How is Fibromyalgia Classified/Diagnosed Part 1 – Historical background – From Fibrositis to Fibromyalgia


How Fibromyalgia is diagnosed is often changing as physicians realise new and different things about the illness.

I’d like to share a bit of Fibro history to help us understand just how slow that progress has been before indulging ourselves into the current World of Fibro Diagnosis.


 

Early studies

Recorded evidence of medical conditions described as involving chronic widespread pain and historians write that evidence of Fibromyalgia goes as far back as the 1800’s and first described in 1843 as a type of Rheumatism with painful hard places.

At the turn of the twentieth centutry, in 1904, the term ‘Fibrositis’ was coined by Sir William Gowers as the name for Fibromyalgia, Gowers wasn’t the only one to come forward and speak out.  Also in 1904,  Ralph Stockman, a pathologist noted specfic changes in the fibrous showing evidence of inflammatory changes to the intra-muscular septa (a thin membrane that divides two soft masses of tissue) on biopsies from patients.


Definition of Fibrositis:Inflammatory hyperplasia of white fibrous connective tissue, especially surrounding muscles, causing pain and stiffness.

medical-dictionary –  thefreedictionary -fibrositis


Fibromyalgia has had a string of other names/titles/descriptors in subsequent years none of which have been as prevalent as ‘Fibrositis’, with other names/titles/descriptors for Fibromyalgia being fibromyositis, psychogenic, psychosomatic, or muscular rheumatism.


‘fibrositis has been most resilient and “eventually became synonymous with idiopathic local or diffuse musculoskeletal pain of any type.’

Fibromyalgia: Evolution of Fibromyalgia

Fibromyalgia: Evolution of Fibromyalgia

A Spine-health.com Peer Reviewed Article 

Written by Thomas K. Van Sistine, MD, Jan 2000)


What is Fibrositis and its characteristics? 

Explained here on the following link to: New Medical Information and Health Information (NMIHI)

NMIHI | FIBROSITIS, FIBROMYOSITIS, FIBROMYALGIA | Last updated 21 December 2011


Microsoft Word - PainPhysiologyEducationCleanCopy.doc

(How to explain central sensitization to patients with unexplained chronic musculoskeletal pain: Pratice guidelines –

Jo Nijs, C. Paul van Wilgen, Jessica Van Oosterwijck, Miriam van Ittersum, Mira Meeus, 2011, Elsevier Inc )

Idea of central sensitivity syndromes is published

The term fibromyalgia was not used until 1976 Dr P.K. Hench used it to describe the symptoms and the first scientific publication of the term Fibromyalgia came about after researcher Mohammed Yunus coined the term as a ‘synonym for fibrositis’ in 1981. Dr. Yunus continued his studies and in 2007 he once again made a significant donation to the study of chronic pain and fatigue by creating the concept known as central sensitivity syndromes, or CSS.

The following paragraphs are taken from fibromyalgia-symptoms page discussing CSS and tells us a little more about Dr Yunus work.  The blue links amid the text also take you to pages of Fibromyalgia Symptoms website for explanations.


Dr Yunus research

Dr. Yunus and his team reviewed more than 225 publications and found that the data described 13 different conditions that are connected to central sensitization (CS). In CS, the spinal cord and brain or central nervous system, becomes hypersensitive at specific body points so that a light touch may cause significant pain. Associated conditions would include sleep disturbances and chronic fatigue.

“CSS are the most common diseases that are based on real neurochemical pathology and cause real pain and suffering. In some patients stress and depression may contribute to the symptoms but they are all based on objective changes in the central nervous system,” says the indefatigable Dr. Yunus.

Fibromyalgia is from the Latin fibra (fiber) and the Greek words myo (muscle) and algos (pain).


fatigue

 


Tender points and the idea of fatigue is introduced


Throughout the development and history of the ‘Fibromyalgia’ concept there has been noted a central importance of a research paper on ‘Fibrositis’ by Smythe and Moldofsky, which was pubished in the 1977 issue of the ‘Bulletin of the Rheumatic Diseases’.  They characterised the disease fibrositis based on two key criteria involving the existance of numerous tender points which they described as being sensitive to pressure and non-refreshing sleep. 

Fibrositis patients were characterised by the tender points and from a medical history showing the sufference of wide-spread pain for longer than 3 months alongside poor and often disturbed sleep, and early morning fatigue accompanied with stiffness in the muscles.  Unfortunately, Smythe & Moldofsky’s research did not include a definitive method for determining the sleep disturbance, fatigue and widespread aching unlike the tender points which were clearly defined. 


Despite that though! their proposed criteria:

‘offered the first concrete description and set of criteria for diagnosing what we now know as Fibromyalgia.’

taken from Fibromyalgia treatmentdiagnostic history

Tender points – please note not used anymore.


From there to…


1981 – The first controlled clinical study of the characteristics of Fibro were published and provided much support for symptom associations.


1984 – interconnection between Fibro and similar conditions was proposed.


1986 – Trials of the first proposed medications was published.


1987 – An article in the Journal of the American Medical Association used the term “fibromyalgia syndrome” while saying it was a “controversial condition”.


1990 – The American College of Rheumatology  pdf (ACR) published its first classification criteria for fibromyalgia (although these are not strictly diagnostic criteria.)


I’ll end this part of the topic here as we have reached our destination and in part 2 I will give you The Tender point test (TpT) & ‘The American College of Rheumatology (ACR’s) first classification criteria for fibromyalgia’ and progress of diagnostic criteria through to their new criteria of 2010.

All are important to the way that our Fibromyalgia is diagnosed today. 🙂


Updated June 2017 / May 2018 / Oct 2019


Further reading


The American College of Rheumatology (ACR) – www.rheumatology.org/


Posted by   on 10 April 2013, 8:57 am  – In Memoriam: Hugh A. Smythe, 1927-2012  Shared Via:  The Fibromyalgia Perplex


Does Fibromyalgia Run in the Family? | Fibromyalgia Symptoms |



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