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ACCOMMODATING PEOPLE WITH FIBROMYALGIA

 

By Kendra M. Duckworth, MS and Beth Loy, Ph.D.

Preface

Fibromyalgia syndrome (FMS) is a form of generalized muscular pain and fatigue that affects seven to ten million Americans. The Americans with Disabilities Act (ADA) coupled with the high number of working individuals with FMS show why knowing about workplace accommodations for people with FMS is important.

When considering accommodations for people with FMS, the accommodation process must be conducted on a case-by-case basis. Symptoms caused by FMS vary, so when determining effective accommodations, the person's individual abilities and limitations should be considered and problematic job tasks must be identified. Therefore, the person with FMS should be involved in the accommodation process.

Not all people with FMS will need accommodations to perform their jobs and many others may need only a few accommodations. For those who need accommodation, the following pages provide basic information about common limitations, symptoms, useful questions to consider, and accommodation possibilities. The following is only a sample of possibilities to consider; numerous other solutions and considerations may exist.

Also included in this publication is a list of resources for additional information.

FIBROMYALGIA SYNDROME

The following information regarding FMS was edited from several sources, including many of the resources listed in the resource section of this publication. The information is not intended to be medical advice. If medical advice is needed, appropriate medical professionals should be consulted.

What is FMS?

FMS is a complex, chronic condition that causes widespread pain and severe fatigue. FMS is a syndrome because it is a set of signs and symptoms that occur together, affecting muscles and their attachments to bones. It is not a true form of arthritis and does not cause deformities of the joints. It is, however, a form of soft tissue or muscular rheumatism.
What are the symptoms of FMS?

Deep muscular pain is the most common symptom of FMS. Usually starting at the neck and shoulders and spreading to other parts of the body over time, the pain varies according to the time of day, weather, sleep patterns, and stress level. People with FMS experience extreme tenderness when pressure is applied to the knees, thighs, hips, elbows, and neck. Approximately 90 percent of people with FMS experience fatigue and exhaustion. People with FMS are also likely to have sleep disorders; severe changes in mood and thinking, including depression and chronic anxiety; headaches; impaired memory; irritable bowel syndrome; multiple chemical sensitivity syndrome; restless legs; skin and temperature sensitivity; TMJ; and tingling similar to the symptoms of cumulative trauma disorders. Painful menstrual periods (dysmenorrhea), chest pain, morning stiffness, muscle twitching, irritable bladder, dry eyes and mouth, frequent changes in vision, dizziness, and impaired coordination can also occur. According to criteria established by the American College of Rheumatology, a patient must suffer from widespread pain in all four body quadrants for at least three months and 11 of 18 tender points should be present to be diagnosed with FMS. Identified by the American College of Rheumatology in 1990, FMS tenderpoints are:

~1 & 2: the base of the skull beside the spinal column,
~3 & 4: the base of the neck in the back,
~5 & 6: the top of the shoulder toward the back,
~7 & 8: over the shoulder blade,
~9 & 10: at the breastbone,
~11 & 12: on the outer edge of the forearm about two centimeters below the elbow,
~13 & 14: on the outside of the hip,
~15 & 16: at the top of the hip, and
~17 & 18: in the fat pad over the knee.

What causes FMS?

One or several factors may trigger FMS: an illness, physical or emotional trauma, and/or hormonal changes. It affects women much more than men in an approximate ratio of 20:1. Although most patients are diagnosed during their 20s or 30s, FMS is seen in people of all ages. Recent studies have shown that FMS occurs worldwide and has no specific ethnic predisposition.

How is FMS treated?

Since no laboratory test exists for diagnosing FMS, conditions that mimic its symptoms must first be excluded (i.e., thyroid disease, lupus, Lyme disease, rheumatoid arthritis, etc.). Doctors treat FMS by alleviating symptoms. Because deep level (stage 4) sleep is so crucial for many body functions, such as tissue repair, antibody production, and hormone and immune system regulation, the sleep disorders that frequently occur with FMS are thought to be a major contributing factor to the symptoms of the condition. Due to severe sleep disruptions, people with FMS are usually treated with medications to improve sleep and reduce pain perception. In addition, other medications, exercise and physical therapy programs, and relaxation and stress management techniques are used to alleviate symptoms.

QUESTIONS TO CONSIDER WHEN DETERMINING ACCOMMODATIONS

 

~What symptoms or limitations is the individual with FMS experiencing?

~How do these symptoms or limitations affect the person and the person's job performance?

~What specific job tasks are problematic as a result of these symptoms and limitations?

~What accommodations are available to reduce or eliminate the individual's problem job tasks? Are all possible resources being used to determine possible accommodations?

~Has the employee with FMS been consulted regarding possible accommodations?

~Once accommodations are in place, would it be useful to meet with the person with FMS to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?

~Do supervisory personnel and employees need training regarding FMS, etiquette, other disability areas, or the ADA?

