Could Fibromyalgia Be Labeled as a Psychiatric Illness?

Could Fibromyalgia Be Labeled as a Psychiatric Illness?

May 12th is Fibromyalgia Awareness Day – a day we try to educate and build awareness about a disease that affects over six million Americans and many more around the world.

The pain, fatigue, depression and other symptoms that come with fibromylagia are notoriously difficult to diagnosis and treat. Soon they may become even harder. There are some important developments underway that could affect how fibromyalgia is classified as a disease and whether health insurers pay for its treatment.

Let me explain.

The preliminary and modified diagnostic criteria for fibromyalgia has come under fire — and rightly so — because it only looks at somatic complaints, which are symptoms that have no medical explanation.

512px-Tension-headacheThe American Psychiatric Association’s fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is due be released this month, could change the diagnostic criteria for fibromyalgia – but not for the better.

The new DSM-5 describes somatic symptom disorder this way:

“Somatic symptom disorder (SSD) is characterized by somatic symptoms that are either very distressing or result in significant disruption of functioning, as well as excessive and disproportionate thoughts, feelings and behaviors regarding those symptoms.”

The current diagnosis of somatization disorder in the DSM-IV requires a specific number of complaints from among four symptom groups. But the new SSD criteria no longer have such a requirement; symptoms must be significantly distressing or disruptive to daily life and must be accompanied by excessive thoughts, feelings, or behaviors.

An important change to the older version, termed somatization disorder, is that while medically unexplained symptoms were a key feature for many mental health disorders, the new SSD diagnosis does not require that the somatic symptoms be medically unexplained.

In his study, Fibromyalgia Prevalence, Somatic Symptom Reporting, and the Dimensionality of Polysymptomatic Distress, Dr. Frederick Wolfe, the lead author of the proposed diagnostics for fibromyalgia, points out that 40% of fibromyalgia patients will fall into the new DSM-5 somatic symptom disorder classification.

It bears mentioning that this study used a modified tool that has not been approved for evaluating psychiatric somatic disorders, which brings into question its validity.

It also makes the margin between psychiatric disorder and fibromyalgia blurry.

Wolfe’s criteria for somatic symptom disorder will put many patients at risk for being diagnosed with a mental disorder without investigating their medical conditions.  Fibromyalgia patients are particularly at risk, because the new criteria for diagnosis only considers somatic complaints and uses a questionnaire platform, such as those used in diagnosing psychiatric illness. The value of a physical exam is omitted.

Living with pain every day, regardless of the reason, interferes with a person physically, mentally, emotionally, financially and socially. The absence of specific medical testing, or ignoring conditions that do have objective measurements (such as hypothyroidism, autoimmune dysfunction, migraine, myofascial pain syndrome, rheumatoid arthritis, etc.) will make it difficult to smooth out the rough edges involved in both mental health disorders and fibromyalgia.

Ignoring research such as that done by Behm, et al. (2012), Homann, et al. (2013) and effects on the autonomic nervous system, such as that done by Lerma, et al. (2011) will leave the patient floundering in pain and dysfunction, adding to stress, and could aid in mental collapse that might otherwise be avoided.

So what’s the problem?

The International Classification of Diseases Codes (ICD) are used to support areas such as morbidity coding and statistics, public health reporting and tracking trends. They are used by hospitals, nursing homes, assisted living and rehab facilities, private and public medical clinics, psychiatric facilities, medical insurance companies, physician practices and other medical providers. The ICD code is a quick way to identify diagnosis and can affect everything from the classification of your disease to what tests and treatments your doctor can order, and how insurance billing is done.

The current U.S. clinical modification of ICD-9CM is to be replaced by ICD-10CM by October 1, 2014.  In the US ICD-9CM, there is no specific code for fibromyalgia; rather it falls under myalgia and myositis, unspecific, 729.1.

With muscle pain being the primary complaint in fibromyalgia, it could remain where it is. However, a great deal of research suggests that fibromyalgia also has neuro-endocrine-immune components, in which case it could be given neurologic or immune coding.

This could all be jeopardized if Dr. Wolfe’s new criteria are embraced within the medical community.

If fibromyalgia is coded as a somatic symptom disorder, as suggested by Wolfe, your primary insurance will no longer cover visits to your medical doctor. Instead, you will have to be seen by a psychiatrist or psychologist under the mental health rider of your insurance policy.

