Mayo Clinic Proceedings Home

Tension Myalgia as a Diagnosis at the Mayo Clinic and Its Relationship to Fibrositis, Fibromyalgia, and Myofascial Pain Syndrome

      Tension myalgia is a diagnosis that has been in use at the Mayo Clinic for more than 40 years. The term describes a common muscle pain disorder that is conceptually similar to other muscle pain disorders such as fibrositis, fibromyalgia, and myofascial pain syndrome. This article outlines the history of these disorders and proposes “tension myalgia” as a term that unifies these separate diagnoses under one conceptual framework. Recause the diagnostic criteria for tension myalgia have been vague, the Department of Physical Medicine and Rehabilitation at the Mayo Clinic has developed specific criteria for generalized, regional, and localized forms of this disorder. The recommended treatment approach includes reassurance, elimination of contributing factors, physical therapy to restore normal neuromuscular function, conditioning, and medications.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Stonnington HH
        Tension myalgia (editorial).
        Mayo Clin Proc. 1977; 52: 750-751
        • Wolfe F
        • Cathey MA
        Prevalence of primary and secondary fibrositis.
        J Rheumatol. 1983; 10: 965-968
        • Yunus M
        • Masi AT
        • Calabro JJ
        • Miller KA
        • Feigenbaum SL
        Primary fibromyalgia (fibrositis): clinical study of 50 patients with matched normal controls.
        Semin Arthritis Rheum. 1981; 11: 151-171
        • Moldofsky H
        • Scarisbrick P
        • England R
        • Smythe H
        Musculoskeletal symptoms and non-REM sleep disturbance in patients with “fibrositis syndrome” and healthy subjects.
        Psychosom Med. 1975; 37: 341-351
        • Smythe HA
        'Fibrositis' as a disorder of pain modulation.
        Clin Rheum Dis. December 1979; 5: 823-832
        • Sheon RP
        Regional myofascial pain and the fibrositis syndrome (fibromyalgia).
        Compr Ther. September 1986; 12: 42-52
        • Travell JG
        • Simons DG
        Myofascial Pain and Dysfunction: The Trigger Point Manual. Williams & Wilkins, Baltimore1983
        • Wolfe F
        Fibrositis, fibromyalgia, and musculoskeletal disease: the current status of the fibrositis syndrome.
        Arch Phys Med Rehabil. 1988; 69: 527-531
        • Kraft GH
        • Johnson EW
        • LaBan MM
        The fibrositis syndrome.
        Arch Phys Med Rehabil. 1968; 49: 155-162
        • Simons DG
        Muscle pain syndromes (in two parts).
        Am J Phys Med. 1975; 54 (55:15-42, 1976): 289-311
        • Reynolds MD
        The development of the concept of fibrositis.
        J Hist Med Allied Sci. 1983; 38: 5-35
        • Gowers WR
        Lumbago: its lessons and analogues.
        Br Med J. 1904; 1: 117-121
        • Stockman R
        The causes, pathology, and treatment of chronic rheumatism.
        Edinb Med J. 1904; 15: 107-116
        • Hench PS
        • Bauer W
        • Boland E
        • Dawson MH
        • Freyberg RH
        • Holbrook WP
        • Key JA
        • Lockie LM
        • McEwen C
        Rheumatism and arthritis: review of American and English literature for 1940; diseases of muscles and fibrous tissue.
        Ann Intern Med. 1941; 15: 1002-1108
        • Slocumb CH
        Clinics. 1943; 2: 169-178
        • Kelly M
        The nature of fibrositis. Parti. Themyalgic lesion and its secondary effects: a reflex theory.
        Ann Rheum Dis. 1945; 5: 1-7
        • Kelly M
        The nature of fibrositis. Part II. A study of the causation of the myalgic lesion (rheumatic, traumatic, infective).
        Ann Rheum Dis. 1946; 5: 69-77
        • Moldofsky H
        • Warsh JJ
        Plasma tryptophan and musculoskeletal pain in non-articular rheumatism (“fibrositis syndrome”).
        Pain. 1978; 5: 65-71
        • Golden H
        • Weber SM
        • Bergen D
        Sleep studies in patients with fibrositis syndrome (abstract).
        Arthritis Rheum. 1983; 26: S32
        • Ahles TA
        • Yunus MB
        • Riley SD
        • Bradley JM
        • Masi AT
        Psychological factors associated with primary fibromyalgia syndrome.
        Arthritis Rheum. 1984; 27: 1101-1106
        • Campbell SM
        • Clark S
        • Tindall EA
        • Forehand ME
        • Bennett RM
        Clinical characteristics of fibrositis. I. A “blinded” controlled study of symptoms and tender points.
        Arthritis Rheum. 1983; 26: 817-824
      1. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the Multicenter Criteria Committee.
        Arthritis Rheum. 1990; 33: 160-172
      2. Conferences on therapy: treatment of painful disorders of skeletal muscle.
        N Y State J Med. 1948; 48: 2050-2059
        • Simons DG
        Myofascial pain syndrome due to trigger points.
        in: Goodgold J Rehabilitation Medicine. CV Mosby Company, St. Louis1988: 686-723
        • Bennett RM
        Current issues concerning management of the fibrositis/fibromyalgia syndrome.
        Am J Med. 1986; 81: 15-18
        • Cobb CR
        • deVries HA
        • Urban RT
        • Luekens CA
        • Bagg RS
        Electrical activity in muscle pain.
        Am J Phys Med. 1975; 54: 80-87
        • Elliott FA
        Tender muscles in sciatica: electromyographic studies.
        Lancet. 1944; 1: 47-49
        • Fricton JR
        • Auvinen MD
        • Dykstra D
        • Schiffman E
        Myofascial pain syndrome: electromyographic changes associated with local twitch response.
        Arch Phys Med Rehabil. 1985; 66: 314-317
        • Smythe HA
        Fibrositis and other diffuse musculoskeletal syndromes.
        in: Kelley WN Harris Jr, ED Ruddy S Sledge CB Textbook of Rheumatology. Vol 1. WB Saunders Company, Philadelphia1981: 485-493
        • Yunus MB
        Primary fibromyalgia syndrome: current concepts.
        Compr Ther. August 1984; 10: 21-28
        • Krusen FH
        Physical therapy of fibrositis.
        Arch Phys Ther. 1937; 18: 722
        • Jacobson E
        Progressive Relaxation. University of Chicago Press, Chicago1929
        • Ferraccioli G
        • Ghirelli L
        • Scita F
        • Nolli M
        • Mozzani M
        • Fontana S
        • Scorsonelli M
        • Tridenti A
        • De Risio C
        EMG-biofeedback training in fibromyalgia syndrome.
        J Rheumatol. 1987; 14: 820-825
        • McCain GA
        Role of physical fitness training in fibrositis/fibromyalgia syndrome.
        Am J Med. 1986; 81: 73-77
        • Goldenberg DL
        • Felson DT
        • Dinerman H
        A randomized, controlled trial of amitriptyline and naproxen in the treatment of patients with fibromyalgia.
        Arthritis Rheum. 1986; 29: 1371-1377
        • Clark S
        • Tindall E
        • Bennett RM
        A double blind crossover trial of prednisone versus placebo in the treatment of fibrositis.
        J Rheumatol. 1985; 12: 980-983
      3. Davis RW: Newer, non-narcotic analgesics: current role in treatment of specific pain disorders (submitted for publication)