Fibromyalgia is a complex, chronic condition that causes widespread pain and severe fatigue. Fibromyalgia is often considered 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 fibromyalgia. 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 fibromyalgia experience extreme tenderness when pressure is applied to the knees, thighs, hips, elbows, and neck. People with fibromyalgia 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; and tingling similar to the symptoms of cumulative trauma disorders.
JAN's Effective Accommodation Practices (EAP) Series: Executive Functioning Deficits is a publication detailing accommodations for individuals with limitations related to executive functioning. These ideas may be helpful in determining accommodations.
Fibromyalgia and the Americans with Disabilities Act
The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet. A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having an impairment. For more information about how to determine whether a person has a disability under the ADA, see How to Determine Whether a Person Has a Disability under the Americans with Disabilities Act Amendments Act (ADAAA).
Accommodating Employees with Fibromyalgia
People with fibromyalgia may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with fibromyalgia will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.
Questions to Consider:
- What limitations is the employee experiencing?
- How do these limitations affect the employee and the employee’s job performance?
- What specific job tasks are problematic as a result of these limitations?
- What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?
- Has the employee been consulted regarding possible accommodations?
- Once accommodations are in place, would it be useful to meet with the employee to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
- Do supervisory personnel and employees need training?
Situations and Solutions:
A guidance counselor for a large high school experienced severe bouts of irritable bowel syndrome, depression, and fatigue as a result of fibromyalgia.
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.
A nurse with fibromyalgia 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. Accommodation 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 switchboard operator with chronic pain and fibromyalgia was accommodated with flexible scheduling, rest breaks, and an adjustable workstation.
The adjustable workstation allowed her to alternate between a sitting and standing position.
An individual employed as a patient rights advocate had carpal tunnel syndrome and fibromyalgia.
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.
An administrative assistant with fibromyalgia working for a utility company reported neck pain and upper body fatigue.
Her duties included typing, answering the telephone, and taking written messages. She was accommodated with a wireless 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.