Myalgic and fibromyalgic forms of Occupation Neurosis

In 1904 Gowers (1904) had described a condition which he called "muscular fibrositis" of the arm or "brachial myalgia". This condition was "met with in every degree of severity, and when intense it is a very terrible malady, distressing and prolonged. ... Its great feature is pain in the muscles, not spontaneous, but induced by their contraction, or by sudden tension, however slight". Muscle strain (either acute or chronic) was said to be the causative factor, but the condition was supposedly more common in those who had inherited "the tendency to gout".

By the 1930s, the Occupational Neuroses were thought by rheumatologists to be examples of "localized myalgia" or "muscular rheumatism" brought on by fatigue in acutely or chronically overused muscles (Bach, 1935). "Brachial myalgia" (also known as "brachial fibrositis") affected telephone operators, laundry workers and typists (Bach, 1935). "Fibrositic" conditions associated with occupation were attributed to the effects of trauma (either direct or as the result of prolonged or repeated microtraumata) on the soft tissues of the trunk and limbs (Copeman, 1947). Mennell (1940) drew attention to the many forms of "pseudo-occupation spasms" where psychological factors were aetiologically important and physical treatment methods were doomed to failure. He recommended a trial of psychoanalysis in those cases of failed physical treatment. Halliday (1937) argued that when no evidence of "organic" change is found on physical examination, symptoms commonly attributed to "rheumatism (or fibrositis, neuritis, sciatica, lumbago, myodynia, and so on)..." are best understood, and treated, as "incidental manifestations of a chronic psychoneurotic state". Other investigators, who had assigned a central role in these conditions to the "fibrositic nodule", were unwilling to accept that mental factors could play a causative role (Copeman and Pugh, 1945; Copeman, 1947).

In the 1950s "fibrositis" was regarded as rather a "banal complaint" (Copeman and Mason, 1957). Anderson (1971) summarising the consensus view, declared that "fibrositis" had become a diagnostic scrap-heap. He advised doctors to avoid using unscientific labels and that in the then current state of knowledge, such terms as "pains of undetermined origin" were more appropriate. For a time, rheumatologists tended to largely ignore these problems (Wood, 1978). However an awakening interest in these pain syndromes during the 1970s and 1980s saw the emergence of new terminologies such as "myofascial trigger points" (Travell, 1976) and "localised fibromyalgia syndrome" (Yunus, 1983).

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