Generally, I am sad to say, the mental health benefits provided by many insurers are insufficient to serve the current patient base and would be even more inadequate if millions of fibromyalgia patients are added.

It is very scary indeed to think that we could be denied the care we need.

What can we do?

Understanding what goes into disease classification is important. The proposed diagnostic criteria for fibromyalgia are non-specific in relating symptoms and complaints to known overlapping conditions. Most of these conditions have objective tests such as palpating for myofascial trigger points, brain mapping for migraine, blood tests for hypothyroidism or Hashimoto’s thyroiditis, table tilt test for dysautonomia and holter monitors for measurement of heart rate variability, sleep studies to evaluate a disruption in normal sleep cycles and periodic limb movement, cystoscopy and other tests for evaluation of bladder problems, etc.

Fibromyalgia has not been classified in the new criteria yet. Studies for biomarkers for fibromyalgia are promising, but if the codes are changed, not only will our insurance reimbursement be in jeopardy, so will research.

The burden of reporting symptoms rests solely on each individual patient, but the burden of knowing what tests to order resides with healthcare providers. Pay attention to your symptoms, and learn about fibromyalgia and the comorbid disorders. Be proactive in your healthcare.

In the long run, it is the patient and the physicians that help those making these decisions make the right ones.  Don’t let your care get lost between the cracks.

Celeste Cooper, RN

Celeste Cooper, RN

Celeste Cooper is a retired RN, educator, fibromyalgia patient, and lead author of the Broken Body Wounded Spirit: Balancing the See Saw of Chronic Pain devotional series (coauthor, Jeff Miller PhD), and Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain: The Mind-Body Connection (coauthor, Jeff Miller PhD), and Insider Secrets for Treating Fibromyalgia.

Celeste is a fibromyalgia expert for Dr. Oz, et, al. at Sharecare and advocates for all chronic pain patients as a participant in the Pain Alliance to Implement a National Strategy (Pains Project). Her website is www.TheseThree.com.

The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that!  It is for informational purposes only and represent the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.

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Resources:

American Health Information Management Association, ICD-10-CM/PCS Implementation Toolkit (accessed 5/2/2013)

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_049431.hcsp?dDocName=bok1_049431

Behm FG, Gavin IM, Karpenko O, Lindgren V, Gaitonde S, Gashkoff PA, Gillis BS. Unique immunologic patterns in fibromyalgia. BMC Clin Pathol. 2012 Dec 17;12(1):25. doi: 10.1186/1472-6890-12-25.

Bennett, Robert (MD) A report and opinion on the preliminary guidelines for the clinical diagnostic criteria for fibromyalgia by Fibromyalgia Information Foundation. (accessed 5/2/2013)

http://www.myalgia.com/Diagnosis/New_preliminary_criteria_2010.htm

2013 ICD-10-CM Diagnosis Code M79.7 (accessed 5/2/2013)

http://www.icd10data.com/ICD10CM/Codes/M00-M99/M70-M79/M79-/M79.7

International Statistical Classification, Fibromyalgia ICD 9 (accessed 5/2/2013)

http://www.icd9data.com/2012/Volume1/710-739/725-729/729/729.1.htm

Homann D, Louzada FM, Goes SM. 2013. Acylated ghrelin: A potential marker for fibromyalgia? Eur J Pain. [Mar 8 Epub ahead of print].

Lerma C, Martinez A, Ruiz N, Vargas A, Infante O, Martinez-Lavin M. Nocturnal heart rate variability parameters as potential fibromyalgia biomarker: correlation with symptoms severity. Arthritis Res Ther. 2011;13(6):R185. Epub 2011 Nov 16.

Smythe, HA. Unhelpful Criteria Sets For ”Diagnosis” and ”Assessment of Severity” of Fibromyalgia. J Rheumatol 2011;38;975-978

Somatic Symptom Disorder – American Psychiatric Association (accessed 5/2/2013)

www.psych.org/…/Practice/…5/DSM-5-Somatic-Symptom-Disorder.pdf‎

http://plus.url.google.com/url?sa=z&n=1367513737527&url=http%3A%2F%2Fwww.psych.org%2FFile%2520Library%2FPractice%2FDSM%2FDSM-5%2FDSM-5-Somatic-Symptom-Disorder.pdf&usg=dQYhR6wLj1rR24eTYzZexIZV_Zw.

