A remarkable study published in the journal Pain has discovered that the body may possess a unique sensory system apart from the nerves that gives individuals the ability to touch and feel. This new found sensory system has been located in two patients throughout blood vessels and sweat glands. Most people have various nerve endings located right below the skin, allowing them to feel their environment. The study was conducted by a research team supported by various pharmaceutical companies and the National Institutes of Health.
When examining two patients who had an inability to feel pain, known as congenital insensitivity to pain, the researchers discovered this hidden layer of sensory nerve endings. The condition often manifests itself through excessively dry skin, patients accidentally harming themselves or developing severe handicaps. The study was initiated due to the patients’ complaints of excessive sweating. Upon first examination, the researchers found that the skin reactions were very impaired, when presented with varied temperatures and mechanical contact. However, the patients had good sensation for daily living, telling the difference between hot and cold, and what was touching them. When the skin biopsies were sent for further examination, the researchers were astounded to find out that the skin completely lacked nerve endings necessary for sensation.
What confounded the researchers was the fact that the patients had some ability to feel and the lack of nerve endings on the skin would make that impossible. Upon further examination, they found sensory nerve endings on small blood vessels and sweat glands in the skin. The patients were able to feel their surroundings because of these hidden sensory nerves. Researchers knew that there were nerve endings on blood vessels and sweat glands, however, they assumed that these endings only regulated blood flow and sweating. Despite the standard nerve endings missing from the skin, these hidden nerves provided the sensory needs for the patients.
The researchers noted that the discovery of these hidden nerves may provide a new possibility to understanding the mysterious pain condition of fibromyalgia. If the pain associated with fibromyalgia is radiating and originating from these hidden nerves, doctors and scientists may be able to better treat and diagnose patients. Additionally, they may be able to determine the cause of the pain. Being able to diagnose an individual with fibromyalgia is very important for treatment, as well as decisions regarding the disability. Often the pain is so serious that individuals cannot perform their daily functions. Understanding the make up of this secret sensory system in the sweat glands may help sufferers to control their disease more effectively.
Filed under Fibromyalgia - research by on Jan 5th, 2010. Comment. 
A new study published in the journal Sleep may provide insight into the mysterious disease known as fibromyalgia. The disease impacts over 6 million individuals, with most of those being women. Additionally, the disease is notoriously difficult to diagnose and treat. Because fibromyalgia has no known cause, traditional treatment options are limited, and many do not keep the symptoms at bay for very long. This new study regarding sleep disorders, however, may be able to show a link between disrupted sleep patterns and fibromyalgia.
The study consisted of 28 women (since women are the majority of fibromyalgia sufferers) who were examined for sleep patterns. 14 of the women noted that they snored on a regular basis, 4 snored occasionally, and 10 noted they never snored. In addition to these fibromyalgia sufferers, the study also examined 11 women who did not have that particular disease, rather they had upper airway resistance syndrome (UARS). UARS is a less severe form of the traditional sleep apnea, in which individuals stop breathing numerous times during the night, in intervals of 10 seconds or more. With UARS, the patients have mild obstruction to breathing during sleep because the soft tissues collapse.
The women underwent sleep examinations to measure the amount of inspiratory airflow and to discover how much continuous positive airway pressure (CPAP) was needed to alleviate the obstruction. Of the 28 fibromyalgia participants, 26 were found to have UARS and one had sleep apnea. Of the UARS-specific group, all participants showed a limitation in respiratory airflow. To further study what these figures meant, the researchers requested that 14 of the fibromyalgia patients undergo CPAP nasal treatments for 3 weeks. They found, with this treatment, 47% improvement of gastrointestinal symptoms, 46% improvement in fatigue, 39% improvement in sleep problems, 33% improvement in rheumatic symptoms, 30% improvement in pain, and 28% improvement in functional disability. Further, some of the patients opted to stay on CPAP therapy after the conclusion of the study.
The researchers concluded that the limitation of airflow during sleep was a likely cause for some of the fibromyalgia symptoms. Further research is necessary and certainly larger, more varied participant groups should be evaluated. At first glance, however, the study appears to provide good news for fibromyalgia sufferers due to the fact that most of the participants had some form of inspiratory sleep airway obstruction, which can be alleviated by CPAP treatments. These CPAP treatment devices are readily available and fairly simple to operate. The authors of the study opine that CPAP may, in time, become the most efficient and effective method of treating those with fibromyalgia.
Filed under Fibromyalgia - research by on Dec 28th, 2009. Comment.
The community of lawyers who publish and maintain blogs is relatively small. One of the better and most prolific lawyer/bloggers is Sherrie Sisk from North Myrtle Beach, South Carolina. This past April, Sherrie inaugurated a new blog called The Tramadol Diaries which describes her struggle with fibromyalgia and discusses the legal, medical and lifestyle issues of living with and thriving despite chronic pain.
