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Is there new support for fibromyalgia disability insurance claims?

Unfortunately, there are thousands of people that are disabled and unable to work as a result of suffering from fibromyalgia. Long term disability companies are notorious for challenging the claims of people suffering from fibromyalgia. Hopefully some new medical research will help doctors solidify a diagnosis of fibromyalgia.

The 19 point pain index, a new way to diagnose fibromyalgia

Diagnosing fibromyalgia has long been a problem in the medical community. However, the American College of Rheumatology (ACR) has proposed a new set of diagnostic criteria for fibromyalgia that is inclusive of common symptoms such as fatigue, sleep disturbances, and cognitive problems, as well as pain. The new criteria were published in the May 2010 issue of the ACR journal Arthritis Care & Research.

These new criteria recognize that fibromyalgia is more than just body pain,” said Robert S. Katz, one of the authors of the new criteria and a rheumatologist at Rush University Medical Center. “This is a big deal for patients who suffer symptoms but have had no diagnosis. A definite diagnosis can lead to more focused and successful treatment and reducing the stress of the unknown.”

A diagnosis of fibromyalgia had previously been made by a tender point test, a physical exam that was developed in 1990 by the ACR and focused on 18 points throughout the body. Patients must have had widespread pain in all four quadrants of their body for a minimal duration of three months and experienced moderate pain and tenderness at a minimum of 11 of the 18 specified tender points.

However, the tender point test did not account for fluctuation of pain, which can affect the number of tender points, and the tender point test did not adequately measure symptom severity, including common symptoms such as fatigue, sleep disturbances, and cognitive problems.

The authors of the new criteria also noted that most primary care doctors don’t bother to check tender points or they aren’t checking them correctly. Consequently, fibromyalgia diagnosis in practice has often been a symptom-based diagnosis.

The resulting confusion of diagnosing fibromyalgia has not been lost on disability insurers, who often deny claims from people suffering with fibromyalgia, particularly when claimants cannot get a definitive diagnosis of their condition.

The new criteria seek to standardize a symptom-based diagnosis so that all doctors are using the same process. The tender point test is being replaced with a widespread pain index and a symptom severity scale. The widespread pain index score is determined by counting the number of areas on the body where the patient has felt pain in the last week. The checklist includes 19 specified areas.

The symptom severity score is determined by rating on a scale of zero to three, three being the most pervasive, the severity of three common symptoms: fatigue, waking un-refreshed and cognitive symptoms. An additional three points can be added to account for the extent of additional symptoms such as numbness, dizziness, nausea, irritable bowel syndrome or depression. The final score is assessed between 0 and 12.

To meet the criteria for a diagnosis of fibromyalgia a patient would have seven or more pain areas and a symptom severity score of five or more; or three to six pain areas and a symptom severity score of nine or more, the symptoms still must have been present for at least three months, and the patient must not have a disorder that would otherwise explain the pain.

Getting a solid fibromyalgia diagnosis is still a fairly new concept, as much of the medical community had once dismissed the disorder as merely a figment of the patient’s imagination. The new diagnostic criteria should legitimatize fibromyalgia and help those who suffer from the disease receive the help they need.



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