Fibromyalgia is a common chronic pain disorder, affecting an estimated 6.4% of people in the United States. It is characterized by widespread pain, tenderness, and other symptoms such as fatigue and cognitive difficulties. [1]
Although fibromyalgia syndrome (FMS) is now a recognized medical condition, this has not always been the case. In this article, we’ll dive into the history of fibromyalgia and how its understanding has evolved in the medical community as more research has been published.
Fibromyalgia Meanings over Time
People have described fibromyalgia symptoms for centuries, and several names have been associated with the condition, including:
- Rheumatism
- Fibrositis
- Psychogenic rheumatism
- Muscular fibrositis
- Non-articular rheumatism
- Affective Spectrum Disorder
We’ll look into the evolution of these terms here.
Rheumatism and Fibrositis
As early as the 16th century, scientists and doctors recorded a disease with symptoms we now recognize as fibromyalgia symptoms, such as muscle pain, tenderness, and other symptoms such as fatigue and cognitive dysfunction. Guillaume de Baillou called the condition “muscular rheumatism” in 1642.
In the early 1900s, the medical community recognized this set of symptoms as a medical condition and called it “fibrositis.” [2]
The term “fibrositis” first appeared in 1904 when British neurologist, Sir William Richard Gowers, described a condition that caused pain when doctors pushed against hardened fibrous tissues in the body. He also noted pain, hypersensitivity to pressure, fatigue, difficulty sleeping, and muscular problems aggravated by overexertion and weather changes often accompanied these tender areas.
The same year, Dr. Ralph Stockton built on Gower’s theory by stating that connective tissue inflammation may cause fibrositis. However, biopsies on the muscle tissues of people with the condition showed no evidence of inflammation.
In 1947, Dr. E. W. Boland called the condition “psychogenic rheumatism” because of the lack of physical evidence of underlying injury or disease processes causing the pain and other symptoms. He defined it as “a musculoskeletal expression of functional disorders, stress states, or psychoneurosis.” Although we now know that fibromyalgia does have a biological basis, this categorization of fibromyalgia as a “psychological” condition persisted.
The First Use of “Fibromyalgia”
In 1976, Dr. P. K. Hench first used the word “fibromyalgia” to describe rheumatism that did not affect the joints. At first, doctors and researchers criticized this medical condition, calling it not legitimate or valid.
The following year, in 1977, Dr. Harvey Moldofsky and Dr. Hugh Smythe continued to study fibromyalgia as defined by Hench. They described the condition and suggested criteria for diagnosis based on the features they considered key: widespread pain, tender points, unrefreshed sleep, and fatigue. Twelve out of 14 specific pressure points had to be positive before a doctor could definitively diagnose a set of symptoms as fibromyalgia.
These criteria had limitations, however. They did not give recommendations for assessing or defining these symptoms. Because of this early criteria, tender points were considered the most prominent feature of fibromyalgia for many years, and the other symptoms were often ignored.
In 1981, the medical community finally accepted the condition as “fibrositis” or “fibromyalgia,” and laid out a set of diagnostic criteria for the condition. To be diagnosed with fibro:
- The patient must have aching, pain, or stiffness in three areas for at least three months and no apparent underlying physical cause for the symptoms.
- The patient must have at least five consistent tender points in typical areas.
- If the patient only has 3-4 tender points, they must have five of the minor criteria:
- Difficulty sleeping
- Fatigue
- Anxiety
- Numbness
- Chronic headaches
- Irritable Bowel Syndrome (IBS)
- Subjective swelling (the patient feels swollen)
- Symptoms are aggravated by physical activity, weather, or time of day
- Symptoms are aggravated by stress or anxiety
- Symptoms are relieved with rest and stress reduction
The criteria also suggested diagnosing the condition solely on symptoms and not on the absence of other recognizable medical conditions. It was at this point that symptoms became more critical to diagnosing fibromyalgia.
