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The physician Charles-Édouard Brown-Séquard was a neurologist of considerable importance. In 1846 his thesis 'Researches and Experiments on the Physiology of the Spinal Cord' brought out knowledge about the sensory pathways which remains until today. The Emperor, Dom Pedro II was the second and last Emperor of Brazil, reigning for 49 years and remembered for defending the nation's integrity, the end of slavery, support for education and culture, diplomacy and relations with international personalities. He married Dona Teresa Cristina of Bourbon-Two Sicilies (1822-1889) by proxy in 1843, the fourth and last Empress consort of Brazil. This paper reports the exchange of letters between these personalities of the XIX century. Although they lived far from each other and worked in areas so different, they discussed the health of the Empress in letters. Dom Pedro II made contact with Brown-Séquard hoping that ' … your knowledge shall help heal my wife of nervous disease … . ' According to Dom Pedro the Empress suffered ' … for a long time with more or less long interruptions of horrible neuralgic pains in the legs, head and the scalp. Two points on the dorsal spine feel the effects more or less with pressure applied … . ' In addition to describing and documenting the exchange of letters, this paper raises the possibility that the Empress suffered from the fibromyalgia syndrome., (© The Author(s) 2014.)

Fibromyalgia or fibromyalgia syndrome (FMS) is a complex chronic pain disorder of unknown causation frequently associated with debilitating fatigue, unrefreshing sleep, cognitive and affective symptoms. A fibromyalgia-type suffering was possibly described in the Book of Job. Analogous symptomatic conditions have been medically recognized since the early 1900s, when initially labeled as "fibrositis". Since the early 1980s, FMS has evolved and differentiated after its characterization in a controlled study. Since then, research has focused on multiple aspects of this disorder, including characterization and management of symptoms, psychophysiology, neuroendocrine-immune pathophysiology, including central sensitization mechanisms. The complex and multifaceted nature of FMS lends itself better to a holistic (integrative medicine) or biopsychosocial approach than the more specific bioscientific pathways typical for a pathologically-defined disease. A person-centered approach to evaluation and care more effectively addresses and encompasses the biopsychosocial aspects of this disorder than traditional bioscientific clinical methods. This review outlines a holistic multi-modal, patientcentered approach to evaluation and care as a framework for primary clinic settings. Future directions in research, diagnosis, and management of fibromyalgia patients should incorporate revised person-centered and other qualitative models of care for critical comparison to current conventional concepts and clinical practice. The more comprehensive personcentered services need to be compared to the current standardized practice in terms of their cost-effective outcomes, patient satisfaction, physician gratification, and practical logistics of providing long-term follow up and management.

Fibromyalgia is a chronic pain condition present in 2-4% of the population. Fibromyalgia consists of widespread pain with similarities to neuropathic pain in clinical findings, pathophysiology, and neuropharmacology. Pain is the predominant symptom and allodynia and hyperalgesia are common signs. Extreme fatigue, impaired cognition and nonrestorative sleep difficulties coexist in addition to other somatic symptoms. Research including neuroimaging investigations shows abnormalities in neurotransmitters and an abnormal response to pain. Altered pain processing peripherally and centrally contribute to central sensitization and a dampened effect of the diffuse noxious inhibitory control (DNIC). Successful management incorporates education of the patient in self-management skills, cognitive behavioral therapy (CBT), exercise, and drug therapy. Tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs) (duloxetine and milnacipran), α2-δ ligands (gabapentin and pregabalin) are effective in reducing pain by≥30%. Some success has been shown with dopamine agonists (pramipexole), tramadol, other opioids and cannabinoids (nabilone). Further evidence-based trials using complementary treatments are needed. Fibromyalgia is complex and requires a multidisciplinary approach to treatment. Patient self-management is key., (© 2014 Elsevier B.V. All rights reserved.)

At the beginning of the 21st century, fibromyalgia syndrome (FM) has become a diagnostic category that includes extremely large numbers of people, predominantly women. Yet only a few decades ago, FM (and its predecessor fibrositis) was of little interest or concern to either physicians or the general public. What, then, were the origins of the FM diagnosis, and why did its boundaries expand so rapidly during and after the 1980s? The answers to such questions are complex. Broad social and intellectual currents, internal developments within medicine, the appearance of a self-conscious women's movement, and the rise of an increasingly important pharmaceutical industry all converged to elevate the importance of FM. Yet the diagnosis has remained highly contested, and there are competing etiological theories and therapies.

The concept of fibromyalgia is fairly recent, by evolving from previous notions such as muscular rheumatism and fibrositis. In this concise report the main stages leading to the development of the concept of fibromyalgia are sketched out, beginning from the notions of fibrositis nodules, trigger points and myofascial pain, up to the most recent knowledge including this clinical condition in the cluster of central sensitivity syndromes.

Fibromyalgia syndrome (FMS) is now a recognized clinical entity causing chronic and disabling pain. For several centuries, muscle pains have been known as rheumatism and then as muscular rheumatism. The term fibrositis was coined by Gowers in 1904 and was not changed to fibromyalgia until 1976. Smythe laid the foundation of modern FMS in 1972 by describing widespread pain and tender points. The first sleep electroencephalogram study was performed in 1975. The first controlled clinical study with validation of known symptoms and tender points was published in 1981. This same study also proposed the first data-based criteria. The important concept that FMS and other similar conditions are interconnected was proposed in 1984. The first American College of Rheumatology criteria were published in 1990 and neurohormonal mechanisms with central sensitization were developed in the 1990s. Serotonergic/norepinephric drugs were first shown to be effective in 1986.

