In the 1930s, interest heightened in muscle pain referred from tender/trigger points and charts of these patterns began to appear. Local injections of anesthetic continued to be a suggested treatment.
Fibrositis wasn’t a rare diagnosis back then. A 1936 paper stated the fibrositis was the most common form of severe chronic rheumatism. It also said that, in Britain, it accounted for 60 percent of insurance cases for rheumatic disease.
Also in that era, the concept of referred muscle pain was proven via research. A study on pain pathways mentioned deep pain and hyperalgesia (a heightened pain response) and may have been the first to suggest that the central nervous systemwas involved in the condition.
Additionally, a paper on trigger points and referred pain put forth the term “myofascial pain syndromes” for localized pain.
Researchers suggested that the widespread pain of fibrositis may come from one person having multiple cases of myofascial pain syndrome.
World War II brought a renewed focus when doctors realized that soldiers were especially likely to have fibrositis. Because they didn’t show signs of inflammation or physical degeneration, and symptoms appeared linked to stress and depression, researchers labeled it “psychogenic rheumatism.” A 1937 study suggested that fibrositis was a “chronic psychoneurotic state.” Thus, the on-going debate between physical and psychological was born.
Fibrositis continued to gain acceptance, even though doctors couldn’t agree on exactly what it was. In 1949, a chapter on the condition appeared in a well-regarded rheumatology text book called Arthritis and Allied Conditions. It read, “There can no longer be any doubt concerning the existence of such a condition.” It mentioned several possible causes, including:
- Traumatic or occupational,
- Weather factors,
- Psychological disturbance.
Still, descriptions were vague mish-mashes that we now recognize as including several very different types of pain conditions. They generally involved fatigue, headaches, and psychological distress, but poor sleep wasn’t mentioned.
The first description of fibrositis that resembles what we recognize today as fibromyalgia came in 1968. Researcher Eugene F. Traut’s paper mentioned:
- Female predominance,
- Generalized aching and stiffness,
- Poor sleep,
- Being “worry worts,”
- Tender points discovered by physical exam,
An important mind-body connection.
Along with generalized pain, he recognized certain regional ones that appeared to be common, including what we now know as carpal tunnel syndrome. He mentioned “various levels of the spinal axis,” which you may recognize from modern diagnostic criteria: pain in the axial skeleton (bones of the head, throat, chest and spine) and in all four quadrants of the body.
Four years later, though, researcher Hugh A. Smythe penned a textbook chapter on fibrositis that had a far-reaching influence on future studies and lead to his being called the “grandfather of modern fibromyalgia.” He’s believed to be the first to describe it exclusively as a widespread condition, thus distinguishing it from myfascial pain syndrome.