Psychosocial Treatment of Fibromyalgia

Psychosocial Treatment of Fibromyalgia

This study1 compared the clinical effects of a behavioral and educational intervention on FM patients. The behavioral treatment involved:

  1. Education on FM pain and the role of cognition in experience and expression of pain.
  2. Progressive relaxation exercises.
  3. Goal setting to increase functioning.
  4. A support person (of relation or acquaintance) aware of pain management skills.

The educational model consisted of various educational videos and group discussion and support.

During the 10-week trial no significant changes occurred, but at the 6-month follow-up, progress was noted. Reductions in depression, self-reported pain behavior, observed pain behavior, and trigger point scores were evident. Pain, however, did not decrease.

The researchers found that reductions in helplessness resulted in improvement in pain and depression; whereas, improvements in passive coping correlated to the patient’s self-reported pain behavior. And there was no difference between the two groups—indicating that both behavioral and educational approaches are beneficial.

Improvement was also seen in the patient’s trigger point scores, which suggests the efficacy of psychosocial interventions with FM patients. To explain the occurrence, the researchers offer:

“It is possible that tender point pain may be an indicator of generalized stress rather than a biological marker of the disorder. Reductions in tender point severity would thus coincide with the improvement noted in depression and pain behavior.”

The improvements indicate that these interventions may be “instrumental to clinical change in FM.”

The greatest benefit of the interventions seemed to be in terms of dealing with “helplessness.” There is a growing awareness in the medical literature that fibromyalgia is getting out of control—one study2 found that as many as 25% of FM patients in the US have received some type of disability or injury compensation. This “disability” mentality may be most harmful to the patient himself. As Wolfe (one of the original researchers who came up with the diagnostic criteria for FM) recently wrote:

“That FM will always be with us because patients suffer with its symptoms is true regardless of what we name the syndrome. It is possible to improve the lot of those with FM, but first we must take control of our own beliefs about FM as a disease, about the effectiveness of treatment, and about the role of psychological factors. We must halt the trend to label patients with FM as disabled, and we must interfere with the societal trend toward encouragement of the disability concept.”3

  1. Nicassio PM, Radojevic V, Weisman MH, et al. A comparison of behavioral and educational interventions for fibromyalgia. Journal of Rheumatology 1997;24:2000-2007.
  2. Wolfe F, Anderson J, Harkness D, et al. The work and disability status of persons with fibromyalgia. Journal of Rheumatology 1997;24:1171-1178.
  3. Wolfe F. The fibromyalgia problem. Editorial. Journal of Rheumatology 1997;24:1247-1249.

Fibromyalgia and Chiropractic

“Fibromyalgia is defined as a chronic, generalized pain condition associated with symptoms of fatigue, stiffness, and sleep disturbance and is characterized by the physical findings of local tenderness in many specific but widely dispersed sites. Fibromyalgia is the most common cause of widespread pain. The prevalence of this disorder in the general population is between 3% and 5%… Most patients with fibromyalgia remain symptomatic for several years, and no cure has been identified.”

The authors of this study set out to see if chiropractic could help patients with fibromyalgia. The study included fifteen women who had suffered from fibromyalgia symptoms an average of 10 years. Each participant was examined for trigger points and was asked to fill out a pain questionnaire. The subjects underwent treatment 2 to 3 times a week, with a total of 30 treatments. The treatment consisted of “applying ischemic compression to a number of tender points” and spinal manipulation of the cervical and thoracic spine.

The subjects filled out a second pain questionnaire after 15 treatments, a third after 30 treatments, and a fourth one month after the completion of treatment. The authors determined that a 50% reduction in pain would be necessary to consider a patient a “respondent” to treatment.

“A total of 9 (60%) subjects were classified as respondents and 6 (40%) as nonrespondents based on their percent improvement rating in pain intensity after the 30th treatment. There was no statistically significant difference between the baseline characteristics of the two groups. However, some clinically significant trends were noted. Nonrespondents were apparently older with more severe and chronic pain and a higher number of tender points.”

The reduction in pain and symptoms that the respondents reported was significant:

  • Pain intensity dropped 77.1%.
  • Sleep was enhanced 63.5%.
  • Fatigue levels dropped 74.8%.

