(The history of the term FIBROSITIS)
This is another letter from, let’s say, “a detractor” of the use of the term FIBROSITIS. There was a lot of discussion about it since Sir Gowers first used the term in 1904 in an article titled Lumbago.
The detractor of the use of the term fibrositis is James L. Halliday. He says that it is a too general term to designate a syndrome that presents as pain stiffness and soreness (PSS), but that can have different etiological factors. He prefers to call it PSSS: Pain Stiffness and Soreness Syndrome.
James Lorimer Halliday (1897–1983) writes this letter titled THE OBSESSION of FIBROSITIS as a response to an article from E. J. Moynahan and E. S. Nicholson from 1942 titled Value of Procaine Infiltration in the Diagnosis and Treatment of Fibrositis.
Personal notes on the article:
THE OBSESSION OF FIBROSITIS
Halliday J. L. “The Obsession of Fibrositis.” British Medical Journal. 1942; 1(4230): 164
Free on line
Halliday is referring to a previous article (Reference: Moynahan E. J., Nicholson E.S. Value of Procaine Infiltration in the Diagnosis and Treatment of Fibrositis. British Medical Journal. 1942; 1(4228): 65-68.)
Flight Lieut E. J., Moynahan and Flying Officer E. S. Nicholson described in Volume January 17, p. 15 the “almost uniformly good results” which followed the treatment of over eighty “cases of fibrositis” by infiltrating the TENDER SPOTS with injections of PROCAINE.
Halliday CRITICIZES Moynahan and Nicholson’s study, comments on that study:
– In the introduction, the authors admit that the etiology and pathology of FIBROSITIS remain indefinite and that many doctors in America “doubt of its existence as a clinical entity”.
-Despite the fact that the authors said that “they noticed these points” and they use the term FIBROSITIS to cover an entity that consisted in “pain stiffness and soreness [all subjective symptoms] which are sometimes associated with spasm of the related muscles.”
–Nodules apparently no longer matter! -whether present or absent is of little diagnostic significance- Halliday wonders then: -What will the masseuse do then?
-The nature of pain can be “sharp, dull, continuous or intermittent, easily located or diffuse.”
-No really account is taken of the duration of the symptoms, in some “typical cases” they point out from days to two years.
-Moynahan and Nicholson admit that with this definition of FIBROSITIS almost every person with symptoms of pain in absence of a collated organic lesion can be “a case”.
-They even estimated that the condition is so common that in Scotland alone there can be 225,000 new cases a year.
But Halliday criticizes the loose definition and the incidence, and says that it resembles “occultism”.
Halliday prefers the term PAIN STIFFNESS AND SORENESS SYNDROME instead of FIBROSITIS
He says that the clinical syndrome of PAIN STIFFNESS AND SORENESS (PSS) should be described as PSS syndrome instead of fibrositis.
Halliday thinks that this would be a better approach to patients that present this syndrome in order to help them.
He categorized the patients with PSS syndrome, and he gave 4 examples of different cases of PSS as:
1-As a response to COLD AIR or WATER: It can appear as an exposure to a knife-edge draught of cold air. Also associated to a “being out of sorts” and also a disturbance of regular bowel functioning. As a rule, in a few days the patient recovers naturally.
2-As a response to SUDDEN MUSCULAR MOVEMENT (“the crick”): As acute TORTICOLLIS, which may occur rising in the morning, during washing or dressing. The pain can be excruciating and any movement of the neck may cause the pain to radiate throughout the whole side of the body affected. Tender spots are present, with rest and warmth the acute phase subsides often dramatically in two or three days.
3- HYSTERIA PSS. Halliday related it to workers with risk professions (miners, window cleaners, explosive workers). The progressive anxiety over one’s bodily safety is often a factor in appearance of hysterical pain in these men workers.
Tender spots are common in hysteria.
4-PSYCHOSOMATIC PSS: They arise in chronic anxiety states and depressions. Tender spots are associated to the side of pain.
Halliday points these 4 categories as an example that the PSS should be categorized and it is a more complex and difficult problem that what Moynahan and Nicholson claim. And he admits that each category present tender spots but they may have different etiologies. Each runs a different and particular course. And probably they have a different pathology.
Moynahan and Nicholson also pointed out other disorders related to FIBROSITIS, such as:
–Headache: tender spots are present in ALL headaches irrespective of the immediate precipitating factor; it can be feverish illness, trauma, drug intoxication, or “neurosis”. If headache moves its position THE TENDER SPOTS ALSO MOVE.
–Pectoral fibrositis associated with effort syndrome- Halliday associates it to psychoneurotic concept.
Finally, Hallyday criticism goes directly…
The theory of FIBROSITIS in its full-blown corresponds to a mode of OBSESSIONAL THINKING, which goes on operating without reference to reality. It refuses facts like the psychological causes.
Then Halliday wonders: “WHAT ABOUT THE ALMOST UNIFORMLY GOOD RESULTS FOLLOWING THE INJECTION OF PSS PATIENTS WITH PROCAINE?”
Halliday answers himself: Does it show anything? Taking hysterical patients in consideration, other remedies have proved valid when used to penetrate the body. Why should it work an anesthetic drug?
Published in September 2018 by Marta Cañis Parera
-Halliday JL. “The Obsession of Fibrositis.” British Medical Journal. 1942; 1(4230): 164
-Moynahan E. J, Nicholson E. S. Value of Procaine Infiltration in the Diagnosis and Treatment of Fibrositis. British Medical Journal. 1942;1(4228):65-68