The History of Fibromyalgia
Introduction
Some may consider fibromyalgia as a fairly new medical condition, but the truth is, this medical condition has actually existed for more than centuries. The term “fibromyalgia” first came into existence in the year 1976. Since the early 1800s, scientists and physicians have written descriptions about a condition that resembles fibromyalgia.
There have been reports of certain medical illnesses, which have striking similar symptoms that date back to 1500 BC. Fibromyalgia has centuries of history, wherein it has undergone a lot of name changes. There were also theories about it, which have been discarded along the way.
Fibromyalgia has come a long way and there are still research studies going on to provide proof that it is a real illness.
History of Fibromyalgia
1592 to 1900
During the early days, doctors were not quite aware of all the separate definitions for every medical condition, which are recognized in today’s world. The descriptions and terminologies were broadly used, but as time passed by, they were eventually narrowed down to what they exactly stand for.
In the year 1592, Guillaume de Baillou, a French physician, first reported a modern description of rheumatism and arthritis. The term "rheumatism" was used to describe any musculoskeletal pain without any source of injury. This was basically a broader term, which may have also included fibromyalgia along with arthritis and other similar medical conditions.
Eventually, doctors started to use the term "muscular rheumatism" for any painful conditions such as fibromyalgia, which did not cause any deformity. The definitions were still vague for some two hundred years later. However, in the year 1815, William Balfour, a Scottish surgeon, noted down nodules on the connective tissues and later suggested that inflammation in the muscles could be the leading cause of both pain and nodules. Balfour was also the first one to provide a description of tender points, which was used in the diagnosis of fibromyalgia centuries later.
French doctor Francois Louis Isidore Valleix used the term “neuralgia” a few decades later to describe the pain from these tender points, which traveled down along the nerves. There were also other theories, which included muscular disorders and hyperactive nerve endings.
In the year 1880, American neurologist George William Beard came up with the terms "myasthenia" and "neurasthenia". These terms were used to describe any kind of widespread pain along with the signs of fatigue and psychological disturbances. Beard believed that these conditions occurred due to stress.
1900 to 1975
In the period of the early 20th century, there was more creation of specific terminologies. For fibromyalgia and similar illnesses, researchers came up with different terms such as "muscle hardening", "myogeloses", and "fibrositis".
In 1904, a British neurologist named Sir William Gowers first coined the term called fibrositis. The symptoms described by Gowers had striking similarities with fibromyalgia. His description of the symptoms included:
- Weakness or fatigue
- Sleep problems
- Pain
- Cold intolerance
- Aggravated symptoms due to muscle overuse
To provide relief from these symptoms, William Gowers suggested the treatment of cocaine injections since cocaine during those times was used for medicinal purposes as a topical anesthetic.
When the term “fibrositis” is broken down, “fibro” would mean connective tissues and “itis” would mean inflammation. After William Gowers put the name forward, there was another researcher who published a theory, which seemed to almost confirm many of the theories mentioned by Gowers. Those theories would include the mechanisms of inflammation in this condition. However, this second research was ironically found to be flawed.
There was an increasing interest in muscle pain, which were referred to as tender or trigger points in the 1930s. Because of the heightened interest, charts of these patterns started to appear.
In the year 1936, one paper regarded fibrositis as the most common form of severe chronic rheumatism. In Britain alone, fibrositis accounted for around 60 percent of insurance cases for this type of rheumatic disease. The concept of muscle pain was also proven through various research. There was a study on pain pathways, which had mentioned deep pain and hyperalgesia or a heightened response to pain. It was probably the first ones to suggest the involvement of the central nervous system in this condition.
However, a paper that published about trigger points and its referred pain had put forth the term "myofascial pain syndrome" for localized forms of pain. Certain researchers had suggested that the widespread pain in the case of fibrositis would have come from one individual having multiple cases of the syndrome.
Renewed attention was brought during the World War II when doctors realized that soldiers were also most likely to suffer from fibrositis. However, since the soldiers did not show any signs of physical degeneration or inflammation, the symptoms were later linked to depression and stress. Thus, researchers termed it as “psychogenic rheumatism”.
In a study published in 1937, it was suggested that fibrositis was a chronic psychoneurotic state, which led to an ongoing debate between the physical and psychological forms of the condition. This era saw a continued acceptance of the term fibrositis even when the doctors were not agreeing on what it exactly meant.
In 1949, there was a chapter about this condition, which appeared in a well-noted rheumatology book called Arthritis and Allied Conditions. The book mentioned several possible causes, which included infection, weather conditions, occupational factors, psychological disturbance, and trauma. The descriptions were often vague, which involved headaches, fatigue, as well as psychological distress. However, there was no mention of sleep disturbances.