Staud R, Price DD, Robinson ME. The provisional diagnostic criteria for fibromyalgia: one step forward, two steps back: comment on the article by Wolfe et al.Arthritis Care Res (Hoboken). 2010 Nov;62(11):1675-6; author reply 1676-8. doi: http://onlinelibrary.wiley.com/doi/10.1002/acr.20291/pdf

Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB: The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken) 62(5):600-10, 2010 May.

Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB: Fibromyalgia Criteria and Severity Scales for Clinical and Epidemiological Studies: A Modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol 38;1113-1122, 2011.

Wolfe F, Brähler E, Hinz A, Häuser W.Arthritis Care Res (Hoboken).Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: Results from a survey of the general population. 2013 Feb 19. doi: 10.1002/acr.21931. [Epub ahead of print]

Authored by: Celeste Cooper, RN

There are 33 comments for this article
  1. John Quintner at 5:08 pm

    @ Deborah. I agree with you, BUT can you tell us how does depression cause pain? To my way of thinking, both are lived experiences and not “things” that can cause “other things”. It might be more acceptable to say that pain and depression can be associated conditions.

  2. Deborah Ackerman at 10:50 am

    How dare they say that it is psychological. Generally fibro is caused by other trauma. Its not psychosomatic. It is Somatic meaning Body pain. Not from having a mental illness although chronic pain is linked to depression, which also causes pain. These fools need to talk to us proactive patients who are well informed and know more obviously then some of these doctors that can read but don’t feel our pain!!!

  3. Cathy at 8:15 am

    No not mental. That was my first diagnosis ! Then a yr later ask my dr to give me Ana test again! I tested positive for scleroderma crest internal and mixed tissue! Shocked that is a diagnosis a dr gives when they have no clue of disordered! I truly believe fibro leads to much more underlining problems!!! Never stay with a dr who blows u off. I changed dr.s till I found compassionate dr. Don’t give up get a good dr

  4. John Quintner at 10:13 pm

    @ Greg. Why are we so obsessed about trying to measure such things, which of course are innately immeasurable?

    As I see it, classifying “fibromyalgia” as a psychiatric illness (the topic of this discussion) does not in any way advance our understanding of the condition.

    Psychiatry is in big trouble because of its unspoken belief that a specific mental process underlies each diagnosis. This belief has seemed to dictate many of its clinical approaches to the problems that come within its ambit.

    Of course, no specific mental process underlies the experience of pain. Yet assigning a psychiatric diagnosis to pain sufferers runs the risk of embedding a spurious and discredited explanatory model for an experience where explanation may not be possible. As another example, how does one explain “love”?

  5. Greg P. Morrison at 9:47 pm

    how can we measure pain, depression,stress.
    i mean how do we measure one’s emotion?
    hope that there will be more study of FIBRO

  6. KIMBERLEE ANNE at 11:22 pm

    OH BOY WHERE DO I START? I have been looking for a place like this to post comments and read what other people are going through and the treatments that have been tried. I started my journey in 1996. I was going through a very bad devorce. The trauma Is what brought the Fm/cps/cf out. I had some health problems early on that after Fm came out I was told they were related. In 1995 fibro was seen as a joke. Somebody looking for attention. All in my head. I was sent to Dr. After Dr. I saw so many shrinks I started to think I was nuts. The pain and fatigue along with migrains was unbearable. I was finally sent to a Dr. That diagnosed me 14out of18 trigger points. I was then sent to a pain management Dr. I did not know it then but that is when the real trouble started. Starting with steroids injections. Oxycontin with percoset for breakthrough pain. By 2001 I was on 60mg three times a day of morphine with endocet 10/750 for breakthrough pain. Sleeping pills wake up pills depression pills and I managed a bowling center that required at least 13hours a day. The more stress the more pain. My Dr started telling me I couldn’t. Work anymore and the battle with disability started. 2003 my oldest son 23 died suddenly. I really don’t know what happened for the next 4years I took all the pills I was told to and they did not even work. I had sunk so low into depression I wanted to die. I knew I would be like this as long as I lived. I did get my disability in 2008. That helped some. My friends were all tired of hearing about my fake illness and I lost most of them. The last time my pain Dr.raised my morphine and started to talk about implanting a pump I knew I had to get off that crape. I did. 8 days of more pain then could be imagined. Puking my guts out sweating and chills I thought I was rising. I was praying for death. I made it and still had a need for it for about 8 months but never gave in. Found new Dr. Test after test we found out all the junk I had been taking thrashed my pancreas. Gallbladder had to be removed. And cataracts all from the steroids being injected in my back. Disc degenerating bone density of a 80 year old. And still in pain. Dr put me on elavilfor depression zanax for angzity. Tramadol 6 times a day. Still in pain but somehow my mind can cope with it better. Dr still adding medications trying to get my pain under control some. I will let u know what happens next. To all I do the following when in severe pain. Sit on the floor if you can breatg deep in and out and tell your pain to go with each exhale. May u all have better days.

