Culture, science and the changing nature of fibromyalgia



Fibromyalgia is a common but contested illness. Its definition and content have changed repeatedly in the 110 years of its existence. The most important change was the requirement for multiple tender points and extensive pain that arose in the 1980s, features that were not required previously. By 2010, a second shift occurred that excluded tender points, allowed less extensive pain, and placed reliance on patient-reported somatic symptoms and cognitive difficulties ('fibro fog') that had never been part of past definitions or content. Fibromyalgia is closely allied with and often indistinguishable from neurasthenia, a disorder of the late 19th and early 20th centuries that lost favour when it was perceived as being a psychological illness. Fibromyalgia's status as a 'real disease', rather than a psychocultural illness, is buttressed by social forces that include support from official criteria, patient and professional organizations, pharmaceutical companies, disability access, and the legal and academic communities.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1: The rise and fall of neurasthenia, the beginning of fibrositis, and the growth of fibromyalgia following the 1990 ACR criteria.
Figure 2: Annual scientific publications on fibrositis or fibromyalgia as identified in PubMed.


  1. 1

    Wolfe, F. et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 33, 160–172 (1990).

    CAS  Article  Google Scholar 

  2. 2

    Wolfe, F., Brähler, E., Hinz, A. & Häuser, W. Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: results from a survey of the general population. Arthritis Care Res. 65, 777–785 (2013).

    Article  Google Scholar 

  3. 3

    Ehrlich, G. E. Pain is real; fibromyalgia isn't. J. Rheumatol. 30, 1666–1667 (2003).

    PubMed  Google Scholar 

  4. 4

    Barker, K. K. Listening to Lyrica: contested illnesses and pharmaceutical determinism. Soc. Sci. Med. 73, 833–842 (2011).

    Article  Google Scholar 

  5. 5

    Conrad, P. & Barker, K. K. The social construction of illness. J. Health Soc. Behav. 51, S67–S79 (2010).

    Article  Google Scholar 

  6. 6

    Barker, K. K. The Fibromyalgia Story: Medical Authority and Women's Worlds of Pain (Temple University Press, 2005).

    Google Scholar 

  7. 7

    Wolfe, F. Fibromyalgia wars. J. Rheumatol. 36, 671–678 (2009).

    Article  Google Scholar 

  8. 8

    Arnold, L. M., Clauw, D. J. & McCarberg, B. H. Improving the recognition and diagnosis of fibromyalgia. Mayo Clin. Proc. 86, 457–464 (2011).

    Article  Google Scholar 

  9. 9

    Williams, D. A. & Clauw, D. J. Understanding fibromyalgia: lessons from the broader pain research community. J. Pain 10, 777–791 (2009).

    Article  Google Scholar 

  10. 10

    Block, S. R. On the nature of rheumatism. Arthritis Care Res. 12, 129–138 (1999).

    CAS  Article  Google Scholar 

  11. 11

    Hadler, N. M. “Fibromyalgia” and the medicalization of misery. J. Rheumatol. 30, 1668–1670 (2003).

    PubMed  Google Scholar 

  12. 12

    Hadler, N. M. & Greenhalgh, S. Labeling woefulness: the social construction of fibromyalgia. Spine 30, 1–4 (2005).

    Article  Google Scholar 

  13. 13

    Cohen, M. L. & Quintner, J. L. Fibromyalgia syndrome, a problem of tautology. Lancet 342, 906–909 (1993).

    CAS  Article  Google Scholar 

  14. 14

    Cohen, M. L. & Quintner, J. L. The derailment of railway spine: a timely lesson for post-traumatic fibromyalgia syndrome. Pain Rev. 3, 181–202 (1996).

    Google Scholar 

  15. 15

    Cohen, M. L. & Quintner, J. L. Fibromyalgia syndrome and disability: a failed construct fails those in pain. Med. J. Aust. 168, 402–404 (1998).

    CAS  Article  Google Scholar 

  16. 16

    Ehrlich, G. E. Fibromyalgia, a virtual disease. Clin. Rheumatol. 22, 8–11 (2003).

