Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Fibromyalgia


Related Terms

  • Fibromyositis
  • Fibrositis
  • Muscle Pain Syndrome
  • Muscular Rheumatism
  • Psychogenic Rheumatism
  • Tension Myalgias

Differential Diagnosis

Specialists

  • Clinical Psychologist
  • Family Physician
  • Internal Medicine Physician
  • Neurologist
  • Occupational Therapist
  • Pain Medicine Physician/Pain Specialist
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Rheumatologist

Comorbid Conditions

  • Anxiety
  • Depression
  • Sleep disorder

Factors Influencing Duration

In FM, the factors influencing perceived disability are unknown because there are no scientifically valid studies addressing this issue.

Medical Codes

ICD-9-CM:
306.0 - Physiological Malfunction Arising from Mental Factors, Musculoskeletal; Psychogenic Paralysis; Psychogenic Torticollis
726.2 - Other Affections of Shoulder Region, Not Elsewhere Classified; Periarthritis of Shoulder; Scapulohumeral Fibrositis
729.0 - Rheumatism, Unspecified, and Fibrositis
729.1 - Myalgia and Myositis, Unspecified; Fibromyositis NOS; Fibromyalgia
729.89 - Other Musculoskeletal Symptoms Referable to Limbs; Other

Overview

Fibromyalgia (FM) is a term used to describe several interrelated chronic conditions characterized by fatigue, stiffness, and achy pain in the muscles, ligaments, and tendons. Fibromyalgia appears to be a centrally-mediated condition (from central nervous system or immunologic origins) that results in symptoms that are perceived as if they originate in the musculoskeletal system. The pain and stiffness occur throughout the body.

In 1990, the American College of Rheumatology (ACR) noted specific criteria for this disorder as follows: 11 of 18 specific areas of the body are painful under pressure (palpation), and widespread pain must last for at least 3 months ("Fibromyalgia"). Widespread pain is defined by the number of body regions involved (greater than 3) and by a pattern of pain that involves the upper and lower body, both sides of the body, and the axial skeleton (cervical spine, anterior chest, thoracic spine, or low back).

There does not appear to be a single cause of fibromyalgia. Possible triggers include chemical changes in the brain, sleep disturbances, injury to the upper spine, viral or bacterial infection, nervous system abnormalities, and changes in muscle metabolism. Hormonal changes and psychological stress may be additional triggers.

Although fibromyalgia can be disruptive, it is not progressive or life-threatening.

Incidence and Prevalence: It is estimated that between 3 and 8 million people in the US have fibromyalgia ("Fibromyalgia").

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors for fibromyalgia include being female and having a family history of the disorder. Approximately 80% to 90% of affected individuals are women between the ages of 20 and 60 ("Fibromyalgia"). Generalized fibromyalgia is approximately 7 times more common in women than in men, whereas localized fibromyalgia occurs more frequently in men (Masi 415, 416).

Source: Medical Disability Advisor



Diagnosis

History: Individuals with FM report pain on both sides of the body, above and below the waist, and in the axial skeleton. They may also report fatigue and disturbed sleep; stiffness; anxiety; depression; facial pain and headache; mental stress; heightened sensitivity to noises, smells, and bright lights; irritable bladder; painful menstruation; dizziness; and irritable bowel symptoms.

Physical exam: Findings on physical examination are unremarkable in persons suspected of having FM. A diagnosis of FM requires that individuals report pain on digital palpation (gentle palpation or evaluation with dolorimeter) in at least 11 of 18 specific tender points, which are located in many different body regions.

Tests: There are no routine hematologic, urine, biochemical, or imaging tests that are diagnostically or prognostically useful in FM. Extensive diagnostic testing is not useful, is not cost effective, and should be discouraged.

Source: Medical Disability Advisor



Treatment

Medications prescribed to reduce pain and improve the quality of sleep include antidepressants, muscle relaxants, and rarely, sedatives or prescription sleeping pills for a short time. Nonsteroidal anti-inflammatory agents are generally not beneficial. In general, treatment for FM that targets the musculoskeletal system directly (massage, manipulation, electrical stimulation) does not appear to be helpful. Local anesthetics, with or without corticosteroids, may be injected into tender areas, but this is not a long-term solution. FM is amenable to light exercise therapy, and cognitive behavioral interventions. Cognitive behavioral therapy may be useful for helping individuals with FM manage stress and cope with a chronic condition.

