By Kendra M. Duckworth, MS and Beth Loy, Ph.D.
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.
included in this publication is a list of resources for additional information.
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?
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.
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:
& 2: the base of the skull beside the spinal column,
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?
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?
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.)
written job instructions when possible
Depression and Anxiety:
distractions in work environment
or eliminate physical exertion and workplace stress
Fine Motor Impairment:
ergonomic workstation design
Gross Motor Impairment:
the work-site to make it accessible
infectious agents and chemicals
flexible work hours and frequent breaks
work-site temperature and maintain the ventilation system
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.
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
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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Page Updated: September 23, 2008