November 13, 2019

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…]

Studies Linking Mouse Retrovirus with Fibromyalgia Appear Flawed

Social Security disability lawyers representing fibromyalgia clients often seen similarities in their clients.  Most fibromyalgia clients are “Type A,” overachieving females between the ages of 30 and 60 who experience a gradual onset of fatigue, myofascial pain, mental confusion, digestive upset and balance issues characteristic of a FM/CFS diagnosis.

Many of these fibromyalgia patients go from doctor to doctor looking for a cure, but, of course, there not only is no cure, but there is no consensus in the medical community as to how to objectively test for this condition.

Medical researchers have been working on this problem and over the past few years there have been a number of studies published that purport to identify unambiguous markers that will enable practitioners to objectively diagnose FM/CFS.

One of the more intriguing medical studies in recent years involved the Whittermore-Peterson Institute and researcher Judy Mikovits.

The fibromyalgia and Chronic Fatigue Syndrome (CFS – also sometimes referred to as “CFS/ME,” where “ME” stands for myalgic encephalomyelitis) community has been roiled by a controversy over the news, reported first in 2009, that a mouse retrovirus might be involved in CFS.  Now, the research group which first asserted the connection between xenotropic murine leukemia virus-related virus (XMRV) and CFS is at the center of another controversy – this one of a decidedly non-medical nature. [Read more…]

Yoga Can Ease Fibromyalgia Pain

For people suffering from fibromyalgia and other chronic pain illnesses, yoga has now been proven both to help ease the pain and cope more efficiently with the pain. Participants report feeling muscles relax that have felt perpetually locked in spasm and a deep sense of relaxation that carries over in daily life from regular participation in restorative yoga.

The study, conducted by researchers from the Oregon Health & Science University in Portland, looked at 53 women diagnosed with fibromyalgia. Twenty-five of these women participated in a “Yoga of Awareness” program once a week (including gentle stretching, mindfulness meditation, breathing techniques, and applying yoga principles to optimal coping); the remaining 28 participants did not take part in the yoga instruction program.

Participants in the study followed a specific routine that introduced them to yoga poses and practice in general, and specific yoga-based pain coping techniques. Classes consisted of a set series of sections or phases, including 40 minutes of gentle “stretch” poses (or asanas, as they’re called in yoga), followed by a 25-minute meditation and a 10-minute session where participants practiced pranayama, or yogic breathing techniques. The yoga classes were followed by lectures and presentations on how to use yoga principles to copy with physical pain and a group discussion geared around how participants could incorporate a home-based yoga practice in their lives.

Three months after the program began, the women who had been assigned to the yoga protocol reported reduced pain and fatigue. They also demonstrated more effective strategies for coping with the pain that they experienced, with less “catastrophizing, self-isolation, and disengagement.”

One of the best resources on the web for yoga is Yoga Journal’s website. You can learn more about this ancient mind-body practice and get instructions on simple asana sequences you can do at home. Another excellent resource is Kelly McGonigal’s Yoga for Pain Relief (available from Amazon).

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.

FDA Panel Rejects Xyrem as Fibromyalgia Treatment

WebMD reports that the United States Food and Drug Administration has rejected a drug called Xyrem as a treatment for fibromyalgia.  Although public comments (primarily from users testing the drug as part of the manufacturer’s trials) supported approval, and the FDA physicians acknowledge that the drug can reduce pain, the FDA advisory panel rejected the drug because of its similarity to GHB – the so-called “date rape” drug.

According to the FDA, Xyrem, or sodium oxybate, “is much better than the stuff you get on the street, and that is the problem.  Approving it for such a large patient population — 5 million people are estimated to suffer from fibromyalgia — would risk flooding the streets with a pharmaceutical-grade version of the highly controlled substance.

Xyrem is currently available for the treatment of narcolepsy.  It is a central nervous system depressant.

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.