Toward an integrated understanding of fibromyalgia syndrome. I. Medical and pathophysiological aspects

&NA; Fibromyalgia syndrome (FS) is a chronic pain disorder characterized by diffuse musculoskeletal soreness, stiffness, non‐restorative sleep and psychological disturbance. At present, much about the etiology, pathological mechanisms and course of FS are unknown. Indeed, standardized diagnostic criteria have only been recently agreed upon. The present paper is the first of a two‐part series which reviews the extant empirical literature concerning FS, with a view to arriving at an integrated understanding of the syndrome. The present paper describes the clinical presentation of FS and historical conceptualizations of the disorder. Available research on pathophysiological mechanisms in FS is then presented. In this section we have included literature concerning histology of muscle, sleep architecture, neurotransmitter anomalies and neuropeptide involvement in FS symptomatology.

[1]  W. Müller The fibrositis syndrome: diagnosis, differential diagnosis and pathogenesis. , 1987, Scandinavian journal of rheumatology. Supplement.

[2]  E. Boland Psychogenic Rheumatism: The Musculoskeletal Expression of Psychoneurosis * , 1947, Annals of the rheumatic diseases.

[3]  T. Merigan,et al.  Clinical and immunologic effects of recombinant leukocyte A interferon in eight patients with advanced cancer. , 1982, JAMA.

[4]  A Lecture on Lumbago: Its Lessons and Analogues , 1904, British medical journal.

[5]  R. Stockman The Causes, Pathology, and Treatment of Chronic Rheumatism , 1904, Edinburgh Medical Journal.

[6]  G. A. Mccain,et al.  Evaluation of amitriptyline in primary fibrositis. A double-blind, placebo-controlled study. , 1986, Arthritis and rheumatism.

[7]  Awad Ea Interstitial myofibrositis: hypothesis of the mechanism. , 1973 .

[8]  G. Asboe-hansen,et al.  Morphological and Chemical Connective Tissue Changes in Fibrositic Muscles * , 1957, Annals of the rheumatic diseases.

[9]  R. Bennett Fibrositis: misnomer for a common rheumatic disorder. , 1981, The Western journal of medicine.

[10]  M. Yunus,et al.  Is chronic pain a variant of depressive disease? The case of primary fibromyalgia syndrome , 1987, Pain.

[11]  G. A. Mccain,et al.  The concept of primary fibromyalgia (fibrositis): clinical value, relation and significance to other chronic musculoskeletal pain syndromes , 1988, Pain.

[12]  Dr. med. Hans Georg Fassbender Pathology of Rheumatic Diseases , 1975, Springer Berlin Heidelberg.

[13]  R. Bennett,et al.  Aerobic fitness in patients with fibrositis. A controlled study of respiratory gas exchange and 133xenon clearance from exercising muscle. , 1989, Arthritis and rheumatism.

[14]  H. Moldofsky,et al.  Sleep and posttraumatic rheumatic pain modulation disorder (fibrositis syndrome). , 1986, Psychosomatic medicine.

[15]  M. Yunus,et al.  Concepts of illness in populations as applied to fibromyalgia syndromes. , 1986, The American journal of medicine.

[16]  H. Moldofsky,et al.  Dysthymic Disorder and Rheumatic Pain Modulation Disorder (Fibrositis Syndrome): A Comparison of Symptoms and Sleep Physiology * , 1986, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[17]  F. Wolfe,et al.  Socioeconomic impact of fibrositis. A study of 81 patients with primary fibrositis. , 1986, The American journal of medicine.

[18]  M. Yunus,et al.  Plasma tryptophan and other amino acids in primary fibromyalgia: a controlled study. , 1992, The Journal of rheumatology.

[19]  X. Caro Immunofluorescent detection of IgG at the dermal-epidermal junction in patients with apparent primary fibrositis syndrome. , 1984, Arthritis and rheumatism.

[20]  I. Russell,et al.  Is there a metabolic basis for the fibrositis syndrome? , 1986, The American journal of medicine.

[21]  A. Komaroff,et al.  The "chronic, active Epstein-Barr virus infection" syndrome and primary fibromyalgia. , 1987, Arthritis and rheumatism.

[22]  F. Wolfe,et al.  Fibrositis: symptom frequency and criteria for diagnosis. An evaluation of 291 rheumatic disease patients and 58 normal individuals. , 1985, The Journal of rheumatology.

[23]  W. Clark,et al.  Pain sensitivity, mood and plasma endocrine levels in man following long-distance running: Effects of naloxone , 1984, Pain.

[24]  M. Yunus,et al.  Serum β-endorphin in primary fibromyalgia syndrome: a controlled study , 1986 .

[25]  E. Beutner,et al.  Immunopathology of the skin , 1987 .

