What to Know About Telehealth for Fibromyalgia

Fibromyalgia can make it hard to get to doctor’s appointments, but between improvements in technology and the COVID-19 pandemic, telehealth appointments are now a reality and becoming increasingly common. They allow you to stay home and see your doctor remotely via your computer, phone, or tablet.

Fibromyalgia is a chronic condition that typically involves abnormal pain, intense fatigue, lack of energy, cognitive dysfunction ("fibro fog"), and myriad other symptoms, and may include flares when symptoms are especially intense. Often even normal daily activity like getting ready to leave the house can bring on flares and make it difficult for people with fibromyalgia to perform simple tasks.

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When to Use Telehealth for Fibromyalgia

Telehealth appointments may be able to take care of a lot of your medical needs. You can schedule telehealth appointments with doctors, nurse practitioners, and other types of healthcare providers. The benefit for you is that you can stay home rather than expend the time and energy getting ready and driving to your healthcare provider's office.

Telehealth is best suited for when you just need to have a conversation and not be physically examined. These appointments may include:

  • Medication or treatment follow-ups
  • Reporting side effects (nonemergent ones)
  • Medication refills
  • Reviewing test results
  • When you can’t risk exposure to a disease

Medication or Treatment Follow-Up

These follow-ups are usually short appointments during which the healthcare provider asks how your treatments are working, whether anything (such as dosage) needs to be adjusted, and answers your questions about the treatment.

With fibromyalgia, you may need more of these follow-ups than other people because it's common to try a lot of different medications before finding the regimen that works well for you and has tolerable side effects. Telehealth allows you to do these routine appointments from the comfort of your home.

Reporting Side Effects

Between regular appointments, you may need to discuss medication side effects with your doctor or another practitioner. This can help the two of you decide whether you should:

  • Continue on a drug
  • Adjust the dosage
  • Switch to something new

Also, you need to taper off some common fibromyalgia drugs, which may require guidance from your doctor. Using telehealth for these appointments can save you a lot of time and energy.

Medication Refills

You typically need to see a doctor periodically—such as once a year—in order for them to continue refilling your medications. If they don’t need to perform an exam or collect your vital signs to check for side effects, telehealth may be appropriate.

However, some drugs do require in-person exams, especially if they cause side effects such as high blood pressure. Many drugs prescribed for fibromyalgia, including Savella (milnacipran) and tricyclic antidepressants (such as amitriptyline), can cause high blood pressure.

Painkiller Refills

Don't expect to get a refill for opioid painkillers—such as Vicodin (hydrocodone acetaminophen) or OxyContin (oxycodone)—via telehealth. You may need to pick up a paper prescription for the pharmacist. Make sure you know the procedures you’ll be expected to follow for refills of these medications.

Reviewing Test Results

You probably had to go somewhere in person to get a blood test, imaging, or other tests performed (unless you used a home test kit), but an online conversation may be adequate for the provider to go over your test results with you.

Often you can log in to a secure system and view your results, while your provider goes over them over a video or phone call. You may even be able to see them before your appointment, which gives you an opportunity to do some research and prepare questions ahead of time.

When You Can’t Risk Exposure to Disease

COVID-19 caused a rapid increase in telehealth appointment availability to protect you, providers, and their staff members during the pandemic, but COVID-19 isn’t the only dangerous illness out there. Remember that telehealth may also be a way to protect yourself from other contagious illnesses such as influenza.

If you have symptoms that could point to something contagious, it’s also good for you to stay home. Not only should you conserve your energy to fight the illness, you may encounter vulnerable people in the waiting room or infect someone on the staff who works closely with dozens of people a day.

You May Need to Be Seen in Person If…

  • You have new symptoms that require a physical exam
  • You need a vaccine
  • You need lab work done
  • Your vital signs need to be monitored
  • You need immediate care, such as for side effects or severe symptoms (e.g., high fever, fainting)
  • A hands-on component is essential, such as physical therapy, chiropractic, dentistry, and eye exams

Benefits and Challenges

Some people worry that telehealth appointments aren’t enough like a “real” appointment and they will get substandard care. So far, research on telehealth for rheumatologic diseases shows that practitioners provide quality treatment and monitoring virtually.

When you have fibromyalgia, telehealth appointments offer a lot of advantages:

  • Fewer cancellations: A big benefit is that you don’t have to worry about canceling because your symptoms are too bad that day. You can log in to the appointment from bed if you have to. 
  • Saving energy: You won’t have to pace yourself as much that day (or week) due to the effort needed to go to the appointment. That means you can direct the energy you have to something else. 
  • Less time away from work: If you’re employed, telehealth means you can squeeze in an appointment during a break. Less time off for medical appointments allows you to save your sick days for when you really need them, such as during a flare. 
  • Seeing far-away specialists: Not everyone has a rheumatologist or neurologist nearby who treats people with fibromyalgia. Telehealth allows you to see a specialist who lives farther away than you can comfortably travel.
  • Less reliance on others: If you’re unable to drive or aren’t comfortable driving because of your symptoms, telehealth means relying less on other people, public transportation, or driving services to get you to appointments.
  • Lower costs (for some): Your doctor or insurance company may charge you less for telehealth appointments. Not all of them do though, so be sure you know ahead of time what your financial responsibility will be.

Challenges of Telehealth

Telehealth does come with some disadvantages, both in general or specifically for fibromyalgia:

  • Difficulties understanding the system: Whether due to age, cognitive dysfunction, or both, the technology may be hard for you to understand and navigate. Emailed technical instructions and installing apps may be a significant frustration.
  • Unreliable service or devices: If your Wi-Fi is slow or unreliable, or your computer or other device isn’t working well, it may complicate your telehealth appointments.
  • Feeling a lack of connection: Especially if you’re not accustomed to communicating online, you may feel a lack of connection to the provider if you only see them via telehealth.
  • Taking your own vitals: Your doctor may ask you to weigh yourself, check your heart rate, or even take your own blood pressure at home. With fibro fog, it can be hard to remember those things and embarrassing when you forget. Also, you may need to spend money on a blood pressure cuff.