Furthermore, the patients retained the improvement at the one-month follow-up.

The authors conclude: “This study suggests a potential role for chiropractic care in the management of fibromyalgia. Most subjects with fibromyalgia appear to have responded with favorably to a course of 30 chiropractic treatments including spinal manipulation and ischemic compression therapy. Fifteen treatments seem to be an adequate cutoff point to determine if a significant improvement in pain has occurred and if further care is warranted.”

Hains G, Hains F. Combined ischemic compression and spinal manipulation in the treatment of fibromyalgia: a preliminary estimate of dose and efficacy. Journal of Manipulative and Physiological Therapeutics 2000;23(4):225-230.

The Healing Power of Touch

Massage is often thought of as a luxurious spa treatment meant for sheer pleasure, but massage has actually been proven to be beneficial for a number of medical conditions as an alternative or complimentary therapy. The Touch Research Institute highlights the following conditions as being improved through massage in massage therapy studies.1

Aggression: Massage has been shown to lessen the aggressive tendencies of adolescents exhibiting this type of behavior.

Anorexia: Massage has been able to reduce anxiety and improve mood through decreasing the stress hormone cortisol and increasing dopamine (hormone responsible for pleasure, calm).

Arthritis: Children with rheumatoid arthritis had decreased stress and decreased pain after 30 days of 15 minute per day massages.

Asthma:  Asthmatic children showed improvement in lung function and decreased stress after massage therapy.

ADHD:  Various studies have shown decreased anxiety, less fidgeting , better mood, less hyperactivity, better focusing and other improvements in children with ADHD after receiving massage therapy.

Chronic Fatigue Syndrome (CFS): People with CFS who received massage immediately had reduced depression, anxiety and cortisol levels. After 10 days of massage treatments, they also had decreased fatigue symptoms (anxiety and somatic), less pain and better sleep. Cortisol levels continued to decrease and dopamine levels increased.

Depression: Numerous studies have been done on the effects of massage for different types of depression including clinical depression, adolescent depression, post-partum depression and more. Massage increases pleasure hormones (serotonin and dopamine) and decreases cortisol (a stress hormone) so it is highly beneficial in reducing depression. The positive experience of receiving a massage alone helps people who are suffering from depression.

Diabetes:  Diabetic children who received massage had better glucose control and diet compliance after one month of treatment.

Fibromyalgia:  People with fibromyalgia who received massage had better sleep and less pain, fatigue, anxiety and depression. Again, cortisol levels were decreased.

 

These are just a few of the health conditions for which massage is highly beneficial. For more information on massage and its vast wealth of healing, please contact a licensed massage therapist today to see if massage can improve your health and quality of life!

1. Field T, Morrow C, Valdeon C, et al. Massage reduces anxiety in child and adolescent psychiatric patients. J Am Acad Child Adolesc Psychiatry. 1992 Jan;31(1):125-31.

Massage Beneficial for Fibromyalgia Pain

Fibromyalgia and massageFibromyalgia is a frustrating condition in which chronic pain is severe enough to interfere with a person’s life. The most common areas for pain to be are in your lower back, neck, shoulders, back of the head, upper chest or thighs; but the pain may be elsewhere. The pain is most commonly described as shooting or stabbing as well as burning or throbbing. If you suffer from fibromyalgia, you may benefit from massage.

The causes of fibromyalgia are not well understood, which makes treatment difficult. For some people, anti-anxiety medications or antidepressants are beneficial; however, there can be dangerous side effects. Proper nutritional support, daily walks, hot baths and adequate rest are all recommended to help you manage fibromyalgia; however, even when you try your best to follow these guidelines, you may still need more help.

Massage is highly-recommended for fibromyalgia patients. A study in the Journal of Manipulative and Physiological Therapeutics found that fibromyalgia patients had an improvement in symptoms through both manual lymph drainage therapy (MLDT) and connective tissue massage (CTM)1.

Manual lymph drainage therapy uses various massage techniques ranging from light motions to stronger, deeper manipulation. This massage therapy helps relieve the symptoms of fibromyalgia by stimulating the flow of lymph, which can help the immune system.

Connective tissue massage restores full movement and lessens pain by properly aligning the connective tissue that connects muscle to bone. Pressure is applied to stretch and guide the connective tissue restoring proper alignment and balance to the body.