[26]  A. Bengtsson,et al.  MUSCLE BIOPSY FINDINGS OF POSSIBLE DIAGNOSTIC IMPORTANCE IN PRIMARY FIBROMYALGIA (FIBROSITIS, MYOFASCIAL SYNDROME) , 1982, The Lancet.

[27]  H. Moldofsky,et al.  Sleep and musculoskeletal pain. , 1986, The American journal of medicine.

[28]  F. Wolfe The clinical syndrome of fibrositis. , 1986, The American journal of medicine.

[29]  F. Wolfe,et al.  Pain, functional disability, and psychological status: a 12-month study of severity in fibromyalgia. , 1988, The Journal of rheumatology.

[30]  L. Boccassini,et al.  Double-Blind Study of Dothiepin versus Placebo in the Treatment of Primary Fibromyalgia Syndrome , 1987, The Journal of international medical research.

[31]  M. Yunus,et al.  Juvenile primary fibromyalgia syndrome. A clinical study of thirty-three patients and matched normal controls. , 1985, Arthritis and rheumatism.

[32]  G. A. Mccain Role of physical fitness training in the fibrositis/fibromyalgia syndrome. , 1986, The American journal of medicine.

[33]  H. Moldofsky Sleep and fibrositis syndrome. , 1989, Rheumatic diseases clinics of North America.

[34]  B. Danneskiold-Samsøe,et al.  Isometric and isokinetic muscle strength in patients with fibrositis syndrome. New characteristics for a difficult definable category of patients. , 1987, Scandinavian journal of rheumatology.

[35]  K. Mašek,et al.  Muramyl Peptides, Serotonergic System, and Sleep , 1987, Annals of the New York Academy of Sciences.

[36]  G. Hanks Psychotropic drugs. , 1984, Postgraduate medical journal.

[37]  H. Moldofsky,et al.  Two contributions to understanding of the "fibrositis" syndrome. , 1977, Bulletin on the rheumatic diseases.

[38]  A. Hartz,et al.  Undetected fibrositis in primary care practice. , 1987, The Journal of family practice.

[39]  H. Moldofsky Nonrestorative sleep and symptoms after a febrile illness in patients with fibrositis and chronic fatigue syndromes. , 1989, The Journal of rheumatology. Supplement.

[40]  F. Wolfe,et al.  Prevalence of primary and secondary fibrositis. , 1983, The Journal of rheumatology.

[41]  D. Goldenberg,et al.  Psychiatric and psychologic aspects of fibromyalgia syndrome. , 1989, Rheumatic diseases clinics of North America.

[42]  L. Terenius,et al.  Endorphins in chronic pain. I. Differences in CSF endorphin levels between organic and psychogenic pain syndromes , 1978, Pain.

[43]  D. Felson,et al.  A prospective evaluation of 118 patients with the fibromyalgia syndrome: prevalence of Raynaud's phenomenon, sicca symptoms, ANA, low complement, and Ig deposition at the dermal-epidermal junction. , 1986, The Journal of rheumatology.

[44]  M. Yunus,et al.  A controlled study of primary fibromyalgia syndrome: clinical features and association with other functional syndromes. , 1989, The Journal of rheumatology. Supplement.

[45]  O. Gutiérrez-Rodríguez,et al.  Treatment of refractory rheumatoid arthritis--the thalidomide experience. , 1989, The Journal of rheumatology.

[46]  J. Neubauer,et al.  Sleep, sleep apnea and the fibromyalgia syndrome. , 1986, The Journal of rheumatology.

[47]  H. Moldofsky,et al.  The relationship of alpha and delta EEG frequencies to pain and mood in 'fibrositis' patients treated with chlorpromazine and L-tryptophan. , 1980, Electroencephalography and clinical neurophysiology.

[48]  P. Hauri,et al.  Alpha-delta sleep. , 1973, Electroencephalography and clinical neurophysiology.

[49]  D. Felson,et al.  The natural history of fibromyalgia. , 1986, Arthritis and rheumatism.

[50]  Burda Cd Immunoglobulin-G deposits at the dermal-epidermal junction in secondary (traumatic) fibromyalgia syndrome. , 1984 .

[51]  P. Tugwell,et al.  The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. , 1990, Arthritis and rheumatism.

[52]  Wilke Ws,et al.  Proposed pathogenesis of fibrositis. , 1985 .

[53]  D. Felson,et al.  Tenderness in 75 anatomic sites. Distinguishing fibromyalgia patients from controls. , 1988, Arthritis and rheumatism.

[54]  D. Wallace,et al.  Cytokines and immune regulation in patients with fibrositis. , 1989, Arthritis and rheumatism.

[55]  R. Feldman,et al.  Fundamentals of neuropsychopharmacology , 1984 .

[56]  R. Bennett,et al.  A double blind crossover trial of prednisone versus placebo in the treatment of fibrositis. , 1985, The Journal of rheumatology.

[57]  M. Yunus,et al.  Serum beta-endorphin in primary fibromyalgia syndrome: a controlled study. , 1986, Journal of Rheumatology.