Pro Tip: Blood Pressure Cuffs

If you're buying your own blood pressure cuff, consider one that goes on your wrist. They're much less painful than standard ones that wrap around your upper arm. They're readily available, no more expensive than standard cuffs, and simple to use.

Most people aren't put off by these potential challenges though, especially in light of the pandemic. A survey conducted in 2020 found that 84% of people were more likely to choose a healthcare provider who offers telehealth appointments than one who doesn’t. Another survey found that about 25% of Americans over 50 said they'd had telehealth visits early in the pandemic, up from just 4% a year earlier.

How to Prepare for a Telehealth Visit for Fibromyalgia

Preparing for a telehealth visit is much like preparing for any medical appointment, but with some additional other considerations. When making the appointment, you’ll want to ask the following questions:

  • Will you be talking to the doctor, a nurse, nurse practitioner, or physician’s assistant?
  • Will the appointment include audio alone or audio and video?
  • When will you receive a link or instructions for the appointment, and what should you do if you don’t receive it?
  • How long will the appointment be?
  • Will your insurance cover a telehealth appointment and what costs might you face?
  • Will you need to download or install anything? If so, can you get that information early so you can get help with it if needed?
  • How can you go about testing the platform, including your microphone and camera?
  • Will you need to provide information on weight, blood pressure, etc.?

Double check the phone number and email address your provider’s office has for you to make sure you get the information you need.

If you want the doctor to look at something, such as a rash or a mole, you may want to take a picture of it ahead of time since it may be awkward to try to show it to them via a webcam or phone. Find out ahead of time if you can share it directly from your screen or email it to the doctor. If you’re not sure how to do these things, see if you can get a friend or family member to help you.

Alternatively, if something is easy for the doctor to see on your camera, such as a rash on your face, make sure you have plenty of light so they can see it well. 

With all of the technical concerns surrounding a telehealth appointment, it can be easy to forget that you need to prepare for the appointment itself. Remember to think about things like:

  • How your treatments have been working
  • How severe your symptoms have been 
  • Whether you have any new symptoms
  • Whether you have any questions for the provider

Be sure to write this information down and have it with you during your appointment so you can make the most of your time and not be thwarted by memory issues.

Will Insurance Cover Telehealth for Fibromyalgia?

Check with your insurance company about telehealth coverage. Many of them do cover it, and the amount you pay may actually be less than for an in-person appointment. Make sure you know your company’s policies before your first telehealth session.

In early 2021, telehealth was available to Medicaid recipients in all 50 states and Washington, D.C.. However, that could change because each state sets its own policies. Be sure to check on the current situation in your state.

In 2020, due to the pandemic, Congress waived some Medicare restrictions to allow reimbursement for some telehealth services. Again though, be sure to check on your coverage since some restrictions remain. Also, ask your doctor’s office if their telehealth services meet Medicare requirements.

If you don’t have insurance, you may be able to access telehealth through private-pay services, but they can be costly. Access varies, but you may be able to get telehealth appointments through low-cost medical clinics in your area.

Finding a Telehealth Provider

If you’re looking for a provider who offers telehealth appointments, you can go about it in several ways.

Many providers have information about telehealth services on their website. You can also call and ask about what they offer.

Your insurance company may also be able to help. Check their website for lists or call them and ask. You can also get referrals from friends, family, and people in support groups you may be a part of.

What Happens During the Visit

Before the Visit

At some point prior to your telehealth appointment, your provider’s office will typically send an email with instructions. It may include links and information for downloading the virtual-visit platform as well as a link for the appointment itself. You may also be told when to expect a previsit call from a nurse.

At the appointed time (usually between 10 and 15 minutes before your appointment), the nurse will call you and ask all the same questions they would if you were in the office—the reason for the appointment, any concerns, what medications you’re taking, if anything has changed since your last visit, etc. 

If you’ve been asked to provide vital signs, they’ll probably ask you for them during this call. They may also ask you to log in to the platform using the appointment link while they have you on the phone to make sure everything is working. Once you're in, you can wait there and the doctor will join you.

During the Visit

Once the doctor signs in, you’ll be able to see and hear each other. On a computer screen, you should see both yourself and the doctor.

If your doctor has anything to show you, such as lab or imaging results, they may switch the screen to show you or just hold them up to the camera. Otherwise, the appointment will proceed much like the in-person ones you’re used to. When it’s over, you can sign out and close the platform.

After the Visit

Your provider should be able to send in any new prescriptions or refill requests during or immediately after your visit, providing they’re drugs that can be prescribed and refilled this way. They’ll order labs and imaging as they usually would, which may require you to make a trip to their office or another facility.

Whether you should schedule a telehealth appointment for your next visit depends on what that appointment will be for. If it’s a yearly physical, you’ll need to go in person. If it’s simply to check on how your medications are working, telehealth may be appropriate.

The platforms used by the medical profession are required to be secure and HIPAA-compliant, so nothing about your visit or health status should be publicly available or accessible.

A Word From Verywell

It’s probably easy to see how someone with fibromyalgia could benefit from telehealth. If you’re frustrated by the initial learning curve, ask for help. Your doctor's office and your family and friends could both be valuable resources in this process. Not only are telehealth appointments less of a strain on you, they can also keep you from getting illnesses that can cause flares or exacerbate fibromyalgia over the long run.

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Article Sources
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