ACCOMMODATION CONSIDERATIONS FOR PEOPLE WITH FMS

 

(Note: People with FMS will develop some of these limitations/symptoms, but seldom develop all of them. Limitations will vary among individuals. Also note that not all people who have FMS will need accommodations to perform their jobs and many others may need only a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions exist as well.)

Concentration Issues:

~Provide written job instructions when possible
~Prioritize job assignments and provide more structure
~Allow flexible work hours and allow a self-pace workload
~Allow periodic rest periods to reorient
~Provide memory aids, such as schedulers or organizers
~Minimize distractions
~Reduce job stress

Depression and Anxiety:

~Reduce distractions in work environment
~Provide to-do lists and written instructions
~Remind employee of important deadlines and meetings
~Allow time off for counseling
~Provide clear expectations of responsibilities and consequences
~Provide sensitivity training to co-workers
~Allow breaks to use stress management techniques
~Develop strategies to deal with work problems before they arise
~Allow telephone calls during work hours to doctors and others for support
~Provide information on counseling and employee assistance programs

Fatigue/Weakness:

~Reduce or eliminate physical exertion and workplace stress
~Schedule periodic rest breaks away from the workstation
~Allow a flexible work schedule and flexible use of leave time
~Allow work from home
~Implement ergonomic workstation design

Fine Motor Impairment:

~Implement ergonomic workstation design
~Provide alternative computer access
~Provide alternative telephone access
~Provide arm supports
~Provide writing and grip aids
~Provide a page turner and a book holder
~Provide a note taker

Gross Motor Impairment:

~Modify the work-site to make it accessible
~Provide parking close to the work-site
~Provide an accessible entrance
~Install automatic door openers
~Move workstation close to other work areas, office equipment, and break rooms

Migraine Headaches:

~Provide task lighting
~Eliminate fluorescent lighting
~Use computer monitor glare guards
~Reduce noise with sound absorbent baffles/partitions, environmental sound machines, and headsets
~Provide alternate work space to reduce visual and auditory distractions
~Implement a "fragrance-free" workplace policy
~Provide air purification devices
~Allow flexible work hours
~Allow periodic rest breaks
~Allow work from home

Respiratory Difficulties:

~Provide adjustable ventilation
~Keep work environment free from dust, smoke, odor, and fumes
~Implement a "fragrance-free" workplace policy and a "smoke free" building policy
~Avoid temperature extremes
~Use fan/air-conditioner or heater at the workstation
~Redirect air conditioning and heating vents
~Provide adequate exhaust systems to remove fumes from office machines
~Allow individual to wear a respirator mask
~Allow work from home

Skin Irritations:

~Avoid infectious agents and chemicals
~Provide protective clothing

Sleep Disorder:

~Allow flexible work hours and frequent breaks
~Allow work from home

Temperature Sensitivity:

~Modify work-site temperature and maintain the ventilation system
~Modify dress code
~Use fan/air-conditioner or heater at the workstation and redirect vents
~Allow flexible scheduling and work from home during extremely hot or cold weather
~Provide an office with separate temperature control

EXAMPLE ACCOMMODATIONS FOR PEOPLE WITH FMS

 

An administrative assistant for a utility company with FMS reported neck pain and upper body fatigue. Her duties included typing, answering the telephone, and taking written messages. She was accommodated with a telephone headset to reduce neck pain and eliminate the repetitive motion of lifting the telephone from the cradle, a portable angled writing surface and writing aids to take written messages, a copy holder to secure documents, and forearm supports to use when typing.

A nurse with FMS working in a county health clinic experienced a great deal of fatigue and pain at work. The nurse typically worked evening shifts but her doctor recommended a schedule change so she could regulate her sleep patterns. Accommodations suggestions included changing her shift from evening to day, restructuring the work schedule to eliminate working two consecutive twelve hour shifts, reducing the number of hours worked to part time, and taking frequent rest breaks.

A guidance counselor for a large high school experienced severe bouts of irritable bowl syndrome, depression, and fatigue as a result of FMS. He experienced difficulty in opening the heavy doors to the entrance of the school and had to make frequent trips to the bathroom. The individual's employer complained that he was spending too much of his time away from his office and therefore was not available for students. The employer moved the employee's office to a location closer to the faculty restroom, added an automatic entry system to the main doors, and allowed flexible leave time so the employee could keep appointments with his therapist.

An individual employed as a patient rights advocate had carpal tunnel syndrome and FMS. She had difficulty keyboarding, writing, and transporting supplies to presentations. The employer installed speech recognition software for word processing, provided her with writing aids, and gave her lightweight portable carts to assist with transporting materials.

PRODUCTS

 

There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource at <http://www.jan.wvu.edu/soar> is designed to let users explore various accommodation options. Many product vendor lists are accessible through this system; however, JAN provides these lists and many more that are not available on the Web site upon request. Contact JAN directly if you have specific accommodation situations, are looking for products, need vendor information, or are seeking a referral.

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