The History of Fibromyalgia Syndrome

Fibromyalgia syndrome (FMS) is a relatively new diagnostic entity that surfaced in the rheumatology literature in the late 20th century. Certain patients  experienced widespread aches and pains not confined to any specific muscle or joint. At first it was assumed that these patients had early signs of rheumatoid arthritis, lupus, ankylosing spondylitis, or some other systemic arthritic processes. However, for this particular type of patient, serum laboratory testing, such as sedimentation rate, HBLA, and rheumatoid factor, showed negative results. Rheumatologists began to talk among themselves about this interesting type of patient who appeared to have a musculoskeletal disorder but, at the same time, did not have any physical examination or laboratory findings suggestive of any specific diagnosis. The only positive physical finding was a characteristic lowered pain threshold over various soft tissues on digital pressure, which were termed tender points (TePs). There was also the curious finding that most of these patients also had an associated sleep disorder that seemed to correlate with the number of TePs.1,2 In 1989, a rheumatology consensus conference was held in Minneapolis, at which time this issue was discussed in great detail. This meeting resulted in publication the following year of what has become known as the 1990 American College of Rheumatology (ACR) criteria for the classification of fibromyalgia syndrome.3 Essentially, this was the birth of FMS as a new medical term. Although the 1990 ACR criteria were meant to be merely “classification criteria” for research purposes, they quickly filled the void and became used as “diagnostic criteria” by physicians eager to have some established criteria for making the diagnosis of FMS. Essentially, the ACR standard consists of just 2 criteria: (1) chronic, widespread pain (pain that is present on both sides of the body, above and below the waist, and in the axial skeleton) that has been present for more than 3 months, and (2) pain elicited by palpation of TePs. The presence of
“pain” was determined by use of an algometer during digital examination, when less than 4 kg of pressure over a TePevoked a painful response. For a diagnosis of FMS, the required finding was pain induced on palpation of a minimum of 11 of 18 predetermined TeP sites.

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