“I’m jus’ pain covered with skin.” 

-Sairy Wilson in John Steinbeck’s The Grapes of Wrath.

I couldn’t help but think of my Fibromyalgia clients when I read those words. The book doesn’t make it clear what Sairy is dealing with beyond exhaustion, fatigue, and hopelessness. But it’s clear she is deeply troubled by chronic pain. Everybody is worried about her condition. The quarantine has given me more time to read, so I foolishly picked up The Grapes of Wrath, by John Steinbeck. It’s a great book – a classic I’ve been able to avoid for decades – but it’s so sad. Why not ready 400+ pages about pain, struggle, disease, death, poverty, racism, and the perseverance of the American will during a global pandemic that places our economy on the edge of another Great Depression?

Fibromyalgia is terrible.

I’ll never forget one of my clients breaking down in tears during a hearing. She struggled through tears to describe how she instinctively put her arms out to block her running grandchild from the excited, jumping, full-body hugs little kids give their grandparents. She felt like a monster for protecting herself from excruciating pain. Pain so bad that it sometimes hurts to wear certain clothes.

Today’s pain is know, tomorrow’s pain is guaranteed, but the unknown location and severity is a mystery that drains the spirit. Why bother making plans? They’ll likely be cancelled. If you go, you might turn around halfway there. If you make it there, you might leave early. And then you get the questions. You get the whispers. You get the unsolicited advice “my auntie had Fibromyalgia, and she beat it by doing these three things.”

Fibromyalgia is real.

It’s a chronic pain that may hurt here and there today. It may hurt everywhere tomorrow. Even the Social Security Administration acknowledges Fibromyalgia as “a complex medical condition characterized primarily by widespread pain in the joints, muscles, tendons, or nearby soft tissues….” (SSR 12-2p). Fibromyalgia can present with many of the following symptoms:

  • anxiety, depression, nervousness;
  • muscle weakness, numbness and tingling;
  • breathing problems, shortness of breath, chest pains;
  • dizziness, hearing difficulties, ringing in the ears;
  • migraine headaches, blurred vision;
  • bladder/bowel problems, diarrhea, constipation, interstitial cystitis, frequent urination;
  • chronic fatigue, insomnia,
  • abdominal pain, nausea, gastroesophageal reflux disorder;
  • easy bruising, hives or welts, rashes, sun sensitivity; and
  • restless leg syndrome.

Social Security Recognizes Fibromyalgia

SSR 12-2p is Social Security’s policy interpretation ruling on how to address Fibromyalgia claims. SSA acknowledges that Fibromyalgia “can be the basis for a finding of disability.” But it’s not that simple. Fibromyalgia is a diagnosis of exclusion – meaning other conditions are typically ruled out before a person is diagnosed with Fibromyalgia. To make things more difficult, the Social Security Administration generally requires that a Fibromyalgia diagnosis come from the 1990 American College of Rheumatology (ACR) Criteria for the Classification of Fibromyalgia (found here) or the 2010 ACR Preliminary Diagnostic Criteria (found here). Interestingly, the 2010 criteria provides for a Fibromyalgia diagnosis in the “absence of a physical examination.”