THE HISTORY OF FIBROMYALGIA

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The term fibromyalgia originates from these Greek and Latin root words: fibro, myo and algos. These words, when translated, respectively refer to fibrous tissues, muscles and pain.
When combined as fibromyalgia, they refer to the main symptoms of the condition: painful tendons, ligaments and muscles. Of course, fibromyalgia is best characterized by the widespread pain that blossoms throughout the body’s soft tissues.

History of Fibromyalgia

EARLY HISTORY – CHARACTERISATION

Fibromyalgia may have existed for centuries before the 1900s. Conditions with symptoms similar to fibromyalgia have been recorded in medical journals since the early 1800s. There are even reports of similar illness with fibromyalgia-like symptoms dating back to as early as 1500BC.
Fibromyalgia was first thought as a mental disorder, due to the fact that little information about early fibromyalgia existed at the time. Doctors actually first described a fibromyalgia-like condition as early as the 1800s. The condition, known as muscular rheumatism, had symptoms like stiffness, aches, pains, fatigue and trouble sleeping.

One of the most notable early accounts of fibromyalgia actually comes from the Bible. The passages Job 7:3-4 and 30:16-17 describe his physical pain, which demonstrated similarities to fibromyalgia.
Another early real life case of fibromyalgia happened to Florence Nightingale in the mid 1800s. She fell ill with fibromyalgia-like symptoms when working during the Crimean War, and ‘never completely recovered’ from the condition. She spent most of her last years bedridden and suffering from fibromyalgia-like pain and fatigue.
Modern fibromyalgia originates from an earlier condition with similar characteristics as fibromyalgia. Fibrostis, which originated from a 1904 lecture held by Sir William Gowers, is the earliest recorded form of fibromyalgia.

Gowers and colleagues believed fibrositis was caused by inflammation originating from the fibrous tissues in the body. Research from the 1970s and 1980s debunked that assumption, proving that no muscle inflammation occurred in cases of fibrositis (fibromyalgia). By then, the research refocused on learning more about the dysfunction of the central nervous system.
By the mid-1970s, fibrostis was changed to fibromyalgia, and 1990 saw the American College of Rheumatology establish the condition’s current criteria for diagnosis.

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THE TIMELINE OF FIBROMYALGIA

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fibromyalgia has actually been around for centuries. Although not immediately identified as fibromyalgia, the symptoms of the condition more or less revealed that fibromyalgia was around far earlier than most medical researchers assumed.
In order to understand how fibromyalgia has developed over the years, the following is a timeline of events marking the historical medical development of fibromyalgia.

1600s: Symptoms of a condition like fibromyalgia were appointed a name: muscular rheumatism.

1816: Dr. William Balfour, a University of Edinburgh surgeon, characterized fibromyalgia for the first time.

1824: Dr. Balfur first described the ‘tender points’ associated with fibromyalgia.

1904: Sir William Gowers first established the term ‘fibrositis,’ which referred to the inflammation of fibers. It helped described the tender points in people with muscular rheumatism.

1972: Dr. Huge Smythe established the foundation for modern fibromyalgia by describing the condition’s encompassing pain and tender points.

1975: The first sleep electroencephalogram study that identified sleep-related symptoms of fibromyalgia was performed.

1976: Fiberositis was changed to fibromyalgia, after the medical community didn’t find any evidence of inflammation causing fibromyalgia-like symptoms.

1981: The first controlled study, which validated known fibromyalgia-like symptoms and tender points, was published.

1987: The American Medical Association established fibromyalgia as a legitimate physical condition.

1990: The American College of Rheumatology created diagnostic criteria fibromyalgia, which was made for research purposes. The fibromyalgia criteria later became a tool for clinicians, allowing them to properly diagnose patients.

2007: The United States Food and Drug Administration approved Lyrica for fibromyalgia treatment. Since then, Cymbalta and Savella have also received approval by the FDA for treatment.

THE THEORIES AND HISTORY OF FIBROMYALGIA

Over the years, different theories about fibromyalgia have appeared in the medical community. Many of the theories focus on figuring out what causes fibromyalgia, in addition to what the condition may actually be.
For hundreds of years, doctors actually considered a psychological disorder, since there wasn’t enough evidence supporting fibromyalgia as a condition during those early days. Today, we now know fibromyalgia is a disorder with specific symptoms that make people feel constant pain and fatigue.

THE 20TH CENTURY

Starting in the 20th century, fibromyalgia started becoming recognized by medical professionals as a real physical condition. It was first thought to have been a disease within the muscles and surrounding fibrous tissues.
Tests performed on patients with the condition were found to have lacked the damage originating from inflamed muscles and tissues. Some researchers also attributed early fibromyalgia as an autoimmune disorder, but research didn’t find any evidence supporting that.

THE 21ST CENTURY

Once the 21 century arrived, medical researchers and doctors were able to perform better fibromyalgia research. The new laboratory testing methods, along with brain-imaging techniques, allowed researchers to finally identify ‘sensitization of the central nervous system’ in people with fibromyalgia.

What Is Fibromyalgia?: A History of the Condition

Fibromyalgia is a common chronic pain disorder, affecting an estimated 6.4% of people in the United States. It is characterized by widespread pain, tenderness, and other symptoms such as fatigue and cognitive difficulties. [1]

Although fibromyalgia syndrome (FMS) is now a recognized medical condition, this has not always been the case. In this article, we’ll dive into the history of fibromyalgia and how its understanding has evolved in the medical community as more research has been published.

Fibromyalgia Meanings over Time

People have described fibromyalgia symptoms for centuries, and several names have been associated with the condition, including:

• Rheumatism
• Fibrositis
• Psychogenic rheumatism
• Muscular fibrositis
• Non-articular rheumatism
• Affective Spectrum Disorder

We’ll look into the evolution of these terms here.