Source: Medical Disability Advisor



ACOEM

ACOEM's Practice Guidelines, the gold standard in effective medical treatment of occupational injuries and illnesses, are provided in this section to complement the disability duration guidelines.*
 
Chronic Pain
 
* The relationship between the MDGuidelines (MDA) content and ACOEM's guidelines is approximate and does not always link identical diagnoses. The user should consult the diagnostic codes in both guidelines, as well as the clinical descriptions, before assuming an equivalence.

Source: ACOEM Practice Guidelines



Prognosis

FM is a chronic condition. Although symptoms may vary in intensity, they are unlikely to disappear completely.

Source: Medical Disability Advisor



Rehabilitation

FM is often a diagnosis of exclusion, which means that the diagnosis is confirmed when other diseases are ruled out. By the time FM is diagnosed, many individuals are already in the chronic stage of the disease.

The goal of rehabilitation for individuals with FM is to preserve function despite the chronic limitations inherent in this condition. Individuals with FM may benefit from outpatient rehabilitation that includes active stretching and gentle strengthening exercises performed regularly. Individuals learn to stretch tight areas and strengthen muscles in the extremities and the upper and lower back. Physical training, including low-impact aerobic exercises, may improve function and decrease pain when combined with patient education (Busch; Karjalainen). Water exercise, when available, has been shown to be beneficial for these individuals (Gowans).

Affected individuals may also benefit from consultation with an occupational therapist, who can instruct them in modified activities of daily living, and with a psychologist, who can support them in coping with a chronic condition. A multidisciplinary treatment approach will help address both the physical and psychological aspects of FM (Karjalainen).

A long-term, independent exercise program should be initiated before the individual is discharged from rehabilitation.

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistFibromyalgia
Physical or Occupational TherapistUp to 30 visits within 12 weeks
The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.

Source: Medical Disability Advisor



Complications

Complications can arise from treatment (i.e., unwanted side effects from medication or reinforcement of counterproductive behaviors) or from the person's behavior (i.e., self-limitation of personal or occupational activities of daily living).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Because persons with FM have symptoms but a normal physical examination and normal findings on diagnostic testing, there is no objective medical basis upon which to predicate work restrictions or accommodations.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Have similar conditions been ruled out?
  • Has diagnosis of FM been established?
  • Does individual have a comorbid condition that may affect recovery?

Regarding treatment:

  • Has appropriate medication been prescribed?
  • Has individual benefited from cognitive behavioral therapy?
  • Have treatments resulted in unwanted side effects?
  • Have treatment methods reinforced inappropriate illness behaviors?

Regarding prognosis:

  • Have psychosocial factors such as family and workplace dynamics been considered?
  • Have mental and behavioral disorders (depression, anxiety, sleeping disorders) been considered?
  • Have inappropriate illness behaviors (symptom exaggeration, malingering) been considered?

Source: Medical Disability Advisor



References

Cited

"Fibromyalgia." MayoClinic.com. 25 Oct. 2004. Mayo Foundation for Medical Education and Research. 25 Oct. 2004 <http://www.mayoclinic.com/invoke.cfm?id=DS00079>.

Busch, A., et al. "Exercising for Treating Fibromyalgia Syndrome." Cochrane Database of Systematic Reviews 3 (2002): CD003786. National Center for Biotechnology Information. National Library of Medicine. 17 Nov. 2004 <PMID: 12137713>.

Gowans, S. E., et al. "Six-Month and One-Year Follow Up of 23 Weeks of Aerobic Exercise for Individuals with Fibromyalgia." Arthritis and Rheumatism 51 6 (2004): 890-898.

Karjalainen, K., et al. "Multidisciplinary Biopsychosocial Rehabilitation for Neck and Shoulder Pain Among Working Age Adults." Cochrane Database of Systematic Reviews 2 (2003): CD002194. National Center for Biotechnology Information. National Library of Medicine. 17 Nov. 2004 <PMID: 10796458>.

Masi, Alfonse T. "Fibromyalgia." The Merck Manual of Home Health Care. Ed. Mark H. Beers. 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories, 2003. 415-417.

Source: Medical Disability Advisor






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