Fibromyalgia and Chronic Pain

An invisible disability can be one of the most challenging conditions for a person to face. When someone has a visible disability with demonstrable physical impairment, others can clearly see that a certain level of accommodation is required. With an invisible disability, describing your symptoms is often all you can do to explain why you may need assistance or have certain limitations. Unfortunately, when seeing is believing, convincing another person that you suffer from a painful and debilitating condition can take a lot of effort - especially if it’s in their interest not to believe you.

Fibromyalgia is a disorder marked by:

• Chronic, widespread musculoskeletal pain.
• Severe fatigue
• Sleep deprivation
• Memory and/or mood issues. 

Often unable to work for significant periods of time, people experiencing fibromyalgia’s symptoms may qualify for short- and long-term disability benefits. Although the debilitating pain you are experiencing is very real, insurance companies can sometimes be dismissive of invisible disability claims.

If you are in the process of applying for long-term disability benefits or you believe your application for disability benefits has been unfairly denied or delayed, an experienced personal injury lawyer can help.

A chronic pain disorder.

The history and causes of fibromyalgia.

Although there are reports of people complaining of symptoms of fibromyalgia for centuries, the condition was long misunderstood. Previously considered a mental disorder, by the 1800s it had been reclassified as a rheumatic disorder characterized by:

• Widespread pain.
• Stiffness.
• Fatigue.
• Sleep disturbances.

Doctors discovered that many people with this disorder had common tender points on their bodies. Believing these points were sites of inflammation (which was not the case), the condition was named fibrositis. Renamed fibromyalgia in 1976, the first diagnostic tests were created in 1990. However, fibromyalgia is usually diagnosed by ruling out other potential causes of a patient’s symptoms.

Researchers believe fibromyalgia symptoms develop following changes in the brain and spinal cord that occur following repeated nerve stimulation.

First, there is increased chemical production in the brain associated with pain signals.

Second, there is a tendency for pain receptors in the brain to develop a memory of pain or become sensitized to pain.

These pain receptors cause an overreaction or abnormal pain from non-pain signals.

Although genetics may play a role in fibromyalgia (since the condition appears to run in families), certain infections or traumatic physical or emotional events have been found to contribute to symptoms or cause the disorder to present. According to the Mayo Clinic, fibromyalgia is more common in women than men, and people with rheumatoid arthritis, osteoarthritis, or lupus are at greater risk of developing the condition.

Common symptoms of fibromyalgia.

The most notable symptom associated with fibromyalgia is chronic, dull, aching, pain. The pain must not be isolated in one part of the body, but rather be widespread and affect both sides of the body and occur above and below the waist.

Many fibromyalgia sufferers also experience extreme fatigue and somatic disorders such as sleep apnea and restless leg syndrome. Although many people with fibromyalgia sleep for lengthy periods of time, when they awake they tend to still feel very tired. Moreover, sleep can be disrupted by pain - even if the person is not aware of it.

Fatigue is frequently associated with “fibro fog” - a cognitive impairment that prevents people from paying attention, focussing or concentrating on a task. 

These long-lasting symptoms frequently cause fibromyalgia sufferers to experience anxiety and sink into depression. Other common comorbidities (additional conditions) include:

• Chronic fatigue syndrome.
• Migraines and tension headaches.
• Temporomandibular (jaw bone) joint disorders. 
• Irritable bowel syndrome.
• Interstitial cystitis (bladder pressure and pain).
• Postural tachycardia syndrome (abnormal heart rate, dizziness and fainting when going from sitting to standing).

Diagnosis and treatment.

Previously doctors would examine 18 common tender points on a person’s body by applying pressure and gauging sensations. If a person experienced pain or tenderness in more than half of these points, it would assist them in offering a fibromyalgia diagnosis.

Since not all people with the disorder feel painful sensations when being tested, diagnostic criteria was revised to a person experiencing generalized pain in multiple areas of the body for a period longer than three months.

Other tests are often administered to help a doctor rule out other conditions known to cause similar symptoms. These include:

• A variety of blood tests.
• Imaging tests.
• Sleep studies.

Diagnosis can take many months and even years. It is important to consult with a doctor who takes your concerns seriously and who is willing to order the appropriate tests to help narrow the potential causes of your symptoms. It is also important to determine whether your doctor believes fibromyalgia is a real condition as there are still people in the medical profession who are skeptical of these kinds of disorders.