Sherrie describes herself as a “recovering lawyer” and notes that she has phased out her law practice because of her fibromyalgia. Now, she is transitioning into a new career as a write and a coach.
While the legal community will miss this talented and vocal advocate, the fibromyalgia community now has a passionate, determined and thoughtful voice who will discuss medical developments, communication issues and, I suspect, legal issues related to fibromyalgia. Besides her blog, Sherrie is at work on a book and offers coaching and speaking services.
In my law practice I have observed that many of my fibromyalgia clients often fit a profile – intelligent, over-achieving, type “A” individuals (mostly female) who are extremely organized and committed to finding relief from their symptoms. If you were not previously aware of Sherrie’s blog, I strongly recommend that you bookmark it or add its feed to your home page or blog reader software.
Filed under Fibromyalgia resources, Fibromyalgia web resources by on Dec 5th, 2009. 1 Comment.
As you probably know, filing a Social Security disability claim based on fibromyalgia is just the first step in what can be a long process. Whether you are filing on your own or have representation, it is pretty unlikely that your personal and financial situation or even your medical condition will look exactly the same at the beginning, middle, and end of this process. Some changes are inevitable, and some are the intended or unintended product of decisions made over time. Since it is not always obvious that a particular change or decision could impact your claim, I make sure that clients understand their claim, the arguments and evidence we are presenting, and the importance of keeping each other up to date on any changes that might affect our chances of success. In cases involving fibromyalgia, it can be especially important to have a detailed account of your symptoms and how they interfere with daily functions, especially your ability to work.
For the most part, the Social Security Administration gets information on your eligibility and medical condition when you apply for benefits. While it is difficult to outline all possible changes and decisions that could have a positive or negative impact on fibromyalgia disability claims, it is worthwhile to examine some of the more common or impactful issues for disability claims in general. Some are obvious; others are not. If you are uncertain of whether a change or decision in your life might hurt or help your disability claim, I would be happy to discuss it with you.
The following is a list of changes to your financial situation that should be discussed with your lawyer:
- You receive help through any Public Assistance Program (e.g., Medicaid, Food Stamps, Cash Assistance);
- You go back to work (part time, full time, temporary, etc.)
- You begin to receive (or cease receiving) payments from a recurring source such as unemployment, workers’ compensation, short-term or long-term disability, retirement fund, or Social Security;
- Your spouse loses his or her job or receives payments from the sources mentioned above;
- You file for bankruptcy, or face losing your home to foreclosure or eviction;
- You are involved in another legal proceeding, either as a plaintiff or as a defendant
You should also inform your lawyer of any of the following “personal” changes:
- You get married or divorced;
- You have or adopt a child;
- You start (or leave) school or vocational training;
- You are arrested, charged with a crime, or a warrant is issued for your arrest;
- You fail to pay (or no longer receive) child support;
- You move or change your address or telephone number
Clearly, if your doctor releases you back to work, it is going to be relevant to your disability claim. You should also be aware of additional medical and treatment decisions or changes that should be discussed with your lawyer:
- You begin treatment with any new healthcare providers;
- You are diagnosed with any new medical conditions or are treated for additional symptoms;
- You have had or are scheduled for surgery;
- You are hospitalized or treated in an emergency room;
- You are involved in an accident, experience a new injury, or aggravate an existing injury;
- You stop receiving treatment for your condition, or your treatment changes;
- Your treatment is terminated by any of your doctors for any reason;
- You are using illegal drugs (including non-prescribed prescription medications);
- You begin to use or abuse alcohol
For disability claims involving fibromyalgia, it is especially important that I have complete and updated medical information so that the Social Security Administration has an opportunity to review a complete and accurate medical profile before making a decision. In addition to the more obvious changes discussed above, disability claimants with fibromyalgia will need to provide evidence proving that their condition prevents them from working. The symptoms of fibromyalgia vary from patient to patient and, often, over time. Consider keeping a diary of how you feel each day, what you did and/or tried to do, whether you were too tired to complete normal tasks, and note any exacerbations following over-exertion. When you see a physician, make sure that he or she actually includes all of your symptoms and the specific ways your illness limits your life in the notes included in your medical record.
I find that lawyers and clients have varying preferences on how, and how often, informational updates are communicated, so you may want to agree on an efficient and reliable system that works for everyone on your team.
Filed under Fibromyalgia Case Strategies by on Nov 20th, 2009. Comment.
There is a perception that Social Security disability cases based on fibromyalgia are difficult to win. It is not surprising that some judges have a problem acknowledging a medical syndrome that cannot be detected by a blood test and that can have a wide range of generalized symptoms. Until fairly recently, in fact, physicians did not have a way to specifically “code” a fibromyalgia diagnosis on insurance claim forms, and there were no medications approved by the FDA to treat it. Every once in a while, you will find a judge who does not believe that fibromyalgia exists. But even these non-believers will still approve your case if you can show that your symptoms are chronic and severe, that you have sought medical treatment, and that your condition prevents you from performing any kind of work at all.
