Women with fibromyalgia: work and rehabilitation.

PURPOSE: To explore disability in women with fibromyalgia with a focus on their work situation. METHOD: Review of literature on work status of women with fibromyalgia. RESULTS: Major differences exist between studies in reported disability and in the percentages of women working. Limitations caused by pain, fatigue, decreased muscle strength, and endurance influence work capacity. However, 34 - 77% of the women work. Individual adjustments in the work situation are reported. When the women find a level that matches their ability, they continue to work and find satisfaction in their work role. Many factors besides degree of impairment or disability influence whether clients with longstanding pain can remain in their work role or return to work after sickness leave. CONCLUSION: The total life situation, other commitments, type of work tasks, the ability to influence the work situation, and the physical and psychosocial work environment are important factors in determining whether a person can remain in a work role. More knowledge is needed about how to adjust work conditions for people with partial work ability to the benefit of society and the individual.

Living with continuous muscular pain--patient perspectives. Part I: Encounters and consequences.

The purpose of the present study was to focus on the patient perspectives of living with chronic muscular pain, and to identify factors that can explain and give further understanding of how the condition influences everyday life. Forty women with fibromyalgia, living in two different cultural, health care and social security settings, Sweden and the USA, were interviewed, using a semi-structured format. Three preliminary typologies are suggested for further studies: Encounters, Consequences, and Strategies. The study is presented in two articles: Part I: Encounters and consequences, Part II: Strategies for daily life. This first article shows that the contradiction between the patients' perception of illness and the lack of objective findings is stressful. The women feel rejected, misunderstood, and disbelieved, which prevents them from dealing with their situation constructively. Long investigation periods provoke anxiety, and confirmation of the diagnosis is a relief. Daily routines are disrupted, conflicts between life roles lead to additional stress and the women experience loss of ability to perform valued activities, lack of physical fitness and loss of future opportunities. Patients need early and adequate information and the consequences of the condition must be acknowledged and taken into consideration if secondary economic and psychosocial consequences are to be minimized.

Living with continuous muscular pain--patient perspectives. Part II: Strategies for daily life.

This second article of the study Living with Continuous Muscular Pain is Part II: Strategies for Daily Life. The primary purpose was to explore, analyse and describe how women with fibromyalgia, living in two different cultural, health care and social security settings, managed their everyday life in spite of the limitations imposed by the condition. Data were collected through qualitative semi-structured interviews with 40 women, 20 living in the USA and 20 in Sweden. The different strategies used by the women were identified and a preliminary typology of strategies is proposed as a base for further and more specific studies. The results support earlier findings, though the qualitative approach adds knowledge regarding the women's own perception, interpretation and experiences of how to deal with the problems that arose. The findings in the two national groups were very similar, but differences in the medico-legal compensation systems influenced the women's opportunities to reduce working hours. Changes of habits, roles and lifestyle, as well as ergonomic considerations were required. These changes take time and require continued support from the environment and the health care providers. Further insight into the consequences of the condition is necessary for the planning of successful treatment and support programs.

Longterm effects of fibromyalgia on everyday life. A study of 56 patients.

Fifty-six patients with fibromyalgia, previously studied in 1984, were followed up after five years, using a mail questionnaire and a global health assessment instrument, the Sickness Impact Profile. The aim was to investigate the patients' perception of their symptoms and to describe the consequences for everyday life. Half of the patients reported that pain, fatigue and sleep problems had increased, less than 20% reported improvements, and 30-40%, no change. In spite of this, 25% reported that their overall condition had improved. Motor tasks were somewhat less difficult to manage. The symptoms had severe consequences for the patients' ability to manage everyday life activities. The study confirms that fibromyalgia, once established, is a non-remitting syndrome. Also, the social consequences were constant over time.