History of Fibromyalgia

by

When it was first described in the scientific literature, fibromyalgia was shunned by a large part of the medical community and disregarded as simply a product of affected individuals’ imaginations. Many clinicians simply believed that people with fibromyalgia were imagining their symptoms. Others maintained that fibromyalgia was not a singular disease, but rather a combination of symptoms from a group of related conditions. In addition, some in the medical community refused to acknowledge that fibromyalgia existed as a true diagnosis at all, due to the lack of physical evidence to confirm its existence. This, unfortunately, is still the belief among some medical professionals in modern times. Fortunately, research continues to unravel pieces of the fibromyalgia puzzle. In recent years, scientists have gained a better understanding of why fibromyalgia occurs and how it manifests itself in different individuals. This enlightened understanding has led to the development of newer and more effective treatments, and added credible evidence that has established fibromyalgia as a true diagnosis. The following timeline provides an overview of major events in the history of fibromyalgia, with regard to diagnosis, treatment, and its overall understanding.

180 A.D.:  The Greek physician and anatomist Galen (120-200A.D.) attributes symptoms associated with widespread pain to the rheuma. When later interpreted, Galen’s words suggest that rheuma represents “a great fluxion which races to various parts of the body and goes from one to another.”

1592:            Guillaume de Baillou coins the term rheumatism to describe collective muscle and joint pain.

18th century:  Physicians begin to distinguish joint rheumatism that is accompanied by signs of deformity from painful, non-deforming musculoskeletal disorders, commonly referred to as muscular rheumatism.

1815:  British surgeon William Balfour suggests that inflammation in muscle connective tissue is the cause of nodules and pain, and reports for the first time on focal tenderness which he describes as “tender points.”

1835:   Hans Christian Andersen publishes The Princess and the Pea, a literary fairytale describing a princess who suffered from a heightened state of physical sensitivity that interferes with her ability to sleep.

1841:  Valleix puts forth the concept of trigger points, and suggests that these points’ proximity to specific nerves indicates that muscular rheumatism is actually a disorder of the nervous system.

1839:   Edgar Allen Poe publishes The Fall of the House of Usher. In this work, Poe writes that Roderick Usher suffered from an “acute bodily illness and mental disorder that oppressed him,” describing how he could only wear soft-textured clothing (as rough-textured materials were too painful for him). Poe also described Usher as hypersensitive to sound and light. Other works by Poe also made reference to illnesses that appear related to problems with central sensitization.

1904:   Sir William Gowers describes diffuse pain as fibrositis and asserts that it results from proliferation and/or inflammation of subcutaneous (i.e., beneath the skin) and fibrous tissue.

1968:  E. F. Traut offers the first near-modern description of fibrositis, complete with its system-wide manifestations.

1972:  H.A. Smythe offers the first modern description of fibrositis – including widespread pain and multiple tender points – and proposed working criteria that triggered renewed interest in fibrositis and clinical research

1975:  H. Moldofsky performs first electroencephalogram (EEG) study to demonstrate sleep-related difficulties in patients with fibrositis

1976:   P.K. Hench coins the term “fibromyalgia.”

1977:   H.A. Smythe and H. Moldofsky refine Smythe’s definition of fibromyalgia, requiring the presence of 12 of 14 tender points when 4kg of manual pressure is applied, and requires that the following four signs and symptoms also be present: a history of widespread pain for at least three months, disturbed sleep, tenderness when lightly squeezing the skin at the upper part of the back muscle (trapezius), and normal results on laboratory tests.

1981:   Yunus and colleagues propose a formal set of criteria for the diagnosis of fibromyalgia, based on the findings of the first controlled clinical study to validate symptoms and tender points in fibromyalgia patients. These criteria require aching, pain, and stiffness for a minimum of three months, in addition to a minimum of five out of 40 possible tender points. The Yunus et al. criteria also require patients to have three of the following 10 symptoms: decreased physical activity in response to symptoms, weather-related symptom aggravation, stress/anxiety-related symptom aggravation, sleep disturbances, fatigue/tiredness, anxiety, headaches, irritable bowel syndrome, swelling, and/or numbness.

1984:  Yunus first describes the concept that fibromyalgia and other syndromes have overlapping features, are mutually associated, and are interconnected

1984:  Wolfe reports a high prevalence of fibromyalgia among rheumatoid arthritis patients

1985:  Yunus publishes the first report of juvenile fibromyalgia by a controlled study

1986:  Carette et al. and Goldenberg et al. both report on the effectiveness of the tricyclic antidepressant amitriptyline in treating fibromyalgia-related symptoms as demonstrated in a randomized, controlled trial.

1987:   The American Medical Association recognizes fibromyalgia as a true disease entity.

1989:  Yunus publishes evidence showing normal results of muscle biopsies in fibromyalgia patients, which shifts the focus of research away from muscle and toward the central nervous system.

1990:   The American College of Rheumatology (ACR) attempts to establish criteria to differentiate fibromyalgia patients from other individuals with widespread pain, in light of statistics that reveal 15% of the general population experiences widespread pain at any given point in time. The 1990 ACR diagnostic criteria state that in order to receive a diagnosis of fibromyalgia, patients should have widespread pain and at least 11 of 18 possible tender points. Moreover, these criteria assert that a decreased threshold for pain is the hallmark sign of fibromyalgia.

