Topic: Medical Care
From: “A Look at Questions Surrounding Fibromyalgia”:
MIND OVER MATTER? Patients diagnosed with fibromyalgia are more likely to have a history of mental illness, be overweight and economically disadvantaged. Some doctors say their suffering may stem from difficult circumstances rather than disease. http://abcnews.go.com/Business/wirestory?id=6831204
Quote from “Primary Care for Women”, Second Edition by Jeffrey F. Peipert:
Factors associated with fibromyalgia in the general population include female sex, divorce, failure to complete high school, low household income, decreased pain threshold, subjective joint swelling, parenthesis, irritable bowel syndrome, moderate or sever impairment demonstrated by the health assessment questionnaire, increased pain, fair or poor self-reported health status, and moderate dissatisfaction with health. (pp. 590-591)
From “A Review of Fibromyalgia” by Devi E. Nampiaparampil, MD; and Robert H. Shmerling, MD:
Disability secondary to chronic pain appears to result from a combination of patients’ past experiences, self-esteem, motivation, psychological distress, fatigue, ethnocultural background, education, income, and potential financial compensation... Disability in chronic pain does not appear to be related to the severity of the pain. (pp798-799 The American Journal of Managed Care November 2004 ) http://www.hcplive.com/_micro/ajmc/_picture/folder_12/AJMCnovNampiaparampil794.pdf.
Some Sociological/Sociodemographic Questions:
What is the average household income for someone who has been diagnosed with fibromyalgia? How many or how few people with household incomes over $100,000 are diagnosed with this condition? How many have incomes over $60,000? Are lower income people- the working poor and the public assistance-dependent more likely to be given this diagnosis? What about health insurance coverage and policies? Is it a case of: “the better health insurance coverage you have, the less likely you'll be diagnosed with fibromyalgia?” Are the underinsured more likely to be told they have fibromyalgia versus those with more comprehensive health coverage? Are uninsured clinic patients, those reliant on Medicaid or Charity Care, given this diagnosis at much higher rates then those with health insurance coverage? What about education levels and fields of employment, or lack thereof? Are high school drop-outs and those with just a high school diploma more likely to be diagnosed with fibromyalgia than someone with multiple or advanced college degrees? Are people who work in low-income jobs, the unemployed, and housewives more likely to be diagnosed with fibromyalgia than people with higher paying white collar jobs, financially successful business owners, or people who have good civilian jobs working for State Government, or the Federal government?
If a doctor thinks a patient is stupid, or whiny or flaky or neurotic or a pest does that make her a more likely candidate for receiving the fibromyalgia diagnosis? Are patients judged by their appearance? Are patients who appears to be lesser educated and lower income through their mannerisms, speech, and physical appearance (such as the quality of clothing and accessories they wear) more likely to be viewed with less credibility and have their symptoms taken less seriously versus patients who comes across as better educated and more affluent? Can such distinctions lead some doctors to casually slap the Fibromyalgia diagnosis label on patients from lower educational and financially modest backgrounds? Is a female patient who is either shy, timid and hesitant to speak; or who comes across as nervous, anxious, and easily excitable; or who uses a lot of emotion-laden words to describe her physical symptoms more likely to have her ailments diagnosed as fibromyalgia than a female patient who comes across as calm, cool, and collected? Are women who are overweight more likely to be hastily given the fibromyalgia diagnosis versus women who aren't overweight?
If a doctor knows the patient has, or did at one time suffer from depression or anxiety, does this increase the likelihood the patient will be automatically told her (or his) symptoms are caused by fibromyalgia, with little or no diagnostic testing done to rule out other medical conditions with similar symptoms? Does the same hold true if the patient responds with a “yes” when questioned about whether or not she was ever in a car accident, or ever had surgery, or was abused as child, or had beaten by a boyfriend or husband, or if she was ever raped, or if her parents ever consumed alcohol during her childhood, or if she smokes, drinks or had ever used illegal drugs?