Tender Points Criteria
The American Medical Association accepted fibromyalgia as a recognizable disease in 1987, and the American College of Rheumatology (ACR) set up a committee to establish definitive diagnostic criteria. These criteria were established and published in 1990. These criteria included: [9]
- A history of chronic, widespread pain in the skull, spinal column, and rib cage
- A history of chronic, widespread pain on both sides of the body and above and below the waist.
- This pain must be present and consistent for at least three months.
- A history of pain in at least 11 of 18 specific tender points
- The tender points must be painful when pressed, not just tender.
Over time, doctors noted that tender points were not a reliable diagnostic criteria. In 2010, the Widespread Pain Index (WPI) was developed to measure the number of painful body areas. Additional diagnostic criteria were formed into a Symptom Severity Scale (SSS), which measures cognitive symptoms, unrefreshed sleep, fatigue, and other symptoms such as headaches. The two scales are now combined to create a diagnostic tool for fibromyalgia. [10]
In 2016, the criteria was modified again. According to these guidelines, fibromyalgia could be diagnosed without regard to any other diagnoses, and a doctor could give a diagnosis of fibromyalgia if: [11]
- Symptoms have been present consistently for three months or more.
- Generalized pain is present in at least 4 of 5 regions.
- The WPI is greater than or equal to 7 and the SSS is greater than or equal to 5 or the WPI is 4-6 and the SSS is greater than or equal to 9.
Central Sensitization and Primary Pain
For decades after fibromyalgia was first defined, doctors and scientists were unclear about the biological mechanism, or pathophysiology, behind the condition. However, as more research has emerged, the medical community now recognizes it as a central sensitization, or centralized pain, condition.
At first, doctors and scientists used the term “central sensitization” to describe pain originating from a brain or spinal cord injury. Now, it describes pain that occurs when the brain and spinal column, the central nervous system, don’t process pain properly. [1] [7]
In central sensitization, the nerves in the brain and spinal cord are hyperreactive to nerve impulses. You may have a decreased pain tolerance level or allodynia, a condition in which something that does not cause others pain is painful. Some have described it as the volume control on your pain has been turned up.
Fibro is the most common form of central sensitization syndrome. [7]
Other central sensitization syndromes include:
- Migraines
- Restless leg syndrome
- Chronic fatigue syndrome
- Myofascial pain syndrome
- Multiple chemical sensitivity
- Irritable bowel syndrome (IBS)
.
Current Fibromyalgia Definition and Symptoms
Today, fibromyalgia is also known as FMS or simply “fibro.” The word fibromyalgia comes from three different words:
- “Fibro” means fibrous tissue.
- “Mio” means muscle
- “Algia” means pain
Fibromyalgia is a pain syndrome characterized by widespread pain, along with other symptoms, like fatigue and brain fog.
Diagnosing Fibromyalgia
People are evaluated for fibromyalgia based on symptoms and symptom severity because imaging and blood tests do not routinely show evidence of injuries or diseases that could cause fibromyalgia symptoms. Diagnosis now includes the Widespread Pain Index (WIP), which measures areas of pain, and the Symptom Severity Scale (SSS), which measures other common fibromyalgia symptoms.
The WIP and SSS are self-tests you can take independently and then bring the results to your doctor. Based on the results of these tests, as well as a medical history and any other tests your doctor may order to rule out other conditions that may be causing your symptoms, your doctor may diagnose you with fibromyalgia.
You may be diagnosed with fibromyalgia if you meet these criteria: [1]
- You have had symptoms consistently for at least three months
- You do not have any medical condition that could explain your symptoms.
- You have a WPI of 7 with an SSS of 5 or a WPI of 3-6 with an SSS of 9
What Does Fibromyalgia Feel Like?
The key diagnostic symptoms for fibromyalgia are widespread pain and fatigue with cognitive symptoms, like brain fog. Most people with fibromyalgia experience widespread muscle and bone pain, and sometimes in the joints. This pain is on both sides of the body and above and below the waist.
Fatigue is another prevalent symptom of fibromyalgia. Fatigue is often present early in the morning upon waking and in the afternoon. Activity and inactivity may increase the pain. You may also have sleeping difficulties. You may awaken frequently at night and feel unrefreshed when you wake up, or be stiff in the morning when you wake up.