If you have been suffering from fibromyalgia, give our clinic a call to see if we can help.

  1. Ekici G, Bakar Y, Akbayrak T, Yuksel I. Comparison of manual lymph drainage therapy and connective tissue massage in women with fibromyalgia: a randomized controlled trial. Journal of Manipulative and Physiological Therapeutics 2009;32(2):127-33.

Fibromyalgia and A Multi-modal Treatment Program

A multi-modal pain treatment program entails a combination of cognitive/behavioral techniques with physical therapy and pain medication reduction. This study measured both objective and subjective pain reactions to such a program in female fibromyalgia (FM) patients. The researchers tested the patients’ pain threshold, tolerance, and pain reaction immediately following and six months after the treatment program.

The patients made significant progress on the psychological assessments and pain measures but not on the laboratory evaluations of pain measurements. One hundred percent of the patients showed an improvement in their feeling of control over the pain, and 54% an increase in positive coping skills immediately following the program. The group reported an improvement in physical function, general well being, and overall experienced pain. Since the self-reports of pain were reduced, the researchers conclude the patients gained some relief. Yet, these reports did not correlate to patient reports of symptoms:

“This study is unique in that it found statistically significant improvement in functioning without a correlating decrease in symptomology. These findings are also clinically significant; the treated patients’ functioning increased, their quality of life improved and they perceived much less pain. It may be that improvement in fibromyalgia may depend upon factors such as increased endurance and more effective coping skills rather than upon changes in tender point and generalized pain severity.”

When tested six months following the program, treatment gains were not maintained. The authors suggest the patients did not continue to practice coping skills and the exercise regimen. The authors conclude, “Relapse prevention should be emphasized and efforts made to encourage patients to continue to exercise together and participate in regular support groups.”

Mason LW, Goolkasian P, and McCain GA. Evaluation of a multimodal treatment program for fibromyalgia. Journal of Behavioral Medicine 1998;21(2):163-178.

Multimodal Treatment and Fibromyalgia

This team of researchers evaluated a specific pain controlling treatment plan for FM patients, which involved cognitive-behavioral training such as relaxation techniques, cognitive reconstructing and diversion, and gymnastic exercise. They compared the efficacy of such a program to one that was limited only to relaxation techniques, hoping to find the former more effective due to its educational package.

27 patients participated; 14 in the experimental group and 13 in the relaxation group. Both groups were psychologically comparable at the outset of the study. Significant improvements were found in the educational group; they consisted of: general symptoms, sleep disturbances, medication consumption, pain scores, physical therapies, and patients’ global assessments. Five of the 14 (36%) experimental group patients showed improvement four months after treatment, while none of the relaxation group patients did.

In comparing the successful to unsuccessful patients, the researchers assessed the following conclusions:

“The five successful patients had suffered from their pain for a shorter time, which highlights the importance of early intervention. The goals of the treatment program seem to have fitted their attitude and expectations. They were able to decrease their excess work-activity and extreme helpful nature (learning to say no). Depression did not predict outcome, but negative outcome was associated with an increase in depressive symptoms, which might reflect the helplessness and resignation of the unsuccessful patients.”

Improvements in the relaxation technique group were smaller, and had vanished at the follow-up. The researchers conclude, “…because relaxation training and some discussion time were elements common to both groups, we can assume that information about the illness and a clear cognitive-behavioral concept fostering self-control were effective ingredients of the experimental groups.”

Keel PJ, Bodoky C, Gerhard U, Muller W. Comparison of integrated group therapy and group relaxation training for fibromyalgia. The Clinical Journal of Pain 1998;14:232-238.

Complementary Therapies for Arthritis Pain

In the last five years, awareness and use of complementary and alternative therapies has skyrocketed among both patients and practitioners. This study evaluated the use of such therapies in a sample of rheumatological conditions. The conditions included were osteoarthrits, rheumatoid arthritis, and fibromyalgia. The authors state that these conditions are ideal for evaluating complementary and alternative medicine (CAM) since they are, “prevalent, have no known cause or cure, are characterized by chronic pain and a variable disease course, and often adversely affect functional status.”