From “Bone health in patients with fibromyalgia” by A. W. Al-Allaf, P. A. Mole, C. R. Paterson and T. Pullar1:
Patients with FMS were more likely to be smokers compared with controls (52.5 and 18.9% respectively,P¼0.006). Patients were found to have a higher BMI compared with controls (28.9 and 25.8 respectively, P¼0.016). FMS patients were found to be more likely to have had previous steroid therapy compared with controls (42.5 and 8.1% respectively, P¼0.001). However, FMS patients were significantly less likely to take alcohol on a regular basis (27.5 and 78.4% respectively, P<0.001). www.fibromynet.nl/pdf/voedingssupplementen-vitamined.pdf
From Rx AlterativeMedicine.com “Fibromyalgia Syndrome, Chronic Fatigue Immunodeficiency Syndrome FMS”:
The causal factors that most frequently contribute to FMS/CFIDS are addressed in an online Comprehensive Health Assessment found on the link listed below. The assessment, all easily accomplished from the convenience of your computer, will give you good insight into whether you are experiencing any of the common causes of FMS/CFIDS. Those factors include:
Candidiasis , a common yeast problem frequently associated with FMS/CFS.
Food allergy is usually associated with Candidiasis and undetected in most cases, especially the delayed onset type.
Gastrointestinal disorders including the "leaky gut" and microbial parasites, among others, are often a factor.
Toxic metals including lead, mercury, cadmium and aluminum are unsuspected culprits and should be considered in persons who have been exposed to them.
Hormonal imbalances including thyroid, adrenal and progesterone insufficiencies as well as others may be a problem.
Poor diet, junk food, smoking, obesity, and alcohol should always be considered.
In our clinic, every FMS/CFS patient completes the Comprehensive Health Assessment mentioned above. We consider it to be a required part of every patient's program. It is very easy to complete in spite of being extensive and global in its evaluation of your potential for these FMS/CFIDS causal factors. It is done at your convenience and time table, all online.
The Contributing Factors to Fibromyalgia and Chronic Fatigue Syndrome
As you have read above, FMS/CFIDS are caused by a variety of different conditions which on the surface would seem to be unrelated to fibromyalgia. There is a tremendous amount of literature available on FMS/CFIDS and your challenge is to sort through it all to see what applies to you. http://www.rxalternativemedicine.com/articles/fibromyalgia.html
Quote from the abstract for Characteristics of patients with fibromyalgia syndrome assisted in a hospital of Salvador, BA, Brazil. COSTA, Sergio Ricardo Matos Rodrigues da et al.:
We found a significant association of low family income, sleeping disturbances and smoking habit with a larger amount of tender points. http://www.scielo.br/scielo.php?pid=S0482-50042005000200004&script=sci_abstract
Quote from the abstract “Quality of life, functional disability and lifestyle among subgroups of fibromyalgia patients : The significance of anxiety and depression”:
Anxiety and depression interacted to yield relatively high consumption of coffee and cigarettes among the anxious and depressed subgroup, and this effect emerged only after the elimination of confounding effects of age and duration of the fibromyalgia disease.
http://cat.inist.fr/?aModele=afficheN&cpsidt=1216145
Has Fibromyalgia become a diagnostic label which is largely based upon behavioral stereotypes both here in the United States and abroad?
The Double-Edged Sword of Alcohol Use
Some doctors ask their fibromyalgia patients about their personal backgrounds and childhood and this can potentially include the loaded question: “Did your parents drink when you were a child?” Alcohol use has different connotations when related to socioeconomic factors, race and ethnicity. Obviously both non-abuse related alcohol consumption and alcoholism exists across the socioeconomic spectrum, and in all racial and ethnic groups. But, when it comes to social class, social standing, education, career and income, race and ethnicity there are societal-based stereotypes which can effect how a “yes” answer to the above question will be perceived.