1991:   The Fibromyalgia Impact Questionnaire (FIQ) is published for the first time. The FIQ is a standardized and validated questionnaire designed to assess the overall impact that fibromyalgia has on the patient’s ability to function, their pain level, fatigue, sleep, mental status, and other domains. It is subsequently translated into 14 languages.

1991:   The World Health Organization (WHO) incorporates fibromyalgia into their tenth revision of the International Statistical Classification of Disease and Related Health Problems (ICD-10).

1993:  Researchers demonstrate for the first time that fibromyalgia patients suffer from disordered central sensitization.

1995:  First United States population-based study reveals 2% prevalence of fibromyalgia.

1997:  The National Fibromyalgia Association is formed to promote awareness of fibromyalgia and improve its legitimacy.

1997:  A controlled study implicates the role of trauma (particularly cervical spine injury) in fibromyalgia.

2007:   Lyrica (pregabalin) becomes the first U.S. Food and Drug Administration (FDA)-approved drug specifically for treating fibromyalgia.

2008:            Cymbalta (duloxetine hydrochloride) becomes the second FDA-approved drug to treat fibromyalgia.

2009:   Savella (milnacipran hydrochloride) become the third FDA-approved drug to treat fibromyalgia.

2009:   The FIQ is replaced by a revised version, the FIQR, which is adjusted to improve the way in which questions are presented to patients, create a more accurate scoring system, and assess a more comprehensive sampling of patient signs and symptoms.

2010:   The 1990 ACR diagnostic criteria for fibromyalgia are updated in an effort to better standardize the symptom-based aspect of diagnosis and ensure that physicians use similar, if not the same, processes to arrive at a diagnosis of fibromyalgia. The 2010 revised criteria replace the tender point scale with the Widespread Pain Index (WPI) as well as a measurement of symptom severity, known as the Symptom Severity scale (SS). The WPI is determined by the number of 19 specific anatomic areas in which the patient feels pain within the previous week. The SS score is determined by having patients rate the severity of three common symptoms – fatigue, waking unrefreshed, and cognitive symptoms – on a scale of zero to three (with three being the most severe). Additional points can be added for the presence of other symptoms, such as irritable bowel syndrome, insomnia, depression, Reynaud’s phenomenon, etc., so that final scores for the SS can range from zero to 12. According to the new criteria, patients must meet the following criteria to be diagnosed with fibromyalgia: 1) WPI > 7 and SS > 5 OR WPI between 3 and 6 and SS > 9; 2) symptoms must be present at a similar level for a minimum of 3 months; and 3) patient cannot have any other condition that could potentially explain their widespread pain.

——————————————–

References

1.        Furetiere A. Dictionnaire universel [La Haye-Rotterdam: Arnout-Reinier Leers, 1690]. Geneve: Slatkine Reprints, 1970.

2.        Grob GN. The rise of fibromyalgia in 20th-century America. Perspect Biol Med. 2011;54(4):417-437.

3.        Inanici F, Yunus MB. History of fibromyalgia: past to present. Curr Pain Headache Rep. 2004;8(5):369-378.

4.        Living with fibromyalgia, drugs approved to manage pain. U.S. Food and Drug Administration. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm107802.htm  Last updated March 14, 2012; Accessed June 13, 2012.

5.        Lundeberg T, Lund I. Did ‘The Princess on the Pea’ suffer from fibromyalgia syndrome? The influence on sleep and the effects of acupuncture. Acupunct Med. 2007;25(4):184-197.

6.        Smythe HA, Moldofsky H. Two contributions to understanding of the ‘fibrositis’ syndrome. Bull Rheum Dis. 1977;28:928-931.

7.        Wilke WS. New developments in the diagnosis of fibromyalgia syndrome: say goodbye to tender points? Cleve Clin J Med. 2009;76(6):345-352.

8.        Wolfe F, Hauser W. Fibromyalgia diagnosis and diagnostic criteria. Ann Med. 2011;43(7):495-502.

9.        Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33(2):160-172.

10.     Yunus M, Masi AT, Calabro JJ, Miller KA, Feigenbaum SL. Primary fibromyalgia (fibrositis): clinical study of 50 patients with matched normal controls. Semin Arthritis Rheum. 1981;11:151-171.

Leave a Comment

{ 1 comment… read it below or add one }

annie April 3, 2013 at 4:42 pm

I am so happy to share this with anybody that has been diagnosed or still testing to find out what they have, and if it is fibromyalgia they become diagnosed with that u have been able to to research all this excellent findings, this would really prove alot to the medical physicians that still do not believe in this or is unwilling to understand and take time to learn about this extremely debilitating disease. It should be published in every medical journal that is being distributed around the world. Dr.s should have to take the time to just research this because there is alot of people suffering with this disease and should know or at least try to treat this dieasease with alot more respect and regards for their patients wefare and wellbeing. Thank u for this info.

Reply

Google Analytics Alternative