fibromyalgia

Article

May 23, 2022

Fibromyalgia is a chronic disease characterized by generalized musculoskeletal pain, with exaggerated hypersensitivity (allodynia and hyperalgesia) in multiple body areas and predefined points (tender points), without demonstrable organic alterations. It is related to a wide variety of symptoms, among which persistent fatigue and unrefreshing sleep stand out. In addition, it often coexists with other rheumatologic and psychiatric disorders.[1]​[2]​[3]​[4]​[5]​[6]​ In the middle of the 20th century, some authors considered fibromyalgia to be a somatization disorder, that is, patients who persistently complain of various symptoms that do not have an identifiable physical origin. However, in recent years and after various studies, this belief has been dismissed. Fibromyalgia has been considered a disease by the World Health Organization since 1992 and, although the nosological definition and its consideration in the medical field has not been without controversy, the results of the investigations indicate with considerable consensus that its origin is neurological , and that the pain would result from neurochemical imbalances at the level of the central nervous system that generate generalized allodynia and hyperalgesia.[4][5][7][8][9]​ There is no universal cure for fibromyalgia. The treatments used are focused on controlling symptoms, including exercise, behavioral therapies and certain drugs.[10] A relationship with non-celiac gluten sensitivity and recovery or improvement with follow-up has been demonstrated in a number of patients. of a gluten-free diet.[11][12]​

History

The term fibromyalgia (from the Latin fiber, fiber, which refers to connective tissue,[13]​ from the Greek mio, muscle[14]​ and algia, pain[15]​) is relatively recent in the history of the description of this illness. In 1750, the British physician Sir Richard Manningham in his publication "Symptoms, Nature, Causes, and Cure of Low-Fever or Little Fever: Commonly Called Nervous or Hysterical Fever; the Spirit Fever; Vapors, Hiccups, or Spleen," cites similar descriptions to those made by Hippocrates that could correspond to fibromyalgia.[16] In 1843, the German anatomist Robert R. Floriep described "tender points" in his treatise on the pathology and therapy of rheumatism where he proposed an association between rheumatism and tender points of stiff muscles.[9][17] In 1881, the American doctor George M. Beard wrote a book called "American Nervousness" where he describes patients with neurasthenia who presented chronic loss of strength, fatigue or tiredness, and in whom the presence of multiple painful points and hyperalgia was confirmed. [16][18] In 1904, Sir William R. Gowers referred to "fibrositis" as a condition in which he associated lumbago with pain in the arms and which he attributed to "inflammation of the fibrous tissue of the muscle". In that same year, Stockman, in Scotland, studied a group of patients with stiffness and "painful muscle movement" in whom he described muscle biopsies with "fibrotic nodules."[9] In 1915, Llewellyn and Jones defined fibrositis as "an inflammatory change of the interstitial fibrous tissue of the striated muscle".[9] In 1936, Hench denies the inflammatory origin of fibrositis, and begins the development of theories about the origin psychological of the disease. Hallyday, in 1937, also proposed a psychological origin of fibrositis.[16] In 1946, Australian physician Michael Kelly published a series of studies of fibrositis based on his own experience with the disease. In these works, he reinforces the concept of sensitive points as the central axis of diagnosis, and proposes an eclectic theory between psychological and organic origin [9] [19] [20] [21].