On Finance: Costly pain of fibromyalgia can be reduced with holistic treatment

September 1, 2004

Fibromyalgia is real and prevalent, yet many physicians and employers may inadvertently ignore or demean sufferers, not only at the cost of those with the condition, but at the cost of productivity and healthcare expenditures.

Fibromyalgia is real and prevalent, yet many physicians and employersmay inadvertently ignore or demean sufferers, not only at the cost of thosewith the condition, but at the cost of productivity and healthcare expenditures.

Epidemiological studies say fibromyalgia, a condition which causes painand profound fatigue, strikes between 3.5% and 10.5% of the population.The condition is difficult to diagnose, primarily because there are no teststhat can specifically identify the condition, making it a diagnosis of exclusion.That means a diagnosis of fibromyalgia is arrived at when other illnesseshave been ruled out through patient history, laboratory testing and radiography.Moreover, fibromyalgia can mimic other rheumatologic illnesses such as arthritis.

A recent entry from a fibromyalgia sufferer's blog describes the physicaland emotional experience of this condition:

"It's hard to communicate what fibromyalgia is really like. It hurts.Constantly. Not always at the same intensity or in the same places, butthere's constant pain. On a good day, it's mildly annoying but somethingyou can ignore. On a bad day, your only thoughts are, 'This hurts' and 'There'sgot to be some way to stop this pain.' Remember how your whole body achedthe last time you had the flu? Imagine if that had gone on for years. Rememberhow you felt after pulling two all-nighters in a row and had to take anexam the next day, and the coffee machine was broken? Imagine feeling likethat most days. Remember the last time you pulled a muscle by not warmingup enough before doing something strenuous? Imagine waking up each day witha different body part feeling like that for no apparent reason."

The cause of fibromyalgia is unknown. Recent research has concluded thatfibromyalgia may be more prevalent in certain families, suggesting the possibilityof a genetic component to the condition. The symptoms of pain in fibromyalgiaare similar to other chronic pain states, which suggest that there is aninteraction between the central nervous system and the peripheral pain systemof the body, and may account for the association of symptoms such as coldintolerance, dizziness, irritable bowel syndrome, irritable bladder syndromeand multiple environmental sensitivities.

The American College of Rheumatology has set out criteria for the classificationof fibromyalgia including: 1) history of widespread pain, and 2) pain in11 of 18 tender point sites on examination. Pain must have been presentfor at least 3 months.

Additionally, many people with this condition experience sleep disturbances,depression and anxiety. Symptoms may also overlap those of chronic fatiguesyndrome, another condition that has been hard to diagnose and even harderto effectively treat.

Research numbers from 1997 provided by the National Fibromyalgia Partnership,Linden, Va., reveal that fibromyalgia patients average 10 outpatient medicalvisits a year. They're hospitalized an average of once every three yearsand, in the six-month study period in question, they used a mean of 2.7fibromyalgia-related drugs each.

And while treatment costs increased over the course of the study, themean yearly per-patient cost in 1996 dollars was $2,274. Fibromyalgia patients,the research adds, are more likely than other patients to have back or necksurgery, appendectomy, carpal tunnel surgery, gynecologic surgery, abdominalsurgery and tonsillectomy.

Another more recent study found that annual costs for fibromyalgia patientstotal $5,945, versus $2,486 for the typical beneficiary. About 6% of thosecosts were attributable to fibromyalgia-specific claims, the research notes,and for every dollar spent on them, employers spend another $57 to $143on direct and indirect costs.

To put those numbers in context, experts note that as many as 100 millionAmericans suffer from chronic pain of some type-at a cost to employers ofsome $80 billion a year in sick days and lost productivity. According tothe American College of Rheumatology, fibromyalgia affects 3 million to6 million Americans and primarily occurs in women.

The Occupational Safety and Health Administration says musculoskeletaldisorders (MSDs) cost the country as much as $50 billion a year and mayaccount for a third of employers' workers' compensation costs. The estimatedcost of MSDs, the agency reports, is $15 billion to $20 billion a year incomp costs and $30 billion to $40 billion in other expenses, such as medicalcare. Other reports say 10% of Americans suffer from major depression, atan annual tab of $44 billion a year in direct and indirect costs-including$24 billion a year in absenteeism and lost productivity. Another reportsays the prevalence of chronic fatigue syndrome in the U.S. is at leastfour to 10 cases per 100,000 adults.

The stigma associated with the condition is a significant barrier toeffective treatment. Until recently, it was often called "empty nestsyndrome," suggesting that it was a (woman's) psychosomatic reactionto aging and loss. Also problematic is the fact that fibromyalgia is a chroniccondition.

Smart companies have started using case management and specific programsdesigned to help fibromyalgia sufferers get the right care right away. Onemajor carrier provides a separate disease management program for it, althoughthe firm, BlueCross BlueShield of North Carolina, Durham, has no data onits effectiveness. Still, employers would be well-served by looking at aDM approach. Treatment, after all, isn't high-tech or particularly expensive.

Effective treatment starts with validating the individual's pain andsuffering. A holistic approach to treatment includes medication to improvesleep and reduce pain, addressing psychotherapeutic issues, and behavioralmanagement. Patient education, including goal setting and behavioral modification,is a key component to the plan. Exercise, physical therapy, and massagemay be useful as well. Other symptoms and associated conditions shouldalso be addressed individually. Chiropractic care, acupuncture, yoga, anddiet therapy have also been used with varying degrees of success. The goalof treatment should be to improve the quality of life, and the productivityof that individual; cure of the condition is not considered an endpoint.Thus, the appropriate evaluations of treatment programs focus on qualityof life and functional improvement measurements.

Though more data is needed, conventional wisdom suggests that addressingthe issue of fibromyalgia in a focused way is worth the cost. The pain offibromyalgia is real, and many employees who suffer from it truly want tocontinue to work, though lack of adequate treatment or employer flexibilitymay force the employee to leave the workforce altogether. Providers needto do their part, too. They need to set aside their prejudices toward "subjective"conditions and determine the best treatment modalities-with realistic expectationson both sides.

 

Mitzi Krockover, MD, is a senior consultant with Sokolov, Sokolov, Burgess,a healthcare management consulting, development and investment firm withclients in 150 U.S. and international markets.