, they suggest taking the stairs or engaging in a water activity.  Swimming and water aerobics are both low impact and great exercise, while taking the stairs is a relatively easy way to add in exercise every single day.  Most importantly, you should try to make the activity fun and look for your own creative ways to move that fibromyalgia pain right out of your life.