  7. Emmie Gorrell at 1:45 am

    This article, while news those of us who suffer with the severe pain and overwhelming fatigue, along with a host of other health problems that are frequently part of the syndrome, need to be aware of, makes me want to give up. I have dealt with severe FMS and CFS/ME for over 15 years, and I have not had one day without major pain during that time. My understanding is that it is called a “syndrome” because not enough research has been done to develop a list of symptoms and a method of treatment for this extremely debilitating, yet publicly totally misunderstood, syndrome.
    I wish that those who want to call this an SSD could walk in my body for just a week. They would not be able to stand it. Every single cell of my body hurts, and the “pressure points” diagnostic tool that was used, is a joke to my dr. and to me, because everywhere she touches me, it hurts significantly. I am not the person I once was. I must walk with a three pronged cane, as I have such lack of balance, and I tire so quickly, that I am basically housebound at this point. Digestive, respiratory, neurological, and endocrine, as well as auto-immune problems assault me 24/7. I was always a very active and involved person, who taught ADHD students for 25 years, when, during the last year, it was complete torture to try my best to continue teaching, as I would awaken with the alarm, and start to cry, as the pain that I was experiencing, along with the feeling I had not gotten any sleep, although the clock disagreed, took a gargantuan effort for me to get ready, get in the car, commute to work, and make it through the day in some fashion.I taught until one April day, after all my drs. had told me to resign at Christmas break, I was trying to keep things stable for my students,and one day that I won’t ever forget, I could no longer take a step or move in any way whatsoever. I started sobbing, knowing that the time had come when I would have to leave my students. Somehow, the principal came in, as I was trying to crawl to the computer to type out some sort of lesson plans for the long term sub I knew they would have, and he saw how I was and knew that I could not continue either.I have no idea except that I am persevering and stubborn, of how in this world I made it as long as I did. I cannot tell you how horrible these past 15 years have been, due to the limitations on what I am able to do, and the horribly severe pain that is not like any pain I have ever felt. The pain likes to come in all forms:burning, stabbing
    ,cramping, spasming, and any other adjectives that des-
    cribe pain, like a terrible pain that I feel all over my entire body basically all the time. Migraines, Asthma, Sleep Apnea, Irritable Bowel Syndrome, thyroid disorder,interstitial cystitis, vision blurring, and photo-sensitivity, word finding problems, memory problems, repeating what I have already said, total lack of stamina,
    completely overwhelming exhaustion,flu-like feelings, that are worse than any flu I have ever had before this “syndrome.” are part of what I experience. Muscle pain is constant, and fascial pain is another constant, with severe, severe pain all over my body, just like my fascia is structured. Waking in the night, having sweat so much that I have to change my nightgown.Gastric reflux, frequent choking on a bite of food, difficulty with spatial concepts, no sense of time at all,TMJ that is horrible and so difficult to get to stop, visual changes that occur much more frequently than ever, Tinnitus, extremely sensitive to temperatures, balance problems, insomnia,etc., etc.There is no treatment for this “syndrome” and my dr. has worked with me to try to treat this constellation of symptoms that are part of my daily life, symptomatically. Nothing ever takes away the pain. The best that I have experienced is a feeling that the medication has “taken the edge off” of the pain, but the pain is very much ever-present. 15 years plus, and this has only gotten worse. I truly do not believe I will die at an older age. I would be surprised if I could continue like this for even five more years. I have been very suicidal at times, but my religion keeps me from that, at least so far. And I’m so fortunate to have a husband who takes excellent care of everything, including me. Without him, I could not live here at home. I would need to move to a nursing facility of some sort.And, I do have major clinical depression along with severe anxiety disorder/panic attacks, for which I have taken meds for years. Those are very much separate from the Fibromyalgia and the CFS/ME. I cannot believe that this Dr. Wolfe wants to change the criteria BACK to a psychiatric model. Believe me, I have had the clinical depression and anxiety long before these diseases, whoops, syndromes, entered my life, changing it and shattering it, killing me with the pain, only to have someone
    who obviously has not studied true cases of this syndrome, be the gate keeper as to what may keep us from having our insurance policies allow compensation for.medical bills
    that have nothing to do with the govt.’s healthcare program that hasn’t even truly begun.

