Fibro History

As far back as the Bible there has been writings describing pain that could relate to fibromyalgia.

In Chapter VII, Verses 3 and 4: ” ..months of suffering and nights of pains…when I lie in bed at night I say when will I rise and during the day I hope for the night..”

In Chapter XXX, verses 16 and 17: “…days of pains are my life and at night my bones are pierced and the pains that make me suffer do not let me any rest..”

  • 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.
  • 1600s – Fibromyalgia-like symptoms were first given a name: muscular rheumatism.
  • 1800s – Dr. William Balfour, surgeon at the University of Edinburgh, gave the first full description of fibromyalgia.
  •       Suggesting that inflammation in muscle connective tissue is the cause of nodules and pain & reports for the first time on focal tenderness which he describes as “tender points.”

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.

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 desensitization.

  • 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.” Because no evidence of inflammation could be found, it was changed from fibrositis to fibromyalgia (meaning pain in muscles and tissues).
  • 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 – The first controlled clinical study with validation of known symptoms and tender points was published.

A formal set of criteria for the diagnosis of fibromyalgia was created, 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 recognized fibromyalgia as a real physical condition.
  • 1990 – The American College of Rheumatology developed diagnostic criteria for fibromyalgia to be used; in order to receive a diagnosis of fibromyalgia, patients should have widespread pain and at least 11 of 18 possible tender points.
  • 1993: Researchers demonstrate for the first time that fibromyalgia patients suffer from disordered central sensitization.
  • 1997: The National Fibromyalgia Association is formed to promote awareness.
  • 2007:  The U.S. Food and Drug Administration approved the drug Lyrica for the treatment of fibromyalgia. This was the first drug ever to receive FDA approval for fibromyalgia. (Since then, two additional medications – Cymbalta and Savella – have also reeived FDA approval for the treatment of FM
  • 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 Widespread Pain Index (WPI) replaces the original criteria 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.

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