    Article  Google Scholar 

  17. 17

    Gowers, W. R. A lecture on lumbago: its lessons and analogues. BMJ 1, 117–121 (1904).

    CAS  Article  Google Scholar 

  18. 18

    Edgecombe, W. Visceral fibrositis. Proc. R. Soc. Med. 13, 14 (1920).

    CAS  PubMed  PubMed Central  Google Scholar 

  19. 19

    Freyberg, R. H. Non-articular rheumatism. Bull. NY Acad. Med. 27, 245–258 (1951).

    CAS  Google Scholar 

  20. 20

    Graham, W. The fibrositis syndrome. Bull. Rheum. Dis. 3, 33–34 (1953).

    CAS  PubMed  Google Scholar 

  21. 21

    Traut, E. F. Fibrositis. J. Am. Geriatr. Soc. 16, 531–538 (1968).

    CAS  Article  Google Scholar 

  22. 22

    Smythe, H. A. & Hollander, J. L. in Arthritis and Allied Conditions (Lea and Febiger, 1966).

    Google Scholar 

  23. 23

    Smythe, H. A. & Hollander, J. L. in Arthritis and Allied Conditions 965–968 (Lea and Febiger, 1972).

    Google Scholar 

  24. 24

    Moldofsky, H., Scarisbrick, P., England, R. & Smythe, H. Musculosketal symptoms and non-REM sleep disturbance in patients with “fibrositis syndrome” and healthy subjects. Psychosom. Med. 37, 341–351 (1975).

    CAS  Article  Google Scholar 

  25. 25

    Moldofsky, H. & Scarisbrick, P. Induction of neurasthenic musculoskeletal pain syndrome by selective sleep stage deprivation. Psychosom. Med. 38, 35–44 (1976).

    CAS  Article  Google Scholar 

  26. 26

    Smythe, H. A. & Moldofsky, H. Two contributions to understanding of the “fibrositis” syndrome. Bull. Rheum. Dis. 28, 928–931 (1977).

    PubMed  Google Scholar 

  27. 27

    Yunus, M., Masi, A. T., Calabro, J. J., Miller, K. A. & Feigenbaum, S. L. Primary fibromyalgia (fibrositis): clinical study of 50 patients with matched normal controls. Semin. Arthritis Rheum. 11, 151–171 (1981).

    CAS  Article  Google Scholar 

  28. 28

    Wolfe, F. & Cathey, M. A. The epidemiology of tender points: a prospective study of 1520 patients. J. Rheumatol. 12, 1164–1168 (1985).

    CAS  PubMed  Google Scholar 

  29. 29

    Bennett, R. M. Fibrositis: misnomer for a common rheumatic disorder. West. J. Med. 134, 405–413 (1981).

    CAS  PubMed  PubMed Central  Google Scholar 

  30. 30

    Simms, R. W., Goldenberg, D. L., Felson, D. T. & Mason, J. H. Tenderness in 75 anatomic sites. Distinguishing fibromyalgia patients from controls. Arthritis Rheum. 31, 182–187 (1988).

    CAS  Article  Google Scholar 

  31. 31

    Wolfe, F. et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 62, 600–610 (2010).

    Article  Google Scholar 

  32. 32

    Fietta, P. & Manganelli, P. Fibromyalgia and psychiatric disorders. Acta Biomed. 78, 88–95 (2007).

    PubMed  Google Scholar 

  33. 33

    Wolfe, F., Michaud, K., Li, T. & Katz, R. S. EQ-5D and SF-36 quality of life measures in systemic lupus erythematosus: comparisons with RA, non-inflammatory rheumatic disorders, and fibromyalgia. J. Rheumatol. 37, 296–304 (2010).

    Article  Google Scholar 

  34. 34

    Hahn, S. R., Thompson, K. S., Wills, T. A., Stern, V. & Budner, N. S. The difficult doctor–patient relationship: somatization, personality and psychopathology. J. Clin. Epidemiol. 47, 647–657 (1994).