    I can’t type any longer. I can’t believe the ignorance of some of those who contribute to something as widely acknowledged in this society as the DSM. Find out what is causing this “syndrome” to occur in so many of us. Find a treatment that is feasible. Find a cure. I’m sick and tired(yes, I surely am)of fighting this type of fight along with just fighting to get through a day. How do these so-called experts sleep at night? Maybe like I do, with medication, because without it, I cannot sleep, no matter how wiped out I am.

    Very sad and disturbing news to read.

  8. Ana Bunton at 5:59 pm

    Can we start a petition and try to stop this before its too late? If so, please let’s get it going. If someone out there with a better knowledge of how petitions work and how to create one, please help us and get it started. I’ve been living with fibro for over 12 years and its insulting to know that a doctor thinks its all in my head. I’m not psychotic!!

  9. John Quintner at 4:09 pm

    @ Yvonne. What is meant by the phrase “all in the head”? Could it mean that the person claiming to experience pain is being untruthful? Or, could it mean the clinician/observer has been able in some mysterious way to determine that the pain of another person does not exist? In other words, there has been a suspension of belief until such time as there is independent confirmation of the person’s lived experience. Such is the stuff of philosophy!
    In the context of this discussion it may be worth pointing out that Psychiatry has to date not been able to come up with a useful definition of “psychiatric illness”. By contrast, the International Association for the Study of Pain devised an operational definition for pain that has withstood the test of time.

  10. Yvonne Keeny at 11:20 am

    Thanks, Celeste, for publishing this article. While it can be helpful for some fibromyalgia patients to see a psychologist or other mental health professional, this is the epitome of “It’s all in your head!” ~ Yvonne Keeny, Founder & Executive Director, Fibromyalgia Coalition International

  11. John Quintner at 9:50 pm

    @ Kathy. Functional brain imaging cannot be helpful in this context.

  12. Kathy at 5:55 pm

    Why aren’t they using the functional MRIs as a diagnostic tool…they clearly show physiological not psychological “data”.

  13. John Quintner at 10:37 am

    Dear Seri, the “test” you mention has NOT been shown to be useful in the diagnosis of FM (or of any other condition). Visit the blog of Professor Fred Wolfe (Fibromyalgia Perplex) and look for Junk Science – Junk Ethics.

  14. Sere at 6:40 am

    I have one fly in their ointment, the EpicGenetics blood test to diagnose fibro. How can their be a blood test when it’s a psychiatric illness?

  15. John Quintner at 8:48 pm

    Celeste, as you know, I share your concern. This is why in 2011 we published an hypothesis for chronic widespread pain – one that transcends the body/mind dualistic interpretations of pain that are at the heart of this issue. To date, there has been little if any interest in our work!

    However, there is a concerted movement around the world to categorize “chronic pain” as a disease in its own right. A name for this “new” disease has not been agreed upon but, in my opinion, “Fibromyalgia” would fit the bill.

    Unfortunately, Fibromyalgia itself has become a stigmatic label. In any case, it has characteristics that are more those of a syndrome than of a distinct disease entity.

    In my opinion, which will no doubt upset you and many others around the world, Fibromyalgia is now going the way of 19th century condition known as “Neurasthenia”. It disappeared early in the 20th century!

    I predict there will be little interest and support from rheumatology, the very specialty that formulated the construct of Fibromyalgia. I do not see psychiatrists or neurologists being willing to take up the cause.

