USA Today published a very interesting article on December 15, 2013 about a research which identifies a physiological cause for fibromyalgia. Currently, fibromyalgia is recognized as a medical “syndrome,” which means that it can be identified by symptoms, while the source of those symptoms remains unknown. In the case of fibromyalgia, the American College of Rheumatology has published guidelines for physicians to use for diagnostic purposes, although treatment options remain limited.
The USA Today story quotes neurologist Anne Louise Oaklander at the Massachusetts General Hospital in Boston. Dr. Oaklander has published two studies which show that at least half the cases of diagnosed fibromyalgia arise from small fiber neuopathy, in which patients get faulty signals from tiny nerves all over the body, thereby causing symptoms. Here is a direct link to Dr. Oaklander’s article.
Researchers at Albany Medical College published a paper showing that fibromyalgia patients have excessive nerve fibers lining the blood vessels of the skin. This excess of nerve fibers can lead to increased sensitivity to pain. Interestingly, women have more of these fibers than men, which is consistent with statistics which show more female fibro patients than male patients. Here is a link to the news release from Dr. Frank Rice who conducted the research at Albany Medical College, and who now leads a research team at a private company.
Neurologist Oaklander notes that in 2013 there has been an “absolute explosion of [scientific] papers” discussing fibromyalgia. The small fiber nerve angle is new, suggesting that medical researchers are coming closer to uncovering specific causation for the pain, fatigue and other symptomology.
Presumably this fibromyalgia research will yield more accurate testing methods for patients as well as better treatment options.
Unfortunately, many physicians diagnose “fibromyalgia” as a diagnosis of last resort if they can identify no other cause for their patients’ symptoms. Some of these patients, of course, may actually meet the American College of Rheumatology criteria for fibromyalgia but these patients cannot afford the cost of office visits and testing with a rheumatologist. Other patients most likely do not have fibromyalgia.
In my Social Security disability practice, I speak to a lot of potential clients who assert that they have fibromyalgia. I have become a lot more selective in accepting these cases for representation because SSD judges have also become a lot more cynical about this diagnosis.
At this point, at least, fibromyalgia cases are almost impossible to win without an evaluation, diagnosis and treatment by a rheumatologist. Even some of those cases are denied because judges are less and less comfortable with approving cases for medical conditions that cannot be objectively identified through testing. There is no doubt in my mind that too many severely impaired claimants are being denied because of either lack of access to medical care or inadequate treatment records from their physicians.
Hopefully we will soon see more definitive testing protocols for fibromyalgia so that legitimate sufferers of this condition can be found eligible for disability benefits if their symptoms so warrant.
Jonathan Ginsberg represents Social Security disability claimants in Georgia. In practice for over 29 years, Jonathan publishes a widely known disability blog, a podcast and several disability web sites. In 2004, Jonathan published a "how to" book about Social Security disability called the Disability Answer Guide. Jonathan lives with his wife and 2 children in Atlanta.