What is Fibromyalgia?

            Although disease, in general, is accompanied by some type of pain, it is the hallmark of only a few.  Fibromyalgia  (FM) is one disease where pain is actually the basis of its diagnosis.  This perplexing syndrome leads one to contemplate the question:  What is fibromyalgia? 

            We have known about FM for over 100 years.  It was not until 1904 that Gowers¹ provided us with a name, fibrositis, to a condition associated with pain overlying fibrous covering of muscle.  For many years, without adequate criteria to diagnose this condition, fibrositis was dismissed as a psychosomatic pain syndrome.  The conditions of pain, when tentatively diagnosed, had strange and confusing (albeit medically justifiable) names, such as myofascitis, fibromyositis, myofascial fibrositis, myalgia, tension myalgia, as well as fibrositis. 

            The name, FM, was first applied in 1976 by Hench², because it was determined that inflammation of the fibrous tissue was not present as in arthritic conditions, even though pain appeared to be present in that specific area. It was not until 1990, that Wolfe and colleagues established definitive criteria for diagnosing FM³. According to their criteria, a patient must exhibit three distinct characteristics in order to be diagnosed with FM³.

1.          The American College of Rheumatology states that FM is a syndrome (series of symptoms) causing pain in 11 of 18 “tender points”.  These tender points are differentiated from trigger points in the elicitation of localized pain (at the site of application) rather than diffuse pain.  Pressure is applied with the thumb and forefinger (~ 4 kg) to each of 9 bilateral sites (occiput, low cervical, trapezius, second rib, lateral epicondyle, supraspinatus, greater trochantor, gluteal, knees).  Provocation of  pain responses are not always in precise locations and often requires significant practice and patience to determine affected areas.  Also, the patient who suspects she is afflicted with FM must be educated to discern pressure or discomfort from localized pain. 

2.          The pain must be present for at least three months, and affect all four quadrants of the body. 

3.          In addition, general fatigue must exist.  It is also necessary to rule out other diseases. 

         Fibromyalgia may be overlooked when other symptomatically similar diseases (lupus, rheumatoid arthritis, lymes disease) are positively diagnosed. Significant data has accumulated demonstrating that FM is co-morbidly associated with these and other conditions⁴. 

References

1.  Gowans WR. A lesson on lumbago: its lessons and analogues. BMJ.  1904;I:17-21.

2.  Wolfe F, Smyth H, 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;33:160 -172.

3.  Wolfe F. Fibromyalgia: the clinical syndrome. Rheum Dis. 1988;15:1-18.

4.  Mannerkorpi K, Svantesson U, Carlsson J, Ekdahl C. Tests of functional limitations in fibromyalgia syndrome: a reliability study. Arthritis Care Res. 1999;12:193-199.