    I wish I could end on a more optimistic note, but as you point out, this looks like a crisis situation.

  16. Kimberly at 9:07 am

    Psychiatric?? Seriously?? All of this debilitating pain is soooo not all in my head!! We must band together Y’all. I don’t care what our varying political viewpoints may or may not be . Our government & medical professionals going down this line being “bought” & selling out to the highest bidder affects every single one of us & our families!! What disease will be next that they won’t cover?? Heart disease because the person enjoyed one too many pieces of Fried Chicken so they “asked” for it??? We MUST unite & declare how ludicrous this path of mentality is!!

  17. John Locke at 1:00 pm

    You are all making the wrong argument and that’s why you will fail with your intended rebellion. No one is trying to say that you can’t get treatment. Rather, by reclassifying FM, they are saying that your insurance (and that includes those of you who have the taxpayer pay for your healthcare) will not be paying for it, or at least at the level they do now. And, as Linda pointed out below, this is just another part of Obamacare coming to light. I contend it started several years ago when suddenly they decided that women did not need mammograms or PAP smears every year. Linda is correct, the only way Obamacare can be successful is to start denying people treatment.

    And what’s even more concerning, or at least should be to anyone who has a diagnosis of FM in their medical records, is if this new classification is accepted then suddenly you have been diagnosed with a psychiatric disorder. How do you like them apples?

    Neither Congress or the Executive branch of government cares about your emails, phone calls or letters. They don’t read them. If you do get a response to an email I can promise you that it is a computer-generated canned response that does not personally address your issue. And to the Canadian who made a snarky comment about being an American at times like these I say sleep well tonight knowing that you’re neighbors are paying for your healthcare. That, sir, is nothing to be proud of, living at the expense of others.

  18. Celeste Cooper at 11:24 am

    Bingo! The only thing I might add is our government is not in charge of the ICD-10 codes. They are set by the World Health Organization (WHO) and the current US version is called the ICD-9CM, and the new codes will be in the US, ICD-10CM. These codes are used for many things as described in my article.

    Suzi, TY so much for your addition. “The draft Tabular List for ICD-10-CM is available from the CDC website and is subject to partial code freeze until one year post implementation.” This is helpful information, however, in light of the authors of the Preliminary and Modified Criteria for Diagnosing Fibromyalgia and Dr. Wolfe’s subsequent study in Germany, would you not agree, that the codes are in jeopardy of changing at some point?

    Also of concern is the treating physicians interpretation of the criteria, and ultimately they are the ones who assign the code. According to the DSM-5, a FM patient could fall into two categories, even if the FM code does not change. In my opinion, this could give rise to insurance reimbursement difficulties. You appear well versed on the ICD-10CM and I appreciate your comments. I wish we could connect on this.

    In healing and hope to all my fellow fibromites, Celeste

  19. Ethel at 9:10 am

    How does one measure pain, fatigue, lack of sleep, and soreness? Are these not physical feelings? Must they be mental or do physical feelings become seperated from ones mental feelings? Sometimes I wonder where professionals minds are. I am a retired professional psychiatric RN with a BSN degree. I have FM. This disease is no fabrication or figment of my imagination. It is real as real can get! Why then would one person have the authority to say this disorder should be classified as purely a mental disorder? Should people who complain of severe back pain be classified with MI [mental illness]? You cannot see their pain either can you? Get real about human beings and their bodies which can not be measured in dollars and pennies. We are not going to be labled as something we are not to make monies improve for reasons that have nothing to do with our illness. For all FM persons, I pray you rally for your disorders not to be labled as mental illnesses because mental illnesses are the highest cost health commodities in health care. The question then becomes too, so why would you who want to place FM in the DSM-5 which whould drive health care cost higher? This makes no sense to me!!!!!!!!!