The study consisted a survey that asked 232 patients (who were receiving medical care) about the prevalence and types of CAM use, their motivations for use, its overall effectiveness, and the level of communication about this use with their physician. Keep in mind that the authors define CAM as, “Any intervention not usually prescribed by physicians (for example, herbal remedies, chiropractic manipulations, high-dose vitamins, and elimination diets).” Exercise programs or relaxation techniques were not included in this definition, since they are often prescribed for pain management.

63% of patients had or currently used CAM. 82 currently used them, and 64 had in the past. The table below delineates the number of patients who used a specific therapy, and their perceived level of effectiveness.

Type of Treatment

Number of patients

% who found it helpful

Chiropractic

45

73

Herbal Therapies

41

51

Special Diets

29

69

Acupuncture

11

64

Spiritual Healing

8

75

Diet Supplements

32

34

Copper bracelets or magnets

42

21

Other treatments

32

88

Reasons given for using CAM were to help their condition, and get control of the pain. Interestingly, patients in the sample frequently reported that the use of CAM was for, “symptom relief rather than as a cure for their condition.” So it is not surprising that patients who had severe pain, had a longer disease duration, and a diagnosis of osteoarthritis were most likely and frequent users of CAM.

Nearly half (45%) of the patients discussed their CAM use with physicians. 92% thought their doctors should know everything about their treatment, and 67% thought their doctors would provide information about potential interactions between the two types of treatment. 71% of the patients’ doctors supported their use, and only 15% feared disapproval from the physician.
The authors suggest that future studies, using different samples, should investigate CAM use so medical providers could have a better idea of the patients’ perspective. More importantly, the authors suggest that:

“Future studies should describe the natural history of CAM use and its effect on patient-centered outcomes, such as health status, satisfaction with care, and use of health care resources. Such investigations will complement rigorous efficacy trials of CAM and provide a complete picture to health care providers, policymakers, and patients.”

Rao J, Mihaliak K, Kroenke K, et al. Use of complementary therapies for arthritis among patients for rheumatologist. Annals of Internal Medicine 1999;131:409-416.

Chiropractic Treatment for Fibromyalgia

This study was undertaken to determine whether 30 treatments combining ischemic compression and spinal manipulation could effectively reduce levels of pain intensity, sleep disturbance, and fatigue associated with fibromyalgia. In addition, the researchers wanted to identify which baseline characteristics may be predictors of outcome, and to study the dose-response relation.

Fifteen women, all members of a regional fibromyalgia association completed the trial. All subjects had experienced fibromyalgia for longer than three months. Subjects received thirty treatments including spinal manipulation and ischemic compression. Levels of improvement in pain intensity, fatigue, and sleep quality were evaluated after fifteen treatments, after the completion of the full thirty treatments, and at one month after the study. Pain intensity had to improve by at least 50% by the end of treatment for a patient to be classified as a responder; nine patients qualified as responders.

60% of the patients reported an average improvement of 77.1% in pain intensity. Quality of sleep improved by 63.5%, and fatigue level by 74.8%. The researchers theorize that sleep quality and fatigue improved because those symptoms were aggravated, at least in part, by pain. Lowered pain levels were maintained during the month-long follow-up period. This suggests that the effects of chiropractic treatment continued to help patients, even though the actual treatments had ended. Previous studies of drug treatments for fibromyalgia have shown that medications cease to be effective once drug intake stops.

The authors found that it may be possible to predict which patients are more likely to respond well to chiropractic care. Those more likely to respond poorly to treatment were older, had greater intensity of symptoms, more tender points and a more chronic illness. Those patients that showed a less than 35% improvement in pain intensity after fifteen treatments did not show satisfactory improvement after thirty treatments.

This study is of limited usefulness for several reasons. The sample size is small, self-selected, a single treating physician was used, and no control group or appropriate blinding procedures were used. However, this study does suggest that chiropractic care may play a role in the management of fibromyalgia. The authors conclude:

“Most subjects with fibromyalgia appear to have responded favorably to a course of 30 chiropractic treatments including spinal manipulation and ischaemic compression therapy. Fifteen treatments seem to be an adequate cutoff point to determine if a significant improvement in pain has occurred and if further care is warranted. Chiropractic care appears to provide benefits for at least 1 month after stopping therapy. A placebo-controlled randomized clinical trial is recommended in the near future to test these hypotheses.”

