An interesting case decided in New York recently spotlighted fibromyalgia, and whether a traumatic event could have triggered a recurrence after 15 years of dormancy. The case highlighted the uncertainties surrounding fibromyalgia and points to the need to better understand how it works and how it can be treated.
Fibromyalgia is a chronic pain condition. It's not quite clear what causes or triggers it, and there is no known cure. We do know, however, that cognitive behavioral therapy (CBT) and interventions that help patients release pent-up emotions have been shown to be highly effective in helping injured workers manage their pain and return to productivity.
The case mentioned above involved a pharmacist who was accidentally exposed to pepper spray while working in a prison in 2014. A guard discharged a canister to subdue an inmate and the pharmacist said she immediately felt dizzy and had chest tightness. She briefly returned to work but then left for almost a year.
The pharmacist said she had been diagnosed with fibromyalgia in 2000, but it had been in remission for nearly 15 years. Several medical experts testified as to whether her exposure to pepper spray could have aggravated the condition, although none was well versed in her medical history and/or fibromyalgia. The Workers' Compensation Board ultimately ruled there was no causal relationship and denied her benefits; however, she remained covered under the employer long-term disability policy.
As with many chronic pain conditions, there are uncertainties about fibromyalgia. It's estimated that up to ten million people have it, including pop singer Lady Gaga who recently announced she was canceling ten scheduled tour dates due to the pain it was causing her.
Those with the condition say flare-ups cause excruciating pain, drain their energy and impact their mobility. They describe the pain as anything from a constant dull ache, to a throbbing, stabbing pain that can occur throughout the body. Cognitive issues such as memory and mood issues may also be present. One symptom, dubbed “fibro fog” affects the person's ability to concentrate on mental tasks. In addition to these symptoms, many people also experience depression and/or anxiety, headaches, tinnitus and a variety of gastrointestinal issues.
Diagnosing fibromyalgia is difficult because the symptoms vary from person to person. Before making a fibromyalgia diagnosis, medical providers typically use a combination of the patient's descriptions of symptoms and lab tests to rule out other conditions.
Scientists speculate that the condition may be caused by a variety of factors such as genetics, infections and physical and/or emotional trauma. They believe it amplifies painful sensations by affecting the way the brain processes pain signals. Repeated nerve stimulation causes changes in the brains of those affected, involving abnormal increases in certain chemicals that signal pain. Clearly, a combination of biological and psychosocial factors cause changes in the central nervous system.
Researchers say the condition is a lifelong disorder that affects different parts of the body at different times. Those with fibromyalgia often request any type of intervention to reduce the pain, including opioids. Unfortunately, medications don't seem to ease the pain much or for any length of time.
As with other chronic conditions that have no known cure, fibromyalgia is best treated with strategies that reduce the pain and improve the level of functioning. CBT is considered the gold standard of treatment for fibromyalgia.
Fibromyalgia patients often report catastrophic thinking and exaggerate the likelihood of worst-case outcomes. Injured workers with fibromyalgia typically have thoughts such as, “My pain is horrible and will never get better.” CBT teaches these workers how to change their thinking and behaviors, which ultimately changes their brain chemistry. Modern imaging tools such as MRIs now allow us to actually see changes to the brain. A person in chronic pain demonstrates an enlarged pain map in the brain in MRI imaging.
The science of neuroplasticity has taught us that our brains change throughout our lifetimes. CBT, a short-term goal-oriented therapy, teaches techniques and skills that change our thoughts and actions. This retrains the brain and shrinks the pain map, which can help to significantly reduce the person's perception of pain.
In recent decades, scientists have shown that unprocessed emotions have a direct impact on our perceptions of pain. The mind and body communicate through a complex network, and when this network is interrupted by unprocessed emotions, the result can be increased chronic pain. We now have techniques that can help injured workers release these unprocessed emotions in healthy ways.
One such intervention is called Emotional Awareness and Expression Therapy (EAET). Used in conjunction with CBT, it enables patients to process emotions and express important feelings so they don't clog the mind-body communication network. Rather than avoiding unpleasant emotions, injured workers are able to confront and work through them. Injured workers who undergo this type of intervention along with CBT can turn their lives around for the better.
Fibromyalgia is an unfortunate disorder that affects millions of Americans. So far, there are no clear-cut ways to cure the condition. We can, however, help injured workers move past the pain and return to functionality through our understanding of the science of chronic pain and how to retrain our brains.
Disclaimer: WorkersCompensation.com publishes independently generated writings from a variety of workers' compensation industry stakeholders. The opinions expressed are solely those of the author and do not necessarily reflect those of WorkersCompensation.com.