The past centennium has witnessed scientific progress in the elucidation of the mechanisms involved in the formal pathogenesis of so-called muscular pathogenesis of so-called muscular rheumatism (recently fibromyalgia), but the aetiology of this widespread syndrome and the pathways to its appropriate treatment are still not known. Careful diagnosis based on consideration of numerous conditions relevant for differential diagnosis, patient education and shared decision-making are prerequisites to the efficacy of a complex treatment and rehabilitation plan which should comprise a reasonable combination of physio-, psycho-, and pharmacotherapeutic measures. Medication should be sparingly prescribed and the patient advised that in the end these drugs have a symptomatic effect only. Ultimately, active participation which the physician should continuously demand of the patient is imperative to the success of treatment.

This article deals with the history of the terminological and nosological development of the concept neurasthenia introduced in 1869 by George Miller Beard and in particular with its reappearance in western medicine in the 1980 s. Beginning with its predecessors in antiquity and continuing with hypochondria, which became a fashionable disease in the 18 th century, the concept neurasthenia reached a high point and world-wide medical acceptance at the end of the 19 th/beginning of the 20 th century. However, between the 1930 s and 1960 s it declined in popularity and gradually disappeared until finally it only had a rudimentary nosological role in the term "pseudoneurasthenia". In the countries of the Far East, on the contrary, the concept of neurasthenia has been in continual use since its importation in the first decades of the last century. In the 1980 s, when an interest in the symptoms of chronic fatigue was reawakened in western medicine, the concept neurasthenia reappeared, this time to define the particular form of a neurotic disorder. Parallel to these developments increasing importance was attached to clinical descriptions of illnesses which on account of their similarity to the symptoms of neurasthenia could be termed modern variants of the concept neurasthenia. These are "Chronic-Fatigue-Syndrome", "Fibromyalgia" and "Multiple Chemical Sensitivities" which have more or less adopted the organic inheritance of Beard's former concept of neurasthenia, despite the fact that so far the question of organicity could not be decisively answered in a single case. In order to clarify possible influences on the development of the concept neurasthenia and its variants, the theories and ideas of E. Shorter, medical historian at the University of Toronto, are discussed in the final part of the article, whereby the particular cultural background in each case has a decisive influence on the manifestation of the psychosomatic symptoms.

Fibromyalgia is a good illustration of the fact that a smart new name of an old malady can spread like wildfire if well matched in time socioculturally. "Muscular rheumatism" has earlier been looked upon as a (rheumatic) inflammation of muscle cells or of muscular connective tissue. During the last decades the interest of leading clinicians and researchers have been directed against the pain perceiving system, suggesting defect pain modulating mechanisms peripherally and centrally. Fibromyalgia seems to supply several medical and social needs in our time and might be called a "fin-de-siècle" disease.

Clara Wieck Schumann (1819-1896) and Sergei Vassilievich Rachmaninov (1873-1943) were two of the greatest pianists that ever lived. They had full lives composing and performing music. Each also had more than his or her fair share of hardships. In addition to all the pressures that are part of a performer's life, both Clara Schumann and Sergei Rachmaninov also suffered from chronic pain. This article discusses the pain syndromes that plagued these great musicians and the effect of chronic illness on their music.

The essential symptoms of fibrositis--widespread aching and pain, disturbed sleep, morning stiffness, and fatigue--are common in both rheumatic and nonrheumatic patients. But the essential sign of fibrositis--widespread local tenderness over specific anatomic sites ("tender points")--is rare in any patients except those with fibrositis. Clinical criteria for the diagnosis of fibrositis rely heavily on a high tender point count in the presence of characteristic fibrositic symptoms. Multiple tender points are uncommon in normal subjects and in those with rheumatic and nonrheumatic disorders. The tender point count thus also serves to distinguish fibrositis from other musculoskeletal diseases.

Physicians could use such terms as "fibrositis" and "the myofascial pain syndrome" simply to describe an easily recognized quality of illness. But the terms are chosen as part of a privileged vocabulary designed to assert a pathophysiologic insight(s). On careful consideration, these insights are tenuous at best. Furthermore, the terms, with their pathophysiologic insights, become labels that may perturb the patient's experience of disease in a fashion that is counterproductive.

The association of chronic pain, exhaustion, and multiple somatic complaints with apparent physical good health and long survival has a long history. The syndrome was called by many names including neuresthenia, rheumatism, and invalidism. When skeletal pain and stiffness were prominent, many observers recorded the existence of sites of tenderness and sometimes of areas of induration. The work of Lewis and Kellgren provided an experimentally reproducible method of study of the phenomena of referred pain and referred tenderness, which led to hypotheses about the nature of many of these syndromes, which were unfortunately too numerous and often contradictory. More recently, it has been learned that the sites of tenderness are precisely predictable in location and, under some circumstances, experimentally inducible. They are unknown to the patient and, therefore, due to mechanisms other than distortions of interpretation. The association with a variety of forms of sleep disturbance was discovered. These events have permitted the rapid evolution of controlled, numerical studies of these associations, which are reviewed briefly in this article.

This paper traces the history of disturbed sleep, deep pain and exhaustion from biblical times to the present. This historical review provides the stage for the papers that follow in this volume on fibrositis syndrome.