A Short History of Fibromyalgia
Sometimes, it’s beneficial to understand the medical history behind a disease and fibromyalgia has a fascinating and rich heritage. It was in 1824 that a surgeon from Edinburgh, Scotland, William Balfour, provided the first description of tender points. He found nodules in muscles that he thought were inflammatory and felt these could be the source of pain in his patients. In the next several decades a French doctor, Francois Valleix began to tie trigger points to pain that was felt in other areas of the body, now called “referred pain.” He proposed the term, “muscular rheumatism” to describe this discomfort and felt the pain was transmitted by the nerves in the muscles.
Rudolf Virchow (1821 – 1902) was one of the most famous figures in medicine. Not only a physician, he was also an anthropologist, politician, biologist and historian. His areas of specialty were public health and pathology and he is considered the founding father of the latter specialty. Dr. Virchow also took an interest in tender points and felt they resulted from an alteration in nervous activity to the muscles that created a localized area of malnutrition resulting in damage to the muscles cells. These damaged muscles were then replaced by fibrous non-muscle tissues creating the painful nodule. Although his observations were made over a hundred years ago, he was not that far off from what many current researchers feel may be happening at sites of tender points.
The origins of fibromyalgia syndrome as a distinct entity may be traced to two leading neurologists of the 1880s, George Beard of New York and S. Weir Mitchell of Philadelphia who were strongly influenced by the German physician and physicist Hermann von Helmholtz. Helmholtz’s teachings were that the body is influenced by biological energy produced by digestion then appropriately distributed by the nervous system. Both Beard and Mitchell used this perspective to create the diagnosis of “neuroasthenia,” and attributed the physical pain, fatigue, and emotional suffering they were seeing in their patients to a depletion of nervous energy occurring as a result of the social changes of late 18th century America. There were significant medically historical consequences that followed. Physicians treating patients with neurasthenia were now seen more as humanitarians and scientists rather than idols, or even quacksters, with leeches and cathartics.
As a diagnosis, neurasthenia had a perceived legitimacy as it connected cultural changes to effects and consequences on an individual’s health. The legitimacy of neurasthenia was established by those who were subsequently diagnosed: authors Henry James and Thomas Mann, who also won the Nobel prize in literature; Max Weber, who was one of the founders of modern sociology theory, and; the Harvard physician and philosopher William James, who wrote the book, The Varieties of Religious Experience. Bill Wilson used this book for some of the main ideas when he founded Alcoholics Anonymous.
After neurasthenia became more widely known there followed a range of treatments. Depending on who provided the diagnosis a patient may have been prescribed a “rest cure,” which required staying in bed for 6 to 8 weeks and a diet of fatty foods. If you had the time and money you may have been sent off to a “camp cure” on a beautiful western range to live in “the great outdoors,” eat wild game, and thus replenish your depleted energies. The decline of neurasthenia as a diagnosis began in the 1930s, primarily as a result of Sigmund Freud and other psychiatrists whose thoughts began influencing the diagnosis of psychosomatic disorders, or disorders that were created by the mind. Also, the decline was due to fact that the cataclysmic cultural changes of the early 19th century were no longer considered cataclysmic to the current generations and simply accepted as normal life and hence few people thought them to be unhealthy.
The British neurologist Sir William Gowers introduced the term “fibrositis” in 1904 as being analogous to the skin inflammation known as cellulitis. In 1904 he also described the accompanying symptoms he found: pain, fatigue, and disturbed sleep. The medical term “fibrositis” would be used in the medical world for 72 years and began to receive considerable attention. A full text was published on this new disease in 1913 by two doctors, Llewellyn and Jones. By 1936, fibrositis had been divided into “regional,” most similar to today’s myofascial pain syndrome, and “generalized,” or what is now known as fibromyalgia. Charts of trigger and tender points and pain referral patterns had been published and now injections into the muscles were being used. At this time, it was noted that 60% of rheumatic diseases in the British Ministry of Health were based on fibrositis.
Following World War II the high prevalence of fibrositis was noted with up to 70% of returning British soldiers to one hospital meeting this diagnosis. The 1949 textbook on rheumatology, Arthritis and Allied Conditions, had a chapter on fibrositis in which the author stated that “there can no longer be any doubt concerning the existence of such a condition,” and the cause was attributed to stress, infections, and psychological factors. Dr. Janet Travell, who later became the White House physician to John F. Kennedy, published her first work on myofascial pain and trigger points in 1952. An important contribution was made in 1968 by Dr. Eugene F. Traut, who was then at the University of Illinois. His description of fibrositis matches that of fibromyalgia syndrome in almost exclusively involving females, with complaints of generalized aching pain, fatigue, headaches, poor sleep, colitis, and a distribution of tender points that matched quite closely those later chosen by the American College of Rheumatology in 1990. Interestingly, he also noted that men have more localized symptoms and felt there was a mind-body component.
Dr. Hugh A. Smythe has been referred to as the grandfather of fibromyalgia. The 1972 edition of Arthritis and Allied Conditions contained not only the most complete description of fibromylgia yet to appear in the medical literature, but also the unpublished sleep studies of his colleague Dr. Harvey Moldofsky. These sleep studies, and sleep in fibromyalgia syndrome, will be the topic of a future short report. Smythe and Moldosky wrote a paper in 1977 on the “fibrositis” syndrome. They felt that some of the diagnostic criteria should include pain at 12 of 14 tender points, as well as the presence of chronic pain, morning stiffness, fatigue, and disturbed sleep. This was actually considered a landmark paper and played an influential role in 1990 when the American College of Rheumatology decided on the criteria to be used to formally establish a diagnosis of fibromyalgia. Criteria that have been in place for 20 years and have only recently been changed. That will also be the subject of a future short report.
So, there you have an encapsulated history of fibromyalgia over the last 185 years. You have to admit, it has a rather fascinating past.
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