In our society, for middle and upper income adults, (particularly for white middle and upper income adults) with higher levels of education and well paying white collar jobs, alcohol consumption, especially in social or romantic settings, bears far less of a negative perception. Drinking quality wines with meals; or choosing champaign for special occasions; drinking liqueurs, mixed drinks and microbrewery beers; being knowledgeable about wine; attending wine tastings; going on 'wine country tours' and the like is considered sophisticated and chic. But when it comes to societal perceptions regarding alcohol consumption, even just occasional consumption in social settings, by lower-income workers, and the poor, by anyone who has recently developed a chronic health problem, as well as by members of racial and ethnic minority groups, negative societal stereotyping can come into play.
If a white, middle class or wealthy patient is asked whether or not her parents consumed alcohol during her childhood, and she answers “yes”, the likelihood her questioner may or will automatically assume the alcohol consumption equated with alcoholism and domestic violence can differ somewhat than if that question is posed to a low-income white, or low or middle income black, Hispanic or American Indian patient. The same socioeconomic and racial/ethnic based stereotypes may very well influence how the medical or social support caregiver views the patient if the patient answered “yes” when asked if she or he ever consumes alcohol. With efforts being made to blame many medical problems on “bad personal behaviors” like consuming alcohol, even when that behavior have nothing to do with the development of the patient's medical condition, negative and erroneous assumptions can still be made about any patient who isn't a teetotaler. With efforts made to blame various illnesses and diseases in adults, including musculoskeletal and autoimmune diseases on childhood domestic abuse at the hands of parents and other caregivers, the question of “Did your parents drink when you were a child” becomes a loaded question particularly in light of societal biases and stereotypes against lower income whites and those from racial and ethnic minority group, and this factor needs to be considered.
Can a lower income/poor white, or non-white patient with minimal or no health insurance coverage who presents with chronic fatigue and pain, who answers “yes” to parental alcohol consumption have that “yes” used in part by her medical caregiver to reach a hasty diagnosis of fibromyalgia, based upon the stereotypes, biases and perceptions that exist in our society?
Is Fibromyalgia Partly a Socioeconomic and Social Stereotype Based Diagnosis?
A wide variety illnesses, diseases and medical conditions have symptoms that are similar to fibromyalgia, yet Fibromyalgia is currently a popular “fad” diagnosis for all that ails many people, particularly women; so what roles do socioeconomics, medical care coverage or lack thereof, and social class, gender, racial and ethnic stereotypes play within the medical community which effects physician diagnostic decision making? How do these factors help determine which patients will quickly receive the Fibromyalgia label with little or no medical testing to rule out other conditions, and which patients' doctors will look elsewhere for an answer through thorough diagnostic testing?
On average, how many medical tests are run on a patient with good to excellent health insurance coverage before her doctor even considers the fibromyalgia diagnosis? How many medical tests are run on an underinsured or uninsured patient before her doctor ever considers the fibromyalgia diagnosis?
It would be interesting to see studies run by Sociologists (academic Sociologists, not social workers) which strictly focused on socioeconomic and educational backgrounds, racial and ethnic factors, and levels of health insurance coverage or non-coverage regarding who is more likely to receive the Fibromyalgia diagnosis, particularly in situations where either few or no laboratory or hospital-based medical tests are performed to first rule out other medical conditions with similar symptoms.
It would also be interesting to read some Criminolgists' opinions on linking Fibromyalgia and CFS to child beating and child molestation, as an emotional symptom of suffering physical or sexual abuse. Have those criminologists who've interviewed the offspring of violent criminals (whose victims included family members) ever noticed any tendencies in these offspring to suffer from fibromyalgic and chronic fatigue-like medical problems?
Fibromyalgia and Gender, Race , Ethnicity and Occupation
From the “Fibromyalgia Pain in African Americans” webapge:
An estimated three to six million people suffer from fibromaylgia in the United States...African-American women account for a good portion of those diagnosed. Studies have shown that African-American women with fibromyalgia suffer more widespread severe pain than Caucasian women.. Treatment for fibromyalgia pain has varied for African-Americans.. A study published in 2003 discussed the lack of referrals for specialized pain management for African-Americans.
