Job Accommodation Network

Introduction

JAN's Accommodation and Compliance Series is designed to help employers determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information.

The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each employee's individual limitations and accommodation needs. Employers are encouraged to contact JAN to discuss specific situations in more detail.

For information on assistive technology and other accommodation ideas, visit JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar.

Information about Fibromyalgia Syndrome (FMS)

How prevalent is FMS?

The exact prevalence of FMS in the U.S. population has not been thoroughly studied, but conservative estimates place the total between 4 and 6 million (National Fibromyalgia Partnership, Inc., 2004).

What is FMS?

FMS is a complex, chronic condition which causes widespread pain and fatigue as well as a variety of other symptoms. The name "fibromyalgia" comes from "fibro" meaning fibrous tissues (such as tendons and ligaments), "my" meaning muscles, and "algia" meaning pain. Unlike arthritis, FMS does not cause pain or swelling in the joints. Rather, it produces pain in the soft tissues located around joints and in skin and organs throughout the body (National Fibromyalgia Partnership, Inc., 2004).

What are the symptoms and associated syndromes of FMS?

Deep muscular pain is the most common symptom of FMS. Usually starting at the neck and shoulders and spreading to other parts of the body over time, the pain varies according to the time of day, weather, sleep patterns, and stress level. People with FMS may also have fatigue, sleep disorder, irritable bowel syndrome, chronic headaches, skin and temperature sensitivity, cognitive impairment, depression and anxiety, and irritable bladder (Fibromyalgia Network, n.d.).

What causes FMS?

The cause of FMS remains elusive, but there are many triggering events thought to precipitate its onset. A few examples would be an infection (viral or bacterial), an automobile accident or the development of another disorder, such as rheumatoid arthritis, lupus, or hypothyroidism. These triggering events probably do not cause FMS, but rather, they may awaken an underlying physiological abnormality that is already present (Fibromyalgia Network, n.d.).

How is FMS treated?

Traditional treatments are geared toward improving the quality of sleep and reducing pain. Deep level (stage 4) sleep is crucial for many body functions (such as tissue repair, antibody production, and the regulation of various neurotransmitters, hormones and immune system chemicals). Therefore, the sleep disorders that frequently occur in FMS patients are treated first because they may be a strong contributing factor to the symptoms of this condition. Medications that boost the body's level of serotonin and norepinephrine (neurotransmitters that modulate sleep, pain, and immune system function) are commonly prescribed in low doses. Other medications include pain relievers and muscle relaxers. In addition to medications, most patients will need to use other treatment methods such as trigger point injections with lidocaine, physical therapy, occupational therapy, acupuncture, acupressure, relaxation/biofeedback techniques, osteopathic manipulation, chiropractic care, therapeutic massage, or a gentle exercise program (Fibromyalgia Network, n.d.).

Fibromyalgia and the Americans with Disabilities Act

Is fibromyalgia a disability under the ADA?

The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC, 1992). Therefore, some people with fibromyalgia will have a disability under the ADA and some will not.

A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having such an impairment (EEOC, 1992). For more information about how to determine whether a person has a disability under the ADA, visit http://www.jan.wvu.edu/corner/vol02iss04.htm.

Accommodating Employees with Fibromyalgia

(Note: People with FMS may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with FMS will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.)

Questions to Consider:

1. What limitations is the employee with the FMS experiencing?

2. How do these limitations affect the employee and the employee's job performance?

3. What specific job tasks are problematic as a result of these limitations?

4. What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?

5. Has the employee with the FMS been consulted regarding possible accommodations?

6. Once accommodations are in place, would it be useful to meet with the employee with the FMS to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?

