FIBROMYALGIA (FM) HISTORY
Fibromyalgia (FM) is not a "new" disease, as some skeptics have claimed. It is a disease
as old as mankind. Reports of FM can be found as far back as the Old Testament
Biblical times. In the book of Job, Job gives a vivid description of
his physical anguish:
"I, too, have been assigned months of futility, long and
weary nights of misery. When I go to bed, I think, `When will it be morning?' But the
night drags on, and I toss till dawn. And now my heart is broken. Depression haunts my
days. My weary nights are filled with pain as though something were relentlessly gnawing
at my bones." Job 7:3-4; 30:16-17 - NLT
Another well known person who reported FM-like symptoms was Florence
Nightingale, an English army nurse during the Crimean War (1854-1856) who was a pioneer
in the International Red Cross Movement. Nightingale became ill while working on the
front lines and never really recovered. She was virtually bedridden much of the rest of
her life with pain and fatigue resembling FM until her death in 1910.
Fibromyalgia has been studied since the 1800's. In 1913 in the British Medical
Journal, a physician by the name of Luff talked about the factors of fibrositis.
He noted that the symptoms grew worse when the barometric pressure lowered and rain
was approaching. People with FM today are familiar with this phenomena. Luff's article
also talked about temperature variations, fevers, infections and motor vehicle
accidents. He also drew the connection between "growing pains" in children and
fibrositis (Williamson, 1996, p. 16). We now know that fibrositis is the wrong
name, because there is no inflamation in people with fibromyalgia.
William Balfour, a surgeon from the University of Edinburgh, described FM
in 1815. Over the years, the syndrome has been called by many names, including
"fibrositis", "neurasthenia", "nonarticular rheumatism", "hysterical paroxysm", "muscular
rheumatism" and even "tender lady syndrome."
In 1904, Sir William Gowers again described the syndrome and named it "fibrositis."
Smythe laid the foundation of modern FM in 1972 by describing widespread pain and
tender points. In 1975, Dr. Harvey Moldofsky discovered that
patients deprived of stage-4 sleep developed tender points in symmetrical locations in
the body. The first sleep electroencephalogram study was performed in 1975. The
first controlled clinical study with validation of known symptoms and tender points
was published in 1981. This same study also proposed the first data-based criteria.
The important concept that FM and other similar conditions are interconnected was
proposed in 1984.
In 1976, Dr. Philip Hench coined the term "fibromyalgia," a descriptive term built on
the Latin word for connective tissue (fibra), and the Greek words for muscle (myo-)
and pain (algos). In 1977, Dr. Hugh Smythe classified the 18 tender points.
In 1987, it was first recognized by the American Medical Association (AMA) as a
"true" illness and the cause of disability. In an article that same year, in the
Journal of the American Medical Association (JAMA), Dr. Don
Goldenberg called the syndrome fibromyalgia. Even though Goldenberg's paper was
published in a highly respected medical journal, doctors are still slow to accept FM as
a real diagnosis, although things are getting better. Doctors' reluctance is
largely due to the lack of "clinical" evidence. In other words, there isn't an X-ray
or blood test to prove FM.
The first American College of Rheumatology (ACR) criteria were published in 1990
and neurohormonal mechanisms with central sensitization were developed in the
1990s. Serotonergic/norepinephric drugs were first shown to be effective in 1986.
Over the years there have been a multitude of theories as to what FM is and what causes
it. As the term fibromyalgia implies, it was logically thought to be a muscle
disease, since muscle pain seemed to be the primary symptom. However, research
studies could fine nothing wrong with the muscles. For a while, it was theorized that
it might be an autoimmune disorder, but once again research revealed no disturbance of
the immune system.
Sadly, as often happens when medical science cannot identify an illness using
standard technology of the day, for most of the past 200 years FM was thought
to be a psychiatric or psychosomatic disorder. Even today, there are a few
medical professionals who insist on hanging on to this theory. FM has also been called
a "wastebasket" diagnosis and a fad disease. It is neither. Many doctors do not know how
to diagnose FM, and even fewer receive training in the proper way to diagnose it. A
better understanding of FM is slow in coming, but things are getting better. More and
more medical schools are educating new doctors about this syndrome, so hopefully, it
won't be long until better-educated healthcare providers are available to a make quick
and accurate diagnosis of fibromyalgia.
FM is not directly life-threatening. It does not damage joints or body tissues. And once
it becomes established, the condition does not progress further. However, the severity
of symptoms may vary from day to day with periods of increased symptoms (called flares),
and periods of improvement. Symptoms may worsen at certain times of the day, with
weather changes, and during periods of stress. Although the condition is not progressive
or destructive, it can certainly be disabling.
Fortunately, the 21st century has brought new laboratory tests and brain-imaging
technology that has not only proven FM to be a real physical disorder, but has also
shown that it is caused by a malfunction of the central nervous system. As a result
of these discoveries, new, more effective treatments are on the horizon. Hopefully, one
day the history of FM will be just that - past history!
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