[58]  A. Komaroff,et al.  The chronic fatigue syndrome: definition, current studies and lessons for fibromyalgia research. , 1989, The Journal of rheumatology. Supplement.

[59]  H. Moldofsky,et al.  Musculosketal Symptoms and Non‐REM Sleep Disturbance in Patients with “Fibrositis Syndrome” and Healthy Subjects , 1975, Psychosomatic medicine.

[60]  X. Caro Immunofluorescent studies of skin in primary fibrositis syndrome. , 1986, The American journal of medicine.

[61]  M. Yunus,et al.  Muscle biopsy findings in primary fibromyalgia and other forms of nonarticular rheumatism. , 1989, Rheumatic diseases clinics of North America.

[62]  G. Ferraccioli,et al.  EMG-biofeedback training in fibromyalgia syndrome. , 1987, The Journal of rheumatology.

[63]  G. Norman,et al.  Tender points in fibromyalgia , 1988, Pain.

[64]  B. Farrington,et al.  The medical works of Hippocrates , 1950 .

[65]  V. Harber,et al.  Endorphins and Exercise , 1984, Sports medicine.

[66]  Patrick D. Wall,et al.  Challenge Of Pain , 1983 .

[67]  F. Wolfe Development of criteria for the diagnosis of fibrositis. , 1986, The American journal of medicine.

[68]  L. Terenius,et al.  Cerebrospinal fluid levels of beta-endorphin in patients with fibromyalgia (fibrositis syndrome). , 1988, The Journal of rheumatology.

[69]  M. Karnovsky,et al.  Sleep and the Immune Response , 1987, Annals of the New York Academy of Sciences.

[70]  M. Yunus,et al.  Pathologic changes in muscle in primary fibromyalgia syndrome. , 1986, The American journal of medicine.

[71]  D. Goldenberg Fibromyalgia and its relation to chronic fatigue syndrome, viral illness and immune abnormalities. , 1989, The Journal of rheumatology. Supplement.

[72]  M. Yunus,et al.  Primary fibromyalgia (fibrositis): clinical study of 50 patients with matched normal controls. , 1981, Seminars in arthritis and rheumatism.

[73]  Caro Xj Is there an immunologic component to the fibrositis syndrome , 1989 .

[74]  H. Moldofsky,et al.  Induction of Neurasthenic Musculoskeletal Pain Syndrome by Selective Sleep Stage Deprivation , 1976, Psychosomatic medicine.

[75]  H Merskey,et al.  Psychiatry and Chronic Pain , 1989, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[76]  N. Hadler Medical Management of the Regional Musculoskeletal Diseases: Backache, Neck Pain, Disorders of the Upper and Lower Extremities , 1984 .

[77]  M. Millan Multiple opioid systems and pain , 1986, Pain.

[78]  L. Terenius,et al.  Elevated CSF levels of substance P and high incidence of Raynaud phenomenon in patients with fibromyalgia: new features for diagnosis , 1988, Pain.

[79]  L. Terenius,et al.  Substance P in CSF of patients with chronic pain syndromes , 1988, Pain.

[80]  Y. Lurie,et al.  fibrositis : a therapeutic trial . Imipramine for the treatment of , 2022 .

[81]  Morgane Pj Monoamine theories of sleep: the role of serotonin--a review [proceedings]. , 1981 .

[82]  B. Danneskiold-Samsøe,et al.  HISTOLOGICAL ABNORMALITIES IN MUSCLE FROM PATIENTS WITH CERTAIN TYPES OF FIBROSITIS , 1986, The Lancet.

[83]  D. Felson,et al.  A randomized, controlled trial of amitriptyline and naproxen in the treatment of patients with fibromyalgia. , 1986, Arthritis and rheumatism.

[84]  F. Wolfe,et al.  Fibrositis (Fibromyalgia) in rheumatoid arthritis. , 1984, The Journal of rheumatology.

[85]  R. Bennett,et al.  Clinical characteristics of fibrositis. I. A "blinded," controlled study of symptoms and tender points. , 1983, Arthritis and rheumatism.

[86]  N. Hadler A critical reappraisal of the fibrositis concept. , 1986, The American journal of medicine.

[87]  F. Wolfe,et al.  A controlled and blinded study of immunoreactant deposition at the dermal-epidermal junction of patients with primary fibrositis syndrome. , 1986, The Journal of rheumatology.

[88]  H. Nielsen,et al.  Reduced blood flow in fibromyotic muscles during ultrasound therapy. , 2020, Scandinavian journal of rehabilitation medicine.

[89]  D. Wallace,et al.  Fibromyalgia and interleukin-2 therapy for malignancy. , 1988, Annals of internal medicine.

[90]  L. Jorfeldt,et al.  Primary Fibromyalgia: A Clinical and Laboratory Study of 55 Patients , 1986 .