7. Do supervisory personnel and employees need training regarding FMS?

Accommodation Ideas:

Concentration Issues:

Provide written job instructions when possible
Prioritize job assignments and provide more structure
Allow flexible work hours and allow a self-pace workload
Allow periodic rest periods to reorient
Provide memory aids, such as schedulers or organizers
Minimize distractions
Reduce job stress

Depression and Anxiety:

Reduce distractions in work environment
Provide to-do lists and written instructions
Remind employee of important deadlines and meetings
Allow time off for counseling
Provide clear expectations of responsibilities and consequences
Provide sensitivity training to co-workers
Allow breaks to use stress management techniques
Develop strategies to deal with work problems before they arise
Allow telephone calls during work hours to doctors and others for support
Provide information on counseling and employee assistance programs

Fatigue/Weakness:

Reduce or eliminate physical exertion and workplace stress
Schedule periodic rest breaks away from the workstation
Allow a flexible work schedule and flexible use of leave time
Allow work from home
Implement ergonomic workstation design

Fine Motor Impairment:

Implement ergonomic workstation design
Provide alternative computer access
Provide alternative telephone access
Provide arm supports
Provide writing and grip aids
Provide a page turner and a book holder
Provide a note taker

Gross Motor Impairment:

Modify the work-site to make it accessible
Provide parking close to the work-site
Provide an accessible entrance
Install automatic door openers
Provide an accessible restroom and break room
Provide an accessible route of travel to other work areas used by the employee
Modify the workstation to make it accessible
Adjust desk height if wheelchair or scooter is used
Make sure materials and equipment are within reach range
Move workstation close to other work areas, office equipment, and break rooms

Migraine Headaches:

Provide task lighting
Eliminate fluorescent lighting
Use computer monitor glare guards
Reduce noise with sound absorbent baffles/partitions, environmental sound machines, and headsets
Provide alternate work space to reduce visual and auditory distractions
Implement a "fragrance-free" workplace policy
Provide air purification devices
Allow flexible work hours and work from home
Allow periodic rest breaks

Skin Sensitivity:

Avoid infectious agents and chemicals
Provide protective clothing

Sleep Disorder:

Allow flexible work hours and frequent breaks
Allow work from home

Temperature Sensitivity:

Modify work-site temperature and maintain the ventilation system
Modify dress code
Use fan/air-conditioner or heater at the workstation and redirect vents
Allow flexible scheduling and work from home during extremely hot or cold weather
Provide an office with separate temperature control

Situations and Solutions:

An administrative assistant with FMS working for a utility company reported neck pain and upper body fatigue. Her duties included typing, answering the telephone, and taking written messages. She was accommodated with a telephone headset to reduce neck pain and eliminate the repetitive motion of lifting the telephone from the cradle, a portable angled writing surface and writing aids to take written messages, a copy holder to secure documents, and forearm supports to use when typing.

A nurse with FMS working in a county health clinic experienced a great deal of fatigue and pain at work. The nurse typically worked evening shifts but her doctor recommended a schedule change so she could regulate her sleep patterns. Accommodations suggestions included changing her shift from evening to day, restructuring the work schedule to eliminate working two consecutive twelve hour shifts, reducing the number of hours worked to part time, and taking frequent rest breaks.

A guidance counselor for a large high school experienced severe bouts of irritable bowl syndrome, depression, and fatigue as a result of FMS. He experienced difficulty in opening the heavy doors to the entrance of the school and had to make frequent trips to the bathroom. The individual's employer complained that he was spending too much of his time away from his office and therefore was not available for students. The employer moved the employee's office to a location closer to the faculty restroom, added an automatic entry system to the main doors, and allowed flexible leave time so the employee could keep appointments with his therapist.

An individual employed as a patient rights advocate had carpal tunnel syndrome and FMS. She had difficulty keyboarding, writing, and transporting supplies to presentations. The employer installed speech recognition software for word processing, provided her with writing aids, and gave her lightweight portable carts to assist with transporting materials.

Products:

There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar is designed to let users explore various accommodation options. Many product vendor lists are accessible through this system; however, upon request JAN provides these lists and many more that are not available on the Web site. Contact JAN directly if you have specific accommodation situations, are looking for products, need vendor information, or are seeking a referral.

Resources

References

Equal Employment Opportunity Commission. (1992). A technical assistance manual on the employment provisions (title I) of the Americans with Disabilities Act. Retrieved April 29, 2005, from http://www.jan.wvu.edu/links/ADAtam1.html

Fibromyalgia Network. (n.d.). Fibromyalgia basics - symptoms, treatments and research. Retrieved June 30, 2005, from http://www.fmnetnews.com/pages/basics.html

National Fibromyalgia Partnership, Inc. (2004). Fibromyalgia: symptoms, diagnosis, treatment & research. Retrieved June 30, 2005, from http://www.fmpartnership.org/EngMonograph-04.htm