Medical hypotheses
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Review
The pathogenesis of chronic pain and fatigue syndromes, with special reference to fibromyalgia.
Syndromes characterized by chronic pain and fatigue have been described in the medical literature for centuries. Fibromyalgia is the term currently used to describe this symptom complex, and considerable research has been performed in the last decade to delineate the epidemiology, pathophysiology, and genesis of this entity. Although fibromyalgia is defined by its musculoskeletal features, it is clear that there are a large number of non-musculoskeletal symptoms, such that we now understand that there is considerable overlap with allied conditions such as the chronic fatigue syndrome, migraine and tension headaches, irritable bowel syndrome, and affective disorders. This article will review our current state of knowledge regarding fibromyalgia and these allied conditions, and present a unifying hypothesis that describes both the pathophysiology of symptoms and the genesis of these disorders.
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Humans and apes show clear differences in brain anatomy. In the human cerebral cortex, for instance, the areas that control the fine movements of the hand, the areas that control the breathing and speech musculature, and the association areas have strongly expanded. It will be argued that these differences are best explained by the aquatic ape theory of human evolution (AAT) and originated in our semi-aquatic past, notably in the adaptations necessary for diving and shellfish collection at sea coasts.