Our evolving understanding of Fibromyalgia

Fibromyalgia was referred to as ‘muscular rheumatism’ in the 1800’s and ‘fibrositis’ in the past century. Finally, in 1990, the American College of Rheumatology (ACR) defined ‘fibromyalgia syndrome’ (FMS) for the purpose of research, and in the past 20 years, fibromyalgia has increasingly been accepted as a genuine and disabling condition. Also, fibromyalgia is now recognized as having rheumatologic, neurologic and chronic pain components.

A Canadian Medical Association Journal report, “Fibromyalgia; evolving concepts over the past 2 decades”, states that the specific cause of fibromyalgia is unknown, but it is a condition that originates in the nervous system and causes malfunctioning of the pain-regulating mechanisms in the patient’s central and peripheral nervous symptoms. These abnormalities in the nervous systems, muscles and connecting tissue are generally thought to be the cause of widespread musculoskeletal pain, the primary symptom for persons suffering from fibromyalgia. Other symptoms include non-restorative sleep, fatigue, mood disorders, cognitive dysfunction, and somatic disorders (i.e. extreme anxiety about physical symptoms).

Under the ACR research definition, persons suffering from fibromyalgia exhibit pain in at least 11 to 18 tender point sites in various parts of their body. Health Canada has recommended that clinicians rely on the ACR research definition to identify compulsory pain and tenderness, when diagnosing and treating this condition. In addition, it was recommended that physicians screen for additional symptoms to assess the severity of the illness; at least two of these symptoms are generally present in FMS patients when they seek medical attention, however, patients rarely exhibit all symptoms.

  1. Neurological Symptoms: these include: muscle numbness, tingling and/or weakness; cramps; headaches; light and sound sensitivity; and general weakness.
  2. Neurocognitive Symptoms: these include: reduced concentration and short-term memory loss; inability to multi-task; slowed performance; and cognitive overload.
  3. Persistent fatigue accompanied by diminished physical and mental stamina.
  4. Sleep Dysfunction: sleep is not restorative and patients may exhibit insomnia or hypersomnia.
  5. Autonomic and/or neuroendocrine symptoms: these may include dizziness; irregular heartbeat; intolerance to heat/cold; respiratory disturbances; intolerance to stress; bladder and intestinal disturbances; and emotional disturbances or depression.
  6. Stiffness: this is most severe when the person wakes up and lasts for hours.

The Canadian Guidelines for the Diagnosis and Management of Fibromyalgia Syndrome now define fibromyalgia as a ‘neurophysiological’ condition, based on new guidelines set in 2012 by the Canadian Rheumatology Society and Canadian Pain Association. These guidelines largely assign the responsibility for diagnosing fibromyalgia to family physicians, rather than medical specialists such as rheumatologists or neurologists.

Fibromyalgia is more common among Canadians than most of us realize – about 1.5 percent of the population suffers from this condition (439,000 Canadians in 2010). Also, it has been reported in people of all ages, including children; however, the risk of developing fibromyalgia increases with age and women are 6 times more likely to experience this condition than men. About half the FMS patients are between the ages of 40 and 60, and are therefore typically engaged in their years of greatest income earning and highly involved in raising a family and making other important contributions within the community.

Given the disabling effect of widespread pain and the fact that fibromyalgia generally persists for years, this condition often results in an inability to work and a long-term disability claim. There is currently no cure for fibromyalgia, although medications, learned coping skills, psychological intervention and other treatments can help alleviate the symptoms.

Fibromyalgia can substantially impact a person’s ability to function in a wide spectrum of life’s activities — at home, work and in social interactions. In fact, many people with fibromyalgia report that they are permanently unable to work. It is not difficult to imagine that symptoms such as chronic pain, concentration and memory difficulties, and extreme fatigue can easily interfere with the ability to perform the essential tasks of a person’s job, both mental and physical.

Fibromyalgia and disability claims

FMS sufferers sometimes describe their mental condition as a state of ‘brain fog’, and report that their inability to perform effectively at work often leads to secondary symptoms, such as anxiety, depression and other psychological side-effects. Fibromyalgia symptoms can interfere with a person’s ability to remain focused and perform tasks that require thinking, remembering and decision making. Fibromyalgia pain and fatigue can also make it difficult to stand or sit for long periods, as well as bend down and lift heavy objects, which reduces a person’s ability to perform physical work, or even sit at a desk all day.

When symptoms prevent a person from working, someone who suffers with fibromyalgia is equally entitled to receive long-term disability (LTD) benefits as is a person with heart disease, stroke or another disabling condition. Yet, persons with FMS are sometimes denied owed LTD coverage by their insurer, most often because the insurer asserts that the claimant submitted insufficient medical proof that they experience symptoms that prevent them from performing the essential aspects of their job.

If you were denied LTD coverage or your benefits were unfairly terminated, talk to a long-term disability lawyer at Kotak Personal Injury Law to find out what steps can be taken to having your LTD claim resolved in your favour.