January 26, 2020

Commonly Prescribed Fibromyalgia Meds Work only 20% of the Time Study Says

ScienceDaily.com reports on a recent medical study conducted in Germany which shows that two medications commonly prescribed for fibromyalgia offer benefit to only about 1 out of every 5 patients.

The study looked at testing conducted on 6,000 adults – mostly middle aged females – who were prescribed duloxetine (Cymbalta), milnacipran or a placebo.  Study participants were asked to rate these drugs on a “quality of life” scale.  Only 22% of participants reported significant improvement, while 21% discontinued using medications because of side effects.

A future study will evaluate pregabalin (Lyrica) later this year.

“The medical field does poorly with the treatment of fibromyalgia in general,” says Brian Walitt, M.D., M.P.H., a co-author of the review and an expert in pain syndromes at Washington Hospital Center in Washington, D.C. “Chasing [a cure] with medicine doesn’t seem to work.”

This relative ineffectiveness of prescription medication should not be a surprise to Social Security disability claimants who are applying for benefits due to chronic pain, cognitive decline and fatigue associated with fibromyalgia.   Obviously individuals who allege that the are disabled are not benefiting from medications, and claimant’s attorneys often note symptoms of depression due to the absence of any viable treatment options.

If you have been prescribed Cymbalta, Lyrica or any other prescription medication by your doctor, it is important that you make every effort to remain complaint with recommended treatment.   Social Security judges are often not very understanding if a claimant decides to stop taking a medication on his or her own, even if that medication does not seem to be working.

At the very least, report to your doctors any concerns about the effectiveness and side effects of medications so that your medical record will reflect what you have experienced.  Judges will use non-compliance as a basis for denying claims and this is especially true for cases involving a condition that arises from symptoms that are inherently subjective and self -reported.


Mind-Body Approach to Healing – Zero Pain Now

Neuro-Linguistic Programming practitioner Adam Heller has written a book entitled Zero Pain Now in which he describes a “mind-body” approach to healing fibromyalgia pain.  Mr. Heller argues that fibromyalgia causes physical changes in the brain that can be reversed without the use of narcotic pain mediations.  Take a look at Mr. Heller’ s video.  If you have had experience with Zero Pain Now – either positive or negative, please let us know.

Fibromyalgia from Adam Heller on Vimeo.

Fibromyalgia Patients: Avoid Accidental Overdosing on Tylenol

Many fibromyalgia patients use Tylenol, either in conjunction with other pain medications (such as tramadol) or as over-the-counter pain relief for mild-symptom days. But a recent study warns that even the tiniest overdose of acetaminophen can result in death.

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. [Read more…]

A Holiday Wish from Fibromyalgia-Disability.com

With the holidays upon us, many Americans will feel tired and achy at the end of a long day. But those of us with fibromyalgia are at risk to experience something even worse – post-exertional flare-ups.

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. [Read more…]

So What if Your Social Security Judge Calls Fibromyalgia a Mental Health Condition!

Social Security judges often call psychologists to testify as expert witnesses in fibromyalgia disability cases because there is medical literature that characterizes fibromyalgia as a mental health condition that produces physical symptoms.

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. [Read more…]

Do Disability Applicants Have to Prove Their Fibromyalgia Is “Real”?

Given the level of debate within the medical community about the nature and even the existence of fibromyalgia as a “real illness,” it’s not surprising that many people with fibromyalgia entertain significant doubts about applying for disability. It is true that many fibromyalgia patients, through careful and assertive pain management techniques and treatment protocols, can do most everything they used to do before the onset of their symptoms, and that includes working. However, for some fibromyalgia patients, pain levels are so significant that work is impossible. For those people, applying for Social Security Disability should be considered.

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.

Finding the Right Fibromyalgia Doctor

I recently ran across an interesting article on a blog published by the North Carolina disability law firm Hardison & Associates called “Fibromyalgia: Searching for the Right Doctor.”   This article raises several issues that I regularly face in my own disability practice – many physicians do not understand how to diagnose fibromyalgia and can damage your disability case by offhand comments in your medical record.

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. [Read more…]

What Constitutes a Losing Fibromyalgia Claim

We spend a lot of time on this site and others talking about the elements of a winning Social Security disability claim arising from fibromyalgia.   Because there are no objective tests currently available, Social Security judges have to rely on medical records and testimony from the claimant.

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.

New way to diagnose fibromyalgia: Just look at someone’s gait!

Chronic illnesses like fibromyalgia are notoriously difficult to diagnose, and often, symptoms are characteristic of other conditions. People may live with fibromyalgia for years, never knowing why they are suffering with such severe pain. What may be worse is that they can be diagnosed with another condition entirely and not receive the medical attention they need. Their work, relationships, and daily lives can be adversely impacted, with no answers or relief. Now, a researcher from the University of Grenada has developed a new tool to accurately diagnose fibromyalgia. The unlikely method concentrates on the way a person walks, and when combined with specific diagnostic criteria, is very reliable in diagnosing the condition.

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.

Tips on Winning a Fibromyalgia Disability Case

The importance of work background in a fibromyalgia disability case

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.