Nonrestorative Sleep, Musculoskeletal Pain, Fatigue in Rheumatic Disorders, and Allied Syndromes: A Historical Perspective

This chapter provides a historical perspective of the notion that the sleeping–waking brain is intimately related to complaints of unrefreshing sleep, widespread musculoskeletal pain, fatigue, and suffering. Such a constellation of symptoms extend from the remote biblical past, and involve various religious and cultural belief systems up to the recent evolution in Western medicine application of scientific methods for classification of illness. The contemporary application of scientific principles is directed to the etiology of diseases and to derive procedures for the management of such ill-understood illnesses. Historically, this constellation of rheumatic pain and fatigue symptoms have been given ever-changing medical and psychiatric labels that have been devoid of satisfactory medical understanding. In this chapter, the hypothesis that the sleeping/waking brain is integral to the somatic and behavioral symptoms of these disabling rheumatic chronic illness, termed fibromyalgia and various allied disorders, that are being examined and treated by a variety of health care professionals. Contemporary advances in mechanisms of how the sleeping–waking brain connects to these somatic and behavioral symptoms are reviewed. Potential avenues for further scientific understanding are described. Advances in such understanding are influencing current pharmacological and behavioral management of these suffering patients.