In fibromyalgia cases, there is no “one size fits all” strategy – just as the condition’s symptom cluster can impact each individual differently, each case must focus on the individual claimant’s symptoms and their impact on function. Over the years, I have won favorable decisions for many fibromyalgia Social Security claimants. In one case, the Judge called a psychiatrist as an expert witness. The Judge granted benefits on the ground that my client’s “fibro fog” was equivalent to a chronic state of anxiety – a psychiatric condition.
A short time later, I represented another fibromyalgia client before another Judge in the same hearing office – this Judge awarded benefits (correctly, I believe) on the basis of a combined impairment. This is significant in that it demonstrates the potential importance of convincing the judge to recognize the combined effect of fibromyalgia’s impact on the claimant’s physical and mental condition, and the potential that the combined effect is sufficiently disabling.
Within a few months, another client with fibromyalgia sought disability benefits due to severe, chronic pain associated with fibromyalgia. In this case, a different judge granted disability benefits based on the determination that the client’s condition was equivalent in impact to severe arthritis.
I recently wrote about the recent exciting news for fibromyalgia sufferers – identification of a potential viral cause or precipitator for the condition. As increased research on causes and treatments emerge, I expect that it will eventually become quite rare to encounter a judge who is completely resistant to considering a fibromyalgia basis for disability. In the meantime, though, even if judges don’t understand the condition, many will honor the opinion of your treating physician, especially if you have a long and continuous treatment record (the legal term for a thorough medical history is a “longitudinal treatment record”).
Filed under Fibromyalgia Case Strategies by on Nov 11th, 2009. Comment.
In a fibromyalgia disability case, you need to prove one thing – that you are not able to work. If you remember nothing else about Social Security disability, you should remember that your capacity for performing work is the only thing that matters to a Social Security judge. Your underlying medical condition – fibromyalgia, chronic fatigue syndrome, or any other medical problem, is only important to the Social Security Judge if your symptoms limit you from performing a job 8 hours a day, 5 days a week.
In most cases, the judge’s decision really boils down to a judgment call about whether you could hold down a simple, sit-down type of job that requires no training; that allows you to sit, stand, and adjust your position; and that is not production oriented. In fact, in most hearings, the Judge will call a ‘vocational expert’ to testify about work you have done in the past and about simple, minimally demanding jobs that exist in the national economy.
As a claimant’s lawyer, my job is to identify medical records that suggest work limitations. In many cases this means I need to review all of the medical records, then create a functional capacity checklist that includes both the limitations associated with your fibromyalgia case and the impairment categories used in Social Security cases.
We then ask your doctor to complete the checklist for submission to the Judge. We do not ask the doctor to decide if you are ‘disabled’ – that is a legal decision for the Judge. Instead, we ask your doctor to help ‘translate’ medical conclusions into specific work limitations.
Many fibromyalgia patients get used to living with their symptoms and fail to mention all of them to their doctors or to the judge. It may be helpful to use a calendar to keep diary notes about how you feel, what symptoms you experience each day, and the impact on your performance. Make lists. Ask for your spouse’s or children’s observations.
If you are considering or currently pursuing a disability case based on fibromyalgia, I invite you to get a free evaluation of your case by filling out the simple online form on the right side of this page.
Filed under Fibromyalgia Case Strategies by on Nov 11th, 2009. Comment.
The New York Times cites an article in the medical journal Science which reports that 68 of 101 patients (67%) with chronic fatigue syndrome were infected with an infectious virus, xenotropic murine leukemia virus-related virus, or XMRV. By contrast, only 3.7 percent of 218 healthy people were infected. Author Judy Mikovitz, M.D. states that on-going studies show tha the virus exists in nearly 98 percent of about 300 patients with the syndrome.
“I think this establishes what had always been considered a psychiatric disease as an infectious disease,” said Dr. Mikovits, who is research director at the Whittemore Peterson Institute in Reno, a nonprofit center created by the parents of a woman who has a severe case of the syndrome.
Dr. Mikovitz notes that XMRV is a retrovirus, which is the same family as the AIDS virus. She states that she plans to treat CFS patients with some of the anti-viral medications used to treat AIDS patients.
Chronic Fatigue Syndrome and Fibromyalgia are commonly accepted as legitimate causes of disability in Social Security disability cases, although some judges continue to have difficulty approving claims in which there are no “objective” findings of disease. Because no definitive testing exists, there is no “listing” for CFS or fibromyalgia and disability attorneys must prove that their clients are not able to work by arguing that a claimant’s functional capacity for work has been eroded by the symptoms associated with CFS or fibromyalgia.
If CFS and/or fibromyalgia do arise from a virus and claimants can be tested for that virus, it is likely that SSA will create a listing for these chronic diseases.
Filed under Chronic Fatigue Syndrome, Medical Develoments by on Oct 8th, 2009.
