Why a Fibromyalgia Diagnosis is a Claim Extender for the WC Adjuster

surefire way to make a workers compensation adjuster cringe is to hand them a medical report where it is alleged the injured employee has developed fibromyalgia due to a workers compensation injury. Fibromyalgia can be loosely defined as an incurable condition that causes widespread chronic pain in the muscles and connective tissues with an abnormal increase in pain level in response to touch or pressure. Fibromyalgia has other symptoms besides pain including joint stiffness, muscle spasms, weakness in the limbs, fatigue, and sleep disturbance. Also, some people alleged to have fibromyalgia, will have other symptoms including tingling, numbness, difficulty swallowing, and cognitive issues.



There is a lack of consensus as to the causes of fibromyalgia as there is no conclusive, objective diagnostic test. Some medical providers believe fibromyalgia develops in people who have a low threshold for pain with their brain being super sensitive to pain signals.  Other medical providers question the validity of this. These medical providers do not consider fibromyalgia a valid diagnosis because abnormalities are lacking in the physician’s examination of the employee. It is for this reason that workers compensation adjusters will question the validity of a fibromyalgia diagnosis from a doctor known to be “claimant friendly.” (WCxKit)



People diagnosed with fibromyalgia often are suffering from stress, depression, and anxiety. It is the high level of overlap with stress, depression, and anxiety that leads many medical providers to consider a diagnosis of fibromyalgia to be an incorrect diagnosis. To these medical providers, it is not a musculoskeletal problem, but a neuropsychiatric disease.



Credence is given to the medical providers who consider fibromyalgia a neuropsychiatric condition because most people who develop fibromyalgia have various cognitive disorders including impaired concentration, diminished attention spans, long-term or short-term memory loss, the inability to multi-task, and impaired speed of performance.



Most medical providers, including those who diagnose fibromyalgia, are reluctant to attempt to treat it. The injured employee diagnosed with fibromyalgia will be transferred from the medical provider who was treating the claimant to a pain management specialist. But even with pain management specialists, there is a vast array of methods used to deal with fibromyalgia with no single treatment plan having widespread acceptance.



The pain management specialists will often try various approaches and combination approaches including prescription medications, aerobic exercise, patient education, cognitive behavioral therapy, behavioral intervention, and even alternative medicine including homeopathy, chiropractic, and herbal medicine.



It is the use of prescription fibromyalgia medications that causes concern in the medical community. When injured employees are given prescriptions for pain medicines for a medical condition that is hotly debated, it causes some consternation with the medical providers who do not consider fibromyalgia a valid diagnosis.



When the person with the diagnosis of fibromyalgia is given antidepressants, they improve primarily in their level of pain, depression, sleep disturbances, and fatigue. This seems to bolster the position of the medical providers that fibromyalgia is a neuropsychiatric condition, not a musculoskeletal condition.



Using narcotics to treat fibromyalgia creates a lot of controversy as well. There is a lack of clinical trials that support the use of opioid in people with fibromyalgia, but many pain management clinics prescribe them freely without concern for addiction and abuse. (WCxKit)



The frown on the workers compensation adjuster’s face is due to the fact that rarely do people with fibromyalgia improve. They also never die from fibromyalgia and seldom does the condition degenerate after it is established. The workers compensation adjuster knows the fibromyalgia claim will be around for a long, long time.


_________________________________________________________PERSONAL EXPERIENCE OF MEDICAL CASE MANAGEMENT RN:
After publication of the above article, an RN Medical Case Manager from a major medical case management company provided the following account of an experience she had with one of her  employees. It was important information to relay, so I am reprinting it. She asked me not to use her name:


“I had an employee who suffered from this ‘disorder’ for almost 3 years now – as diagnosed by a Medical Doctor who was a specialist in treating Fibromyalgia.  She had every test you can imagine to rule out brain injury / neuro disorders.   She spent THOUSANDS of dollars and underwent PT for many months . . . I can only guess total costs exceed $150,000 in tests, MD visits, P.T. and medications.

I had a chiropractor who put on an Advanced Nutrition course who happened to mention that he strongly feels and can prove that Fibromyalgia can be ‘cured’ if the patient is willing to change their eating habits.  This involves avoiding all sugars and grains and consuming good fats and protein.  Among the treatment included was chiro adjustments – she underwent approx 12 and will need about 12 more on and off throughout her life.   In under  45  days she had reduced her need for medication (saving over $300/month) and is pain free for the first time in 3 years.

He has implemented this treatment (nutrition, exercise and adjustments) on several occasions with patients diagnosed by medical experts for Fibromyalgia.   My employee took pleasure in telling her Fibromyalgia doctor how she well she is doing now (he is a highly respected MD at Vanderbilt University).   She is now completely free of taking any medications and considers herself back to normal!

But you know how our world frowns on chiropractic treatment! 😉   Such a shame.”

I am providing this link for those who are interested in learning more about a nutrition-based program.
Maximized Living Nutrition Plan book by B. Lerner, BJ Hardick and K. Roberto.

Author Rebecca Shafer
, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.


WORKERS COMP BOOK:  www.WCManual.com



WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

WC GROUP:   www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE:  Workers Comp Resource Center Newsletter


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.


©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.



  1. I find it hog wash that fibromyalgia is in your mind. I was given an antidepressant for fibromyalgia, which confused me as to the validity of the research, but was desperate for pain relief. It did nothing for my pain!!!! When I finally went to a Dr that knew what they were doing, he prescribed Lyrica, which is for Neuro problems. I get some relief, more than anything else. The medicine makes my cognitive abilities mush-it is the high price I pay to not be in excruciating pain day and night-at least it is bearable. About fibromyalgia supposedly being a low threshold of pain is a joke as well. Before my injury I was stronger than most girls and tolerated pain without a second thought. Please do research that is more recent, as I have read that fibromyalgia is caused by damage to nerve fibers from injuries, which makes complete sense to me, considering all the facts in my situation. Do you realize that the fibromyalgia diagnoses is not something anyone would want-I know it was that last thing I wanted to believe-because of the lack of knowledge about it. My mental health has always been good, so that is not an issue as well. Please spread word of the real reason, not old misconceptions, as it is already a diagnosis that is frowned upon and laughed at by non-sufferers. Life is a struggle with my excruciating pain enough, without the added ridicule. Just imagine good days in which your bones have the same cringing feeling as nails on a chalk board, pain everywhere, and many other problems. Sometimes my bones feel like a bad toothache exposed to cold water, but all over. This is just my bones. My whole GI track is messed up, my muscles and viscera always have pain, a lot of times where it feels like someone is taking a steel pole and ramming my insides with it. There is so much more that it upsets me when the diagnosis is disregarded. Maybe some people might be dishonest about it, but to what end? To be considered a crack pot or a complainer? I promise you that anyone with any sense at all would never want this, I also hope for your sake, that you never get this. No one should have to ever deal with this much pain, it is inhumane.

Speak Your Mind


Professional Development Resource

Learn How to Reduce Workers Comp Costs 20% to 50%"Workers Compensation Management Program: Reduce Costs 20% to 50%"
Lower your workers compensation expense by using the
guidebook from Advisen and the Workers Comp Resource Center.
Perfect for promotional distribution by brokers and agents!
Learn More

Please don't print this Website

Unnecessary printing not only means unnecessary cost of paper and inks, but also avoidable environmental impact on producing and shipping these supplies. Reducing printing can make a small but a significant impact.

Instead use the PDF download option, provided on the page you tried to print.

Powered by "Unprintable Blog" for Wordpress - www.greencp.de