A study revealed that African-Americans have a higher severity of chronic pain and an increased sensitivity to pain..
Until recently, there were few studies on African-Americans and fibromyalgia..
Trials are being conducted to study fibromyalgia pain in African-Americans. http://organizedwisdom.com/Fibromyalgia_Pain_in_African_Americans
Excerpts from “Patients of Color” by Sabrina Dudley Johnson:
Why is it important to discuss race and fibromyalgia?
Many minority fibromyalgia patients have recounted incidents with physicians who believed, “Since there are no minorities discussed in fibromyalgia research, they must not have it.”
Members of FACES (Fibromyalgia Association Created for Education and Self-help), including African American, Latina, and white people, males and females, civilians and law enforcement officers, drove three hours to a seminar. During the Q&A session, one member asked, "When are researchers going to do studies on people of color, and police officers with fibromyalgia?" The researcher replied "Never! They don't exist!"..
Marcellus Walker, MD, and Kenneth Singleton, MD, address race and healthcare, stating: “In the current climate of ‘political correctness,’ many people consider it inappropriate to separate people on the basis of race, but, when it comes to health, race really does matter. African Americans . . . will soon experience an epidemic of cancer, fibromyalgia, chronic fatigue, and other degenerative diseases.”..
A University of Alabama study revealed that African Americans have a higher severity of chronic pain, an increased sensitivity to pain, and a lower pain tolerance threshold than their white counterparts. The study went on to relate that coping styles, cultural responses to stress, and biases towards/from healthcare providers may be contributing factors.
Patrick*; an African American law enforcement officer with fibromyalgia, was given a referral for massage therapy. The physician called the therapist and asked if she had an opening for a male patient. She replied yes. The officer was ushered into a treatment room. The therapist entered and, upon seeing her new patient, ran from the room. "He didn't tell me you were black!" she snapped...
FACES was founded by people of color and public safety workers with fibromyalgia. We wanted to ensure that the diversity of people affected by this condition receive equal recognition in research and awareness projects. We also realize that the special issues of pain management disparities and cultural competency must be addressed on multiple fronts. Therefore, FACES concentrates on partnerships with other fibromyalgia organizations, government agencies, members of academia, disability organizations, members of law enforcement, and various community-based organizations... http://www.fmaware.org/site/News2?page=NewsArticle&id=6282
Unfortunately FACES was forced to shut down because its founder Sabrina Dudley Johnson has been struggling with worsening health issues. You can read more about Sabrina Johnson and FACES here: http://fmsglobalnews.wordpress.com/2008/01/06/the-demise-of-fibromyalgia%E2%80%99s-faces-inc/
Beyond medical discriminatory issues faced by members of racial and ethnic minority groups; when it comes to the fibromyalgia diagnosis, the fact that men too are diagnosed with fibromyalgia is often ignored in favor of painting it as a “woman's illness”. Also occupation seems to play a role for some patients. First responders of both genders- police, firefighters and EMTs- along with members of the healthcare profession- nurses, and even some doctors- are being diagnosed with fibromyalgia and CFS. Musculoskeletal and autoimmune illnesses are on the rise among first responders in general. First responders and healthcare providers come into contact with a lot of people as part of their profession- a lot of injured and ill people- so they are frequently exposed to various bacteria and viruses. Also with first responders, particularly firefighters, they are exposed to hazardous materials, toxic fumes/toxic smoke and such as part of their everyday jobs. But, unfortunately “job stress” has become the convenient medical excuse for the rise in such illnesses in healthcare workers and first responders. Several doctors who are involved with Fibromyalgia and CFS research and advocacy suffer from these conditions themselves. They are: Drs. Mark Pellegrino, Daniel Dantini, and Devin Starlanyl.
