COVID-19 Update: How We Are Serving and Protecting Our Clients

Published on:

Examining the New Canadian Guidelines for Fibromyalgia aka Chronic Widespread Pain

The term Fibromyalgia is becoming dated, although doctors, insurance companies and disability claimants still use it.

The preferred term according to the Arthritis Society of Canada is “Chronic Widespread Pain“.

Many of our clients deal with Fibromylagia/Chronic Widespread Pain. We often see it associated with many other symptoms including but not limited to depression, anxiety, fatigue, impaired memory, impaired concentration, shortness of breath, and irregular sleep patterns/habits.

Some doctors believe in Fibromyalgia. Other simply don’t.

Firbromyalgia and Chronic Widepread Pain have been recognized and National Guidelines have been endorsed by the Canadian Pain Society and the Canadian Rheumatology Association.

But for many large, deep pocketed insurance companies, those endorsements aren’t enough to prove an injury or a disability under a Long Term Disability Policy with an insurer like Manulife, Great West Life, SunLife, Desjardins, SSQ, RBC Insurance or Industrial Alliance just to name a few of the big ones.

The Canadian National Guidelines for the diagnosis and treatment of Fibromyalgia and Widespread Chronic Pain have identified the following symptoms for making a proper diagnosis:

Pain is the primary complaint in persons with FM and should have been present for at least 3 months. Pain onset is usually insidious, sometimes beginning in a localized area, may initially be intermittent, and then progressively becomes more persistent. Although pain is felt in muscle or joint areas, there is no physical abnormality of these tissues. A neuropathic mechanism to the pain may be suggested by report of a burning quality to the pain. Pain may vary in location and intensity from day to day, and can be modulated by factors such as weather or stress. Cold and humid weather tends to be associated with increased symptoms. Although the most frequently reported sensory symptom in FM is pressure induced pain, this was only reported to be severe in 58% of FM patients .


Fatigue, reported to be present in over 90% of FM patients, is the most common associated complaint. Fatigue may even be more disabling than pain for some, and contributes to subjective report of functional impairment. Fatigue is challenging to measure, with reliance on subjective patient report to gauge severity. Overlap with chronic fatigue syndrome has been described, although pain is more prominent in patients with fibromyalgia.

Nonrestorative sleepphoto840.png

Nonrestorative sleep is associated with FM. Abnormal components of sleep that have been measured include sleep latency, sleep disturbance, and fragmented sleep leading to impaired daytime function. Poor sleep negatively impacts fatigue, affect, and pain, with improvement in these parameters when sleep specifically is addressed. Other sleep disorders such as restless leg syndrome or sleep apnoea may also occur in patients with chronic widespread pain.

Cognitive dysfunction

Cognitive dysfunction which includes poor working memory, spatial memory alterations, free recall, and verbal fluency associates with pain in FM as well as other pain patients and is different from healthy controls.

Mood disorder

Mood disorder, including depression and/or anxiety, is present in up to three quarters of persons with FM, but mood disorders and FM are likely distinct. Anxiety commonly coexists with depression, but is also independently increased in FM patients. Depression is influenced by low family cohesion, high pain and helplessness, and passive coping skills . First-degree relatives of individuals with either FM or major depressive disorder (MDD) demonstrated similar rates of MDD suggesting that these two conditions share similar risk factors which may be genetically driven.

Pain-related somatic symptoms

Somatic symptoms, including irritable bowel syndrome, migraine headaches, severe menstrual pain, lower urinary tract symptoms, myofascial facial pain, and temporomandibular pain have all been associated with Fibromyalgia.

Non-pain related symptoms

Sexual dysfunction has recently been reported to occur in 97% of FM patients. FM patients may be more vulnerable to posttraumatic stress disorder (PTSD), with depressed FM patients having a three-fold increase in PTSD compared to those with chronic fatigue only. Breast implants, at one time implicated in FM, are not associated with FM. Similarly, cigarette smoking has been associated with more severe Fibromyalgia symptoms, rather than FM per se, and should be discouraged for global health reasons.

Do you notice a pattern with all of these symptoms? None of them can be detected by way of objective diagnostic testing. Your depression doesn’t show up on an x-ray or CT scan. The same goes for your anxiety or feelings of chronic pain. All of these symptoms are SUBJECTIVE; meaning that you and you alone understands them best. If somebody from the insurance company doesn’t believe you, then you’re in for a long hard fight. Insurers will do whatever they can in order to defeat you claim and make you look like your subjective symptoms don’t exist or aren’t as severe as you make them out to be.

How does an insurance company do this? There are a variety of tools which insurance lawyers have at their disposal in order destroy your credibility and defeat your claim. Sending you for a Defence Medical Examination with a doctor hand picked by the insurance company for starters is their #1 tool in the box. Getting investigators to conduct in person and online surveillance on you is another. That feeling of being followed around isn’t a good one and sooner or later, they will catch you doing something you said you couldn’t do; or which your doctors said you shouldn’t be doing. A picture is a powerful and persuasive tool before a Judge and Jury and can help sway the case one way or another. Pictures or video of disability claimants grocery shopping, bending, lifting or laying down on the beach and having a good time go a long way towards defeating a long term disability claim. No jury wants to think they are awarding disability benefits to a person who they suspect is a liar, a cheater, a faker, a malingerer and trying to cheat the system.


According to the Arthritis Society of Canada, there is no single treatment that works for everyone. Over time, most people with fibromyalgia will find the balance of treatments that gives them the best relief. Although a complete resolution of all symptoms is seldom achieved, the aim should be to contain your symptoms as best as possible so that you continue leading an active and enjoyable life.
Your first important step is to become an active participant in your treatment. You are encouraged to develop coping strategies to manage your FM.
While the symptoms of FM may persist over time, there are many steps you can take to help manage this condition:

1. Listen to, and respect, what your body is telling you, but always give yourself that little extra push.

2. Start an enjoyable exercise program, practice relaxation techniques and good sleeping habits. Take time for yourself and rediscover your interests.

3. Try the medications your doctor suggests. Make sure to discuss whether they are working for you.

4. Learn more about your condition and share that information with family and friends,
so they can understand.

5. Keep a diary over several weeks. This can help to keep track of the connection between your FM symptoms and your daily activities, which can help you control your chronic widespead pain.

Non-medication therapies, such as physical activity (walking, low-impact aerobic programs, aquatic programs, using an exercise bike or treadmill), stress management and relaxation techniques, are a very important part of treating fibromyalgia. While you can perform these activities on your own, it’s best that you first ask a health-care professional, such as a physiotherapist or occupational therapist, for guidance.

Contact Information