Hains G, Hains F. Combined ischemic compression and spinal manipulation in the treatment of fibromyalgia: a preliminary estimate of dose and efficacy. Journal of Manipulative and Physiological Therapeutics 2000;23(4):225-230.

Chiropractic Beneficial for Fibromyalgia

FibromyalgiaFibromyalgia refers to pain in the body’s soft, fibrous tissues, which include the muscles, ligaments and tendons. Fibromyalgia is generally indicated by widespread pain, extreme fatigue and by disturbed sleep patterns. Pain is most often described as being intense in regions of the neck, the back and in leg cramps.

Chiropractic makes adjustments to the alignment of the neck and the spine, thus reducing pain significantly throughout the body. It is proven that regular spinal manipulation treatments will help fibromyalgia sufferers to enjoy a better quality of sleep as well as experiencing less pain and reduced fatigue. A 2009 study found that chiropractic adjustments resulted in an instant relief of pain in fibromyalgia patients.

Besides spinal manipulation, ischemic compression therapy is often used as a proven method of treating fibromyalgia with success. This involves a sustained pressure that is applied to an area of tenderness in the muscles. The tender spot is referred to as a trigger point and the ischemic compression therapy serves to deactivate the trigger. This compression deliberately stops the supply of blood to the affected area ensuring that, upon release of the pressure, a resurgence of blood flow to the trigger point will cleanse any waste products, bring a supply of oxygen and allow the tissue to heal.

Don’t let fibromyalgia ruin your life. Chiropractic might be able to help.

If you or someone you know suffers from fibromyalgia, give our office a call.

Panton LB, Figueroa A, Kingsley JD, et al. Effects of resistance training and chiropractic treatment in women with fibromyalgia. Journal of Alternative and Complementary Medicine 2009;15(3):321-328.

5 Tips for Fighting Cold Weather Pain Video

If a drop in temperature makes your pain levels soar, you’re not alone: many people with chronic pain conditions like arthritis and fibromyalgia find that their symptoms worsen during the winter.

We don’t know exactly why cold weather exacerbates pain but one leading theory blames changes in barometric pressure. As the cold sets in, reduced air pressure causes the tissues within the joints to expand, causing an already inflamed joint to become even more swollen and painful.
Although the link between cold weather and chronic pain is still not fully understood, doctors have developed ways to cope with increased pain in the winter.

Here are five easy tips for fighting cold weather pain:

1. Exercise

Rainy, snowy weather may discourage you from getting outside to exercise but that can actually increase your pain and stiffness. Regular physical activity can help you maintain flexible, functioning joints and muscles. Exercise can also improve your mood.

2. Boost Your Mood

Some theories argue that dreary weather results in mood changes that make you more susceptible to pain. Addressing feelings of anxiety and depression could help ameliorate pain.

3. Stay hydrated

Without the warm weather, many people just don’t feel as thirsty and forget to drink enough water. That can prevent the body from properly processing waste, making you feel more achy. Try carrying a water bottle and limiting your caffeine intake.

4. Heat Therapy

Beyond bundling up and staying warm, you can use heating pads to soothe sore muscles and joints.

5. Visit Your Chiropractor

Chiropractic adjustments can keep your spine and joint functioning well throughout the winter months. Studies show that chiropractic can alleviate symptoms of osteoarthritis, fibromyalgia, migraine, headache, as well as chronic neck and back pain.

A 2011 study suggested that chiropractic adjustments can ease stress hormones, which may help with mood changes tied to cold weather.1 Your chiropractor can also provide recommendations on using heat and exercise therapies for relieving pain.

Finally, remember that cold weather doesn’t mean you have to suffer. Contact our office to see how we can make your winter as pain-free as possible.

 Reference

1. Ogura, Takeshi and Manabu Tashiro, Mehedi,Shoichi Watanuki, Katsuhiko Shibuya, Keiichiro Yamaguchi, Masatoshi Itoh, Hiroshi Fukuda, Kazuhiko Yanai. Cerebral metabolic changes in men after chiropractic spinal manipulation for neck pain. Alternative Therapies. 2011; 17 (6): 12-17.