Rheumatism and Fibrositis

As early as the 16th century, scientists and doctors recorded a disease with symptoms we now recognize as fibromyalgia symptoms, such as  muscle pain, tenderness, and other symptoms such as fatigue and cognitive dysfunction. Guillaume de Baillou called the condition “muscular rheumatism” in 1642.

In the early 1900s, the medical community recognized this set of symptoms as a medical condition and called it “fibrositis.” [2]

The term “fibrositis” first appeared in 1904 when British neurologist, Sir William Richard Gowers, described a condition that caused pain when doctors pushed against hardened fibrous tissues in the body. He also noted pain, hypersensitivity to pressure, fatigue, difficulty sleeping, and muscular problems aggravated by overexertion and weather changes often accompanied these tender areas.

The same year, Dr. Ralph Stockton built on Gower’s theory by stating that connective tissue inflammation may cause fibrositis. However, biopsies on the muscle tissues of people with the condition showed no evidence of inflammation.

In 1947, Dr. E. W. Boland called the condition “psychogenic rheumatism” because of the lack of physical evidence of underlying injury or disease processes causing the pain and other symptoms. He defined it as “a musculoskeletal expression of functional disorders, stress states, or psychoneurosis.” Although we now know that fibromyalgia does have a biological basis, this categorization of fibromyalgia as a “psychological” condition persisted.

The First Use of “Fibromyalgia”

In 1976, Dr. P. K. Hench first used the word “fibromyalgia” to describe rheumatism that did not affect the joints. At first, doctors and researchers criticized this medical condition, calling it not legitimate or valid.

The following year, in 1977, Dr. Harvey Moldofsky and Dr. Hugh Smythe continued to study fibromyalgia as defined by Hench. They described the condition and suggested criteria for diagnosis based on the features they considered key: widespread pain, tender points, unrefreshed sleep, and fatigue. Twelve out of 14 specific pressure points had to be positive before a doctor could definitively diagnose a set of symptoms as fibromyalgia.

These criteria had limitations, however. They did not give recommendations for assessing or defining these symptoms. Because of this early criteria, tender points were considered the most prominent feature of fibromyalgia for many years, and the other symptoms were often ignored.

In 1981, the medical community finally accepted the condition as “fibrositis” or “fibromyalgia,” and laid out a set of diagnostic criteria for the condition. To be diagnosed with fibro:

• The patient must have aching, pain, or stiffness in three areas for at least three months and no apparent underlying physical cause for the symptoms.
• The patient must have at least five consistent tender points in typical areas.
• If the patient only has 3-4 tender points, they must have five of the minor criteria:
  • Difficulty sleeping
  • Fatigue
  • Anxiety
  • Numbness
  • Chronic headaches
  • Irritable Bowel Syndrome (IBS)
  • Subjective swelling (the patient feels swollen)
  • Symptoms are aggravated by physical activity, weather, or time of day
  • Symptoms are aggravated by stress or anxiety
  • Symptoms are relieved with rest and stress reduction

The criteria also suggested diagnosing the condition solely on symptoms and not on the absence of other recognizable medical conditions. It was at this point that symptoms became more critical to diagnosing fibromyalgia.

Tender Points Criteria

The American Medical Association accepted fibromyalgia as a recognizable disease in 1987, and the American College of Rheumatology (ACR) set up a committee to establish definitive diagnostic criteria. These criteria were established and published in 1990. These criteria included: [9]

• A history of chronic, widespread pain in the skull, spinal column, and rib cage
• A history of chronic, widespread pain on both sides of the body and above and below the waist.
• This pain must be present and consistent for at least three months.
• A history of pain in at least 11 of 18 specific tender points
• The tender points must be painful when pressed, not just tender.

Over time, doctors noted that tender points were not a reliable diagnostic criteria. In 2010, the Widespread Pain Index (WPI) was developed to measure the number of painful body areas. Additional diagnostic criteria were formed into a Symptom Severity Scale (SSS), which measures cognitive symptoms, unrefreshed sleep, fatigue, and other symptoms such as headaches. The two scales are now combined to create a diagnostic tool for fibromyalgia. [10]

In 2016, the criteria was modified again. According to these guidelines, fibromyalgia could be diagnosed without regard to any other diagnoses, and a doctor could give a diagnosis of fibromyalgia if: [11]

• Symptoms have been present consistently for three months or more.
• Generalized pain is present in at least 4 of 5 regions.
• The WPI is greater than or equal to 7 and the SSS is greater than or equal to 5 or the WPI is 4-6 and the SSS is greater than or equal to 9.

Central Sensitization and Primary Pain

For decades after fibromyalgia was first defined, doctors and scientists were unclear about the biological mechanism, or pathophysiology, behind the condition. However, as more research has emerged, the medical community now recognizes it as a central sensitization, or centralized pain, condition.

At first, doctors and scientists used the term “central sensitization” to describe pain originating from a brain or spinal cord injury. Now, it describes pain that occurs when the brain and spinal column, the central nervous system, don’t process pain properly. [1] [7]

In central sensitization, the nerves in the brain and spinal cord are hyperreactive to nerve impulses. You may have a decreased pain tolerance level or allodynia, a condition in which something that does not cause others pain is painful. Some have described it as the volume control on your pain has been turned up.

Fibro is the most common form of central sensitization syndrome.  [7]

Other central sensitization syndromes include:

• Migraines
• Restless leg syndrome
• Chronic fatigue syndrome
• Myofascial pain syndrome
• Multiple chemical sensitivity
• Irritable bowel syndrome (IBS)