    CAS  Article  Google Scholar 

  35. 35

    Gordon, R. Psychological factor in rheumatism. BMJ 1, 1165–1169 (1939).

    CAS  Article  Google Scholar 

  36. 36

    Halliday, J. L. Psychological factors in rheumatism, part II. BMJ 1, 264–269 (1937).

    CAS  Article  Google Scholar 

  37. 37

    Boland, E. W. Psychogenic rheumatism: the musculoskeletal expression of psychoneurosis. Ann. Rheum. Dis. 6, 195–203 (1947).

    Article  Google Scholar 

  38. 38

    Reynolds, M. D. Clinical diagnosis of psychogenic rheumatism. West. J. Med. 128, 285–290 (1978).

    CAS  PubMed  PubMed Central  Google Scholar 

  39. 39

    Bennett, R. M. Nonarticular rheumatism and spondyloarthropathies. Similarities and differences. Postgrad. Med. 87, 97–99; 102–104 (1990).

    CAS  Article  Google Scholar 

  40. 40

    Wolfe, F. & Rasker, J. J. in Kelley's Textbook of Rheumatology (eds Firestein, G. S. et al.) 555–570 (Elsevier, 2008).

    Google Scholar 

  41. 41

    Shorter, E. From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era (Free Press, 1993).

    Google Scholar 

  42. 42

    Taylor, R. E. Death of neurasthenia and its psychological reincarnation. A study of neurasthenia at the National Hospital for the Relief and Cure of the Paralysed and Epileptic, Queen Square, London, 1870–1932. Brit. J. Psychiatry 179, 550–557 (2001).

    CAS  Article  Google Scholar 

  43. 43

    Wessely, S. Old wine in new bottles: neurasthenia and “M. E.”. Psychol. Med. 20, 35–53 (1990).

    CAS  Article  Google Scholar 

  44. 44

    Beard, G. Neurasthenia, or nervous exhaustion. Boston Med. Sur. J. 80, 217–221 (1869).

    Article  Google Scholar 

  45. 45

    Keller, T. Railway spine revisited: traumatic neurosis or neurotrauma? J. Hist. Med. Allied Sci. 50, 507–524 (1995).

    CAS  Article  Google Scholar 

  46. 46

    Brown, P. et al. Embodied health movements: new approaches to social movements in health. Sociol. Health Illn. 26, 50–80 (2004).

    Article  Google Scholar 

  47. 47

    Barker, K. K. Electronic support groups, patient-consumers, and medicalization: the case of contested illness. J. Health Soc. Behav. 49, 20–36 (2008).

    Article  Google Scholar 

  48. 48

    McLean, S. A., Clauw, D. J., Abelson, J. L. & Liberzon, I. The development of persistent pain and psychological morbidity after motor vehicle collision: integrating the potential role of stress response systems into a biopsychosocial model. Psychosom. Med. 67, 783–790 (2005).

    Article  Google Scholar 

  49. 49

    McLean, S. A., Williams, D. A. & Clauw, D. J. Fibromyalgia after motor vehicle collision: evidence and implications. Traffic Inj. Prev. 6, 97–104 (2005).

    Article  Google Scholar 

  50. 50

    Häuser, W., Petzke, F. & Sommer, C. Comparative efficacy and harms of duloxetine, milnacipran, and pregabalin in fibromyalgia syndrome. J. Pain 11, 505–521 (2010).

    Article  Google Scholar 

  51. 51

    Michel, J.-B. et al. Quantitative analysis of culture using millions of digitized books. Science 331, 176–182 (2011).

    CAS  Article  Google Scholar 

Download references

Author information




Both authors contributed to all aspects of this manuscript.

Corresponding author

Correspondence to Frederick Wolfe.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

PowerPoint slides

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wolfe, F., Walitt, B. Culture, science and the changing nature of fibromyalgia. Nat Rev Rheumatol 9, 751–755 (2013).

Download citation

Further reading