Evaluation of working capacity in people with fibromyalgia

Abstract

Social benefi ts are often requested due to symptoms of fi bromyalgia, the most prevalent chronic widespread pain syndrome in the general population, recognized by the World Health Organization (WHO) since 1992. The Court expert is faced routinely with two basic questions: - 1) Is Fibromyalgia a disease that causes labor incapacity? 2) Does this disease have a causal nexus with some labor activity? This study aims to verify the current concept of fi bromyalgia as well as determining the criteria that allow medical-legal evaluation of labor incapacity and the causal nexus with the occupational activities performed by people with fi bromyalgia. For doing so, literature review was performed based on recent publications in major research bases (Pubmed, Scielo and Lilacs). Fibromyalgia is inserted in the group that corresponded to 7.756 sickness benefi ts and 970 benefi ts due to accidents granted in 2010, and 1.927 sickness benefi ts and 242 benefi ts due to accidents until March of 2012, by Social Security. According to literature data the estimated prevalence of the disease is 0.66 to 4% of the population, reaching preferably females. The current diagnostic criteria do not include anymore the tender points, defi ned by the American College of Rheumatology (ACR) in 1990, and comprehend the symptoms unrelated to the limbs, besides the muscular-skeletal pain, which evaluate their intensity. The relation between this disease and the occupational activity is object of discussion, since conditions such as work-related musculoskeletal disorders (MSDs), somatoform disorders and psychiatric disorders are differential diagnoses that use to be diffi cult to be distinguished. Propaedeutic and complementary exams do not completely elucidate the diagnosis. Given these elements, the authors of this paper discourse about the functional consequences of the disease that may justify granting benefi ts like disability retirement or sickness assistance and discuss the medical-expert criteria for assessment of the causal nexus between fi bromyalgia and labor activity exercised by people with fi bromyalgia. The conclusion of this article is that fi bromyalgia can be disabling in consequence of the intensity of the pain and occupational physics demands. Thus, it´s necessary to evaluate labor activity and work environment in order to establish a nexus between work and disease, besides excluding other diagnoses hypotheses. The evaluation of the occurrence of similar symptoms in people who works at the same labor conditions that the worker with fi bromyalgia is also important, since this information guarantees more credibility to the nexus evaluation.