How Our Understanding of Fibromyalgia Evolved
Bibliographic record
Abstract
There are times when rheumatologists have been accused of making up new syndromes. For example, in the last 20 years, our specialty has described new rheumatic entities including Lyme disease, the musculoskeletal manifestations of acquired immune deficiency syndrome (AIDS), eosinophilic myalgia syndrome (from L-tryptophan contamination), and siliconosis (which, if it exists, results from silicone breast implants). Fibromyalgia is not in this group. Evidence for the syndrome can be found as far back in history as the book of Job, where he complained of “sinews (that) take no rest.” Seemingly exaggerated tenderness of the muscles and soft tissues to touch was documented in the nineteenth-century medical literature by French, German, and British scientists, who called it spinal irritation, Charcot’s hysteria, or a morbid affection. Tender points were first described by Balfour in 1824 and Villieux in 1841. The English physician Sir William R. Gowers (1845-1915) coined the term fibrositis in 1904 in a paper on lumbago (low back pain) when he tried to describe inflammatory changes in the fibrous tissues of the muscles of the low back. Gowers was wrong. There is no such thing as inflammation of the fibrous tissues, but the term lived on because British physicians used fibrositis to denote pain in the upper back and neck areas among Welsh coal miners in the 1920s and 1930s. The definition of fibrositis cross-pollinated during the Second World War when United States, Canadian, Australian, and New Zealand physicians served with their British counterparts. Soldiers who were unwilling to fight or who experienced shell shock, or complained of aches and pains due to carrying heavy gear without any obvious disease, were diagnosed as having fibrositis. A symptom complex of fatigue, palpitations, dizziness, gastrointestinal symptoms, headache, sleep disturbance, and aching was first noted by the Union physician J. M. da Costa among 300 soldiers during the Civil War who had what he termed an “irritable heart.” The first mention of fibrositis in the North American medical literature appeared in a rheumatology textbook chapter written by Wallace Graham in 1940.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.020 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.004 | 0.002 |
| Science and technology studies | 0.004 | 0.034 |
| Scholarly communication | 0.011 | 0.028 |
| Open science | 0.002 | 0.005 |
| Research integrity | 0.012 | 0.028 |
| Insufficient payload (model declined to judge) | 0.006 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".