  20. Linda at 9:01 am

    my sister has fibromyalgia, and i have severe depression/anxiety due to pain from an injury…..we are both in pain all the time, meds help but don’t work completely….. this is just another example of obamacare in action….the only way to insure everybody is to DENY everybody….and if they say *it’s just in your head* then there’s their excuse to DENY!!!!!!! as long as the sheeple put people in office who care more about themselves than the people they are *supposed* to serve…..WE ARE SCREWED……

  21. Maureen at 6:53 am

    This plan the government has is ludicrous! I was diagnosed in 2001 which took years to attain. I continued working till all I did was work and sleep and took a lot of Ibuprofen! Then I could no longer get out of bed in the morning or function normally because of the pain. It took 3 years to get my SSD, my ex- husband left after 8 years because he could not deal with it! Now the government wants to say it’s all in our heads?! I wish we could cloak these folks with Fibro for one week and see what they have to say then! Thank God I have a FNP who is knowledgeable and caring, she works with me NOT against me. She sees the myofacial swellings and knots, the muscle spasms and knows I’m doing the best I can. Some good days, others not so good but I don’t give up! Let’s hope and pray this doesn’t pass!!!

  22. Rena Catherine Streetman at 6:51 am

    I am a 60 year old female that worked in education for 34 years. 27 of those years was in teaching and working with at risk students. They use to call me the energizer bunny, but I had to live my job because of so many health issues. I will list some of them. IC IBS Gerd degen. disc disease. 3 dics are damaged with no way to repair them asthma, mild depression. CFS. I did get disability after 2 years of filing. I wake each day waiting on my body to see how much I can do. I also had a sleep study done that resulted in restless legs. I will fight for US. I know in my heart and my mind, that I am sick.

  23. Suzy Chapman at 5:58 am

    A couple of points to add.

    The draft Tabular List for ICD-10-CM is available from the CDC website and is subject to partial code freeze until one year post implementation.

    For ICD-10-CM (which has been developed for U.S. specific use from the International ICD-10) Fibromyalgia is coded under:

    Chapter 13 Diseases of the musculoskeletal system and connective tissue (M00-M99)

    at

    M79.7
    Fibromyalgia
    Fibromyositis
    Fibrositis
    Myofibrositis

    (This mirrors the classification and coding of Fibromyalgia in the International version of ICD-10.)

    ————–

    The DSM-5 field trials for the new disorder which at that point was known as “Complex Somatic Symptom Disorder”, but which will now be known as “Somatic Symptom Disorder,” used three study groups:

    a “diagnosed illness” group: comprising patients with diagnosed cancer or coronary disease;

    a “functional somatic” group: comprising patients with irritable bowel syndrome or “chronic widespread pain”;

    a “healthy” control group

    When one from the “B type criteria” was required to be met for the field trials:

    15% of the diagnosed cancer or coronary disease study group met the criteria for an additional diagnosis of “SSD.”

    26% of the irritable bowel syndrome or “chronic widespread pain” study group met the criteria for an additional diagnosis of “SSD.”

    7% of the healthy control group were captured by the new SSD criteria

    as the criteria stood for the third draft, as posted in May-June 2012.

    Suzy Chapman

  24. Maria dlT at 5:10 am

    Is there an organized effort to start a protest email campaign. We need to have REPEATED mass-email (maybe monthly or weekly) scheduled for emails to be send on a given date to flood our government official’s offices with emails in protest of this inhumane effort? We need the National Fibromyalgia Association (NFA) to organize a UNITED constant hammering movement that will raise our voice to be heard.

    This proposed change introduced by puppets of special interest groups, not patient or lovers of science groups who seek the truth, would only benefit SSI and private insurance companies not patients. Therefore, we need to organize and be heard as an united entity in order to be effective against powerful business groups that state their case against patients by quacks that sell their souls.

    We don’t have to (or can’t because of pain) sit at the door of the White House or Capital Hill to protest, but we can flood their email system with complaints in the pain-relieving comfort of our homes. In fact, we can and should do it over and over again, until they give in to simply get us off their backs. Who should we write to? We need the NFA’s leadership in this respect.

  25. Elsie at 3:30 am

    I find this possible “relabeling” of fibro troubling for several reasons. I might not be able to continue seeing the Rheumatologist, with whom I have built a working relationship over more than a decade. That is a travesty. Even more frightening to me is that I fought my long term insurance disability company for years before finally getting some peace. They wanted to cut me off under their two year mental health exclusion. So after fibro gets recharacterized as a mental disease, I don’t imagine it’s going to be too long before I lose my disability benefits. So let’s summarize: I won’t be able to see my doctor (the doctor who has been my biggest supporter for disability benefits, btw) and I will most likely be in danger of losing my disability benefits even though condition makes it impossible to work. Thanks Dr. Wolf, you’ve been so helpful!