Several medications have been approved for treating the pain associated with fibromyalgia:

• Over-the-counter pain relievers containing acetaminophen, ibuprofen or naproxen sodium may help with symptoms.
• Prescription anti-depressants and anti-seizure medications (duloxetine, milnacipran, gabapentin and pregabalin) and muscle relaxants (cyclobenzaprine) are frequently used to reduce pain, improve mental health, and combat sleep-related problems.

A variety of types of therapies have also proven to be beneficial.

• Physical therapy and low-impact exercise can improve muscle tone, strength, flexibility and stamina.
• Occupational therapy teaches people how to adapt their movement and activities to minimize disruption caused by symptoms.
• Counselling or psychotherapy has also been shown to help with the anxiety and/or depression that often accompanies fibromyalgia.

Finally, some research has suggested that anti-inflammatory diets consisting of lean proteins, lots of vegetables and some fruit and grains can be helpful. 

When you can’t work.

A chronic condition can greatly affect how you live. The pain, fatigue, mental fog and other physical symptoms common to fibromyalgia sufferers can also significantly impact their ability to work.

Beyond taking occasional sick days, many people with this condition have had to apply for short-term disability benefits if their symptoms prevent them from working for weeks at a time. These benefits (paid from an employer’s plan or Employment Insurance sickness benefits) generally last up to six months to a year and cover between 60 to 100 percent of your salary or average pay. Generally, a short-term disability application includes an explanation from an attending doctor as to why you are unable to work, the extent of your disability, prescribed treatments, and an anticipated date when you will return to work.

If your fibromyalgia prevents you from working after your short-term benefits are exhausted, you may be able to apply for long-term disability benefits. Unlike short-term benefits, to receive long-term benefits a person will likely be required to provide additional medical records and/or be examined by a doctor of the insurer’s choosing.

To be eligible to receive LTD benefits, a person must usually be deemed to be “totally disabled” and unable to work based on the language of the policy. Some policies specify that after a period of time (usually two years), a claimant must be disabled to the point where they are not able to work at any occupation rather than just their own occupation, in order to continue receiving LTD benefits.

Unfair denials or delays.

Although an insurer is obliged to pay benefits to people who are unable to work based on their medical condition and the terms of their policy, sometimes insurers will drag their heels when making a decision in hopes it may force a person in financial distress to give up and try to return to work. Similarly, when an application is unjustly denied, the insurer may be hoping a claimant does not bother to appeal the decision or launch a lawsuit to access the funds they may be entitled to.

Benefits can be denied or terminated if an insurer-appointed medical examiner disagrees with your physician’s assessment, or the insurer’s surveillance suggests you have misrepresented your disability.

In the first case, although the insurer’s chosen doctor is supposed to be independent, there may be pressure to deny some otherwise eligible claims to keep receiving future referral work.

In the latter case, while an insurer is legally permitted to put a claimant under surveillance to avoid fraudulent claims, the evidence gathered by an investigator may not accurately reflect your illness.

For example, doctors often encourage people with chronic pain to exercise, or encourage people with depression to get out and socialize. Insurers may suggest that videos or photographs of this activity is proof that you are well enough to work.

We can help you.

At a time when you are already sick and at a low point in your life, the stress of dealing with uncooperative insurers can make matters worse. You are not alone in this. The long-term disability team at Gluckstein Personal Injury Lawyers is available to assist with your long-term disability claim and to pursue these insurers through the courts on your behalf if you were unjustly denied benefits.

With decades of experience handling long-term disability matters, our lawyers understand what is required to build cases that put plaintiffs in a strong position for settlement talks or for court if necessary. Our extensive network of medical experts can be called upon to review your medical records and offer opinions regarding your disability claim. 

Renowned for our commitment to full-circle client care, you can be sure that we put your best interests at the heart of everything we do. Our team will carefully explain the legal process to you, ensure you understand your rights and options, and will always be available if you have questions or concerns. 

As one of Canada’s top personal injury law firms, Gluckstein Personal Injury Lawyers has a proven track record of getting results for our clients. To learn more about how our personal injury lawyers in Toronto, Ottawa, Niagara, and Barrie can help you, contact us today for a no obligation, free consultation. You have nothing to lose, but so much to gain.