Cognitive disturbances are also common. You may experience “fibro fog,” or the inability to focus or concentrate.
Many people also have symptoms such as: [1]
- anxiety
- depression
- migraine headaches
- tension headaches
- numbness, especially in the arms and legs
- Irritable Bowel Syndrome
- Gastroesophageal reflux disease (GERD)
- Dry eyes
- Difficulty breathing
- difficulty swallowing
- heart palpitations or irregular heartbeats
Talking to Your Doctor about Fibromyalgia
Talk to your doctor if you have pain and other symptoms you believe may be fibromyalgia. You may wish to take the WPI and SSS assessments before you meet with your doctor. Bring your results along with you to the appointment. Swing Care offers one-time consultations to discuss your results.
If you have already been diagnosed with fibromyalgia, talk to your doctor if your symptoms change, or your treatments are no longer working. Your doctor may recommend different treatments or refer you to a specialist.
Who Treats Fibromyalgia
Many people see their primary care doctor to treat fibromyalgia, but often specialists can help. Specialty practices like Swing Care can discuss fibromyalgia diagnosis and treatment with you.
If your pain worsens or you cannot exercise or keep up with your daily activities, your doctor may recommend a physical therapist or physiatrist. If you are not responding well to conventional treatments, such as gentle exercise or over-the-counter medication, your doctor may recommend a cognitive behavioral therapist to help with some of the mental health impacts of living in chronic pain. [1]
Questions to Ask Your Provider
Along with your completed WPI and SSS tests, bring a list of questions you want to ask your doctor during your appointment. You might want to ask:
- Will over-the-counter pain medication help my pain?
- Can you prescribe anything that has evidence for fibromyalgia treatment?
- What exercises would you recommend?
- Would cognitive behavioral therapy help?
- What are some other things I can try to ease the symptoms?
- Is there a particular diet I should follow?
Fibromyalgia has been studied at length over the years and was often misunderstood. But doctors and scientists are finding new insights into the condition, with new and more effective treatments as a result.
Medically reviewed by Dr. Andrea Chadwick, MD
Sources:
- Bhargava J, Hurley JA. Fibromyalgia. In: StatPearls. StatPearls Publishing; 2023. https://www.ncbi.nlm.nih.gov/books/NBK540974/
- Masi AT, Vincent A. A historical and clinical perspective endorsing person-centered management of fibromyalgia syndrome. Current Rheumatology Reviews. 11(2):86-95. https://www.eurekaselect.com/article/68152
- Galvez-Sánchez CM, Reyes del Paso GA. Diagnostic criteria for fibromyalgia: critical review and future perspectives. J Clin Med. 2020;9(4):1219. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230253/
- Inanici F, Yunus MB. History of fibromyalgia: past to present. Curr Pain Headache Rep. 2004;8(5):369-378. https://pubmed.ncbi.nlm.nih.gov/15361321/
- Smith HS, Harris R, Clauw D. 2011. Fibromyalgia: An Afferent Processing Disorder Leading to a Complex Pain Generalized Syndrome. https://www.painphysicianjournal.com/linkout?issn=&vol=14&page=E217
- Behm FG, Gavin IM, Karpenko O, et al. Unique immunologic patterns in fibromyalgia. BMC Clinical Pathology. 2012;12(1):25. https://bmcclinpathol.biomedcentral.com/articles/10.1186/1472-6890-12-25
- Understanding centralized pain. https://www.arthritis.org/health-wellness/healthy-living/managing-pain/understanding-pain/understanding-centralized-pain
- NICE Guideline. 2021. Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain – NCBI Bookshelf (nih.gov)
- Wolfe F, Smythe HA, Yunus MB, et al. The american college of rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum. 1990;33(2):160-172. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee – PubMed (nih.gov)
- Wolfe F, Häuser W. Fibromyalgia diagnosis and diagnostic criteria. Annals of Medicine. 2011;43(7):495-502. Full article: Fibromyalgia diagnosis and diagnostic criteria (tandfonline.com)