  26. Brad Warnke at 3:07 am

    It sucks to be an American during times like this, especially when 8 million people are labelled and herded based on one mans opinion. What is worse is that Congress and your entire Governing body will base our illness solely on a financial gain or loss to your insurers.
    Sincerely Canadian,
    Brad

  27. Gigi at 12:53 am

    It’s not the healthcare provider that is at fault here, the only problem I have with them is that some of them would rather not treat fibromyalgia sufferers because it was an “unrewarding illness” meaning it was a frustrating illness that is difficult to treat and impossible, at present at least, to cure. It is those who want to keep their greedy fingers around that money that are the ones dreaming up this little scheme. Insurance companies, politicians wanting to balance that SSI and more that are hiding in the cracks. We will suffer while the fat cats get fatter. We don’t have a mental disease, and we will not be passed off to a psych doc who s supposed to tell us our pain is in my head, no, that won’t wash. They don’t realize what a lot of grumpy fibro patients raining down on them feels like yet but the APA and whoever is behind them better get their fingers out of the till, our numbers are mighty.

  28. Pamela in Calgary, AB at 12:16 am

    I don’t understand why the government feels the need to harrass us Fibromites – again. Honestly folks…we are people in pain and all we want are answers and solutions, so we can feel normal again.

    WE know that the pain we feel is real….it is NOT made up or manufactured. To try and tell us we have a mental problem (which is basically what’s happening here), rather than a physical one, is an absolute sin. It’s a lie and we’re tired of people coming along wanting to “change” things for us. The only way I will EVER expect real relationships with government officials is when (if) we meet in Heaven.

    Keep fighting folks. Make your voices heard by contacting your government representatives and telling them what’s gone on. Call the police if you see anything suspicious. Don’t pick up a strange or unexpected parcel. Be very, very careful with gifts sent by loved ones and if anything feels “weird or different” in the house, pay attention to your instincts.

    Hang in there! We’re all in this together, so lets work at trying to help each other, and not tear people down. That never ends up well, so remember that. .

  29. Stephanie at 9:42 pm

    I was in a car-accident in ’05. I have 7 hernias, stenosis, bone spurs and chronic migraines. Now I have CFS & Fibro. This is NOT in someones mind. I have a very high pain tolerance. I had a gastric-bypass and was up walking after being gutted and having my insides cur & re-arranged. Fibro is like no other pain. PLEASE understand this.

  30. Michelle Bradley at 4:44 pm

    It’s such a shame, already we’re already being label, and it’s very sad what the ‘medical professionals’ have turned to now I can say that I just experienced this same issue last week when I ended up at ER from Chronic Pain. I’m very disturbed by the Health care Industry today. People who don’t suffer from Chronic Pain, have NO clue what we go through and I’m sure it would be much different if we had something physically going on that they could clearly see with the naked eye.? Quite disturbing, of course the Insurance companies also play a role in this whole labeling & diagnosis as well, just my personal opinion, Great article Celeste and thank you so much for your insight and for caring.
    Respectfully,
    Michelle Bradley~

  31. nancy at 4:18 pm

    wow..so 26 years ago I went through 5 years of test after test and now I will have to start over..I think they want to get the ones getting SSI off and save money while we all end up on the street cause we can’t work and then no money coming in..no money no medications.

  32. Christina R at 1:50 pm

    In my opinion this is a waste of money and time. Let me get this right the government wants everyone to have affordable health insurance. So we’re gonna dissect a disease that has had a lot of research already. Then TRY to make a guild line so if they can prove it’s in your head too. Then they can force higher rates. Or not cover something.This is picking on a Human who got dealt a bad hand and picking them apart. Certainly won’t help anyones mental state when you have to deal with what you have been dealt. A blood test is enough proof to say you got the disease. Every person is different and the disease will effect everyone differently.

  33. jan uhlig at 12:59 pm

    I sure hope Fibro will not pass and a ‘brain’ problem. What will come next, honest to goodness nerve & muscle pain! or any pain. Doctors & family members & friends, who don’t suffer, don’t understand. They usually say it’s all in your head and that ‘you’re just self-centered. Yea, right