In 1968, fibrositis was similarly described to what we call as fibromyalgia today. A researcher named Eugene F. Traut mentioned the following symptoms in his paper:
- Poor sleep
- Fatigue
- Generalized stiffness and body aches
- Colitis
- Tender points during physical examination
- Female predominance
- Being overly anxious
- An important connection between the mind and body
Traut recognized the condition with generalized pain, but he also identified other less common regional ones, which what we know now as carpal tunnel syndrome. He also mentioned "various levels of the spinal axis", which is now regarded as axial skeletal pain. It involves pain in all quadrants of the body and affects the chest, throat, spine, and head.
After four years, researcher Hugh A. Smythe came up with a textbook chapter about fibrositis, which had a far-reaching influence on future fibromyalgia studies. Smythe was the first one to describe it as a widespread medical condition, which differentiates it from the myofascial pain syndrome. In his research, he also included the symptom of poor sleep. There was also a detailed description provided as to what sleep meant for those patients. He also provided an unpublished electroencephalogram result or sleep study finding, which provided a picture of dysfunction at stages three and four of sleep. Smythe also stated that a non-restorative sleep along with emotional distress and trauma led to the heightening of the symptoms.
Subsequent research also confirmed sleep abnormalities. It showed that sleep deprivation could lead to symptoms similar to fibromyalgia even in healthy individuals. Smythe was also involved in defining tender or trigger points and suggested that these areas should be used in the diagnosis. He also identified certain symptoms such as fatigue, morning stiffness, chronic pain, and lack of sleep.
1976 to Present
By this time, there was good progress done by researchers. However, it was still unclear, especially on the evidence of inflammation ("itis" in the word "fibrositis"). From the term fibrositis, the name was changed to fibromyalgia, wherein “fibro” would mean connective tissues, “my” would mean muscles, and “algia” would mean pain. However, there were still a lot of unanswered questions about the condition. The primary symptoms of this disease were vague but were common among the population. Doctors still could not get a good hold on what exactly fibromyalgia was.
In the year 1981, there was a seminal study conducted by Dr. Muhammad Yunus, wherein it was confirmed that fatigue, lack of sleep, and chronic pain were quite common in people who had fibromyalgia than those who did not. Moreover, the number of tender points was significantly greater along with other common multiple symptoms.
The traditional symptoms would include an abnormal sensation of the nerves or paresthesia, subjective swelling, and certain overlapping conditions, which would include irritable bowel syndrome (IBS), migraine, and tension headaches. There has been a wealth of research carried out, which confirmed that the symptoms would overlap and were in fact associated with fibromyalgia.
The following are important advances in fibromyalgia research:
- 1984 - In the year 1984, a study was published, wherein there was a higher prevalence of fibromyalgia seen in individuals who had rheumatoid arthritis.
- 1985 - The first controlled study of juvenile fibromyalgia was published in the year 1985.
- 1986 - It was found in the year 1986 that certain drugs that influence serotonin and norepinephrine show signs of effectiveness.
- 1990 - The American College of Rheumatology established the official diagnostic criteria of the widespread pain and tenderness in 11 out of the 18 specific tender points, thereby standardizing the research criteria around the globe.
- 1991 - For a better evaluation, a questionnaire was developed for doctors and was called as the Fibromyalgia Impact Questionnaire (FIQ).
- 1992 - Growth hormone deficiency was discovered.
- 1993 - In the year 1993, there were studies that demonstrate central sensitization and stress regulation abnormalities.
- 1994 - In 1994, elevated levels of Substance P (SP) were confirmed in the CSF.
- 1995 - The prevalence of fibromyalgia was seen in 2 percent of the US population in the year 1995. The first SPECT scan or brain imaging helped in showing the abnormal blood flow patterns present in the brain.
- 1999 - In the year 1999, a genetic component was demonstrated to explain why the condition runs in the family.
- 2005 - In the year 2005, the American Pain Society released its first guidelines for the treatment of pain related to fibromyalgia.
- 2007 - In the year 2007, the FDA approved Lyrica (pregabalin) for the treatment of fibromyalgia in the United States.
- 2008-2009 - Savella (milnacipran) and Cymbalta (duloxetine) also followed the suit in the years 2008 and 2009.
- 2010 - Later in the year 2010, the American College of Rheumatology released the alternate diagnostic criteria, wherein questionnaires were used instead of trigger points.
There have been several researchers still working to establish the subgroups of fibromyalgia with a belief that it would be the key to nailing down the best treatments as well as the underlying mechanisms of actions